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Below is a series of frequently asked questions and their responses regarding
the role and function of a doula and how she can support women and couples.
 Are
you a midwife ?
On
the day of the birth, at what point does the doula join us ?
What
if I want an epidural ? What if I am going to have a caesarean birth?
What
type of training does a doula receive?
How,
and by whom, are you paid?
Are
you reimbursed, recognised by Sociale/insurance?
How
much do you charge?
How
are you viewed by the midwives and other medical professionals?
The
birth plan
Continuity
of Carer
How to choose a doula ?
Are you a midwife ?
No. Midwifery is a regulated medical profession. In France, a doula does not
practice any medical act (use of medical material, examination and its interpretation,
diagnosis, nor does she take medical responsibility (decisions, prescription,
etc..). .
A doula's functions include: informing the parents, providing physical and emotional
support, facilitating communication between the parents and the medical staff,
if necessary, and expressing the desires and the choices of the parents if for
whatever reason they themselves are unable to do so. A doula does not make decisions
in the place of her clients.
On the day of the birth, at what point does the doula join us?
This question is discussed during the prenatal visits and the reality varies
according to circumstances. For a homebirth, it depends on the wishes of the
parents and on what their midwife is accustomed to. For a hospital birth, the
doula can come to the couple's home at the onset of labor. Her presence helps
the woman (as well as her partner) feel more secure and thus able to labor more
efficiently, thereby avoiding leaving for the hospital too soon. Experience
has proven that arriving at the hospital
while still in early labor is usually pointless. The doula follows the parents
once they do decide to go to the hospital. Generally speaking, the doula comes
when the woman or her partner asks her to.
What if I want an epidural? What if I am going to have a caesarean birth?
A doula respects the choices of her clients, whatever those choices may be.
With an epidural, the easing of pain comes at the
price of an intense medicalisation of the birth. It can be difficult for the
woman to feel that she is playing an active role in the birthing process, yet
feeling active and in control of the event is often the key to a satisfying
birth experience in the long
term. Questions and anxieties can remain and the woman may feel alone. The doula
stays with the mother and her partner. She helps them to remain aware of what
is happening, and to stay in touch with their baby. In the event of a caesarean
birth, the support of a doula is even more beneficial as this can be a painful
and traumatic experience for both the mother and the
father. The doula is especially attentive to nurturing the sometimes delicate
mother-infant bond, as well as supporting the woman as she faces a double challenge:
adapting to her new situation as a mother while recovering from a major surgical
intervention. A woman who has given birth by caesarean may need to revisit this
event a long time afterwards. The doula remains available to her for this.
What type of training does a doula receive?
The doulas listed in our directory come from diverse backgrounds. Each doula
describes the path she has followed in her personal listing, and links to the
internet of the organisation where she received her training when possible.
Often, a doula's training resides in the principle of direct woman-to-woman
transmission of knowledge, in valuing and trusting in women's capabilities,
in the sharing of experiences and in the free exchange of ideas, and in the
relational clarity necessary to the
aid relationship. Sometimes the training involves the support of the future
doula, so that she integrates the nature of supporting women. A doula's training
includes the anatomy and physiology of pregnancy, labor, the post-partum period,
complications and medical interventions, the specific techniques and methods
relative to each of these stages, breastfeeding, health, informed consent...
They include theory as well as practical exercises.
The doula's formation is completed by attendance at conferences and seminars,
through exchanges between doulas and with other birth professionals, through
classes, lectures and personal research.
Today in our developed countries, doulas can never possess too much knowledge
in the perinatal field. However, the doula best suited for you may not have
the most training or the most certificates, as human qualities often prevail
over academic knowledge in this activity.
How, and by whom, are you paid?
By the parents (The Cochrane review mentions a study showing that the best
results from a doula's work are achieved when she is hired privately and paid
by the parents, and is thus independent from the medical institution).
Are you reimbursed, recognised by sociale/insurance?
No, not in France.
How much do you charge?
Each doula determines how much she will charge.
How are you viewed by midwives ?
The doula is a professional birth supporter. She has received training and
too has acquired the competencies necessary to practice of this profession.
As such, her conduct is professional and respectful of her clients and of all
persons holding medical
responsibility. Our response to this question is situated in this framework.
In France, the acceptance of doulas is variable. More
and more midwives understand that we are working together for the well-being
of the parents and the child, and that we are not there to do their job. However,
if it is a new experience for the midwife, it may be difficult for her to find
her place. It is the
doula's role to help her, through her conduct and by communication.
The birth plan
Parents can use a birth plan to list their desires and preferences for the
birth of their child.
The parents present the birth plan to the midwife or obstetrician who will attend
the birth. The plan will be added to the woman's file once the parents and the
carer have discussed and agreed upon its contents. It is a good idea to have
several copies of the plan. The birth plan concerns the different stages of
natural or medicalised birth (labor, birth, newborn and mother care, delivery
of the placenta, breastfeeding, the presence of other people, personalisation
of the event?) and can even include a section on what to do in the case of unexpected
events (transfer, caesarean...). The plan is addressed to all those involved
in the
care and well-being of the mother, the baby and the family. The woman has the
right to be informed and to participate in all decisions regarding the interventions
performed on her or on her baby.A few hospitals in France propose a standard
birth
plan to the women giving birth there, but this is still quite rare.It is important
to keep in mind that there is only one thing of which you can be certain: in
childbirth you should always expect the unexpected !
NB : This text has a moral, but not a legal, value.
You can find informations here about both medical
and and physiologic pathways to help you redact your birth plan
The doula's place
The doula shares her knowledge with the parents, provides information, a bibliography
etc... so that they may make fully informed choices, based on objective and
detailed information about childbirth itself, and about the acts that surround
it in France today. The doula follows and supports the parents in creating their
birth plan. It is the parents, however, who make
all decisions and who write the final document. This document also defines the
role and the place of the doula at the birth, as well as the expectations that
the parents have of her and her work. In the event of a hospital birth, the
doula may present the birth plan to the medical personnel. However, we prefer
that the father or mother do this themselves, in order to make it clear that
the wishes listed in the plan are solely those of the parents.
Continuity of Carer
Today in France, it is very unusual for a mother to be followed by the same
caregiver throughout her pregnancy and for a mother to have met the midwife
that will be present at her birth and to have developed a trusting relationship
with her. It is very unusual for the midwife to remain with the mother throughout
the entire labor, especially if it is long.
When in labor, a woman under the care of an obstetrician will probably only
see him or her during the last stage of labor, if everything is progressing
normally. In the postpartum period, and during the period of breastfeeding,
the mother will be cared for by yet another midwife, other nurses, interns,
aides, paediatricians, etc… who, although highly qualified, are most likely
unknown to her, and the woman might receive conflicting advice.
Prenatal visits are usually brief, and the birth preparation courses, when
they exist, may be given by different midwives, or by a midwife who doesn't
work on a labor ward. The information given may vary from person to person,
which can be confusing and disorienting.
For a good birth experience, the mother needs to feel secure within herself,
yet the medical environment does little to foster this sense of emotional and
unconscious security. The presence of a doula can meet this need. A doula creates
continuity and establishes a relationship of trust, complicity, and intimacy
beween women, thus enabling the mother to feel secure throughout her pregnancy,
labor and postnatal period.
How to choose a doula ?
Childbirth is an intimate, unique, and main event in the life of each human
being. It is a moment of rare intensity, one which can have a profound emotional
impact. Choosing those who will accompany you at this time deserves your utmost
attention.
The following questions may help you in making your choice:
* Questions to ask
a doula:
Asking the following questions can help you to determine if a doula’s
vision, experience, qualifications etc. are acceptable to you:
- Why did you become a doula?
-What is your philosophy of birth and the support of women, their partners,
and their families?
- Tell me about your personal as well as professional experiences with birth.
- May I contact a woman or a couple whom you have accompanied in your role as
doula?
- What is your understanding of the medical profession, and what is your relationship
with it?
- What type of training did you receive? (You can verify a doula’s certification
by contacting the certifying organisation).
- Which comfort measures do you propose?
- May we meet with you to discuss our birth plan and the role that you would
play as a birth companion?
- May we call you with questions or concerns before and after the birth?
- During which period will you be on 24-hour-call for us?
- At what point in the labor do you try to join the woman? Do you come to the
house or meet us at the hospital?
- Will you meet with us afterwards to review and discuss the birth and answer
any questions?
- What are your skills in areas such as post-partum care for mother and baby,
breastfeeding, etc…?
- Do you have back-up doulas to replace you in case you are not available? May
we meet them?
- What are your fees and your reimbursement policies?
* Questions to ask yourself
It is important for you and your doula to be compatible: It is a matter of personalities,
affinities, personal feelings, and intuition. Pay attention to first impressions.
-Are you comfortable in the presence of this person ?
-Do you trust her? Does she meet your needs and expectations?
-How do you feel about having her near you, touching you, and talking to you?
-How do you feel after having met with her?
-How does your partner react to the idea of having a doula attend the birth?
-Is your partner at ease with her?
During your labor and birth, it is not up to you to try to accommodate others:
- Is there anything about the doula that bothers you? If so, is it of primary
importance? Could you discuss it with her?
-When in her presence are you free to express yourself, expose yourself, ask
questions, speak, confide in her or disagree with her
Translated by Rachel Grenon
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