When Capella Sherwood discovered she was pregnant within a few weeks of moving to Cork from Canada, one of the first things she did was to Google “doula”.
“I knew nobody in Cork, nobody in Ireland,” says the now mother of two. But she had hired a doula (a non-medical person who helps a woman before, during and/or after birth) for the arrival of her first child nearly three years ago in Ontario, where such assistants are more common.
Through the internet search, she found Cork-based Mary Tighe of BirthingMamas.
“I was so happy; she seemed absolutely lovely. I felt like already I had a family,” says Sherwood, who came here in 2013 when her husband, Gregory Campbell, started to study medicine at University College Cork (UCC).
In this case, Tighe was also invaluable in helping the couple to navigate a maternity system with which they were unfamiliar. She introduced them to the new midwifery-led Domino Scheme at Cork University Maternity Hospital (CUMH) and, in fact, Sherwood became the first mother to give birth using this service last May.
Tighe visited her a couple of times during the pregnancy and then met up with her at the hospital after labour had progressed quicker than expected at home. Baby Winston Campbell arrived within 45 minutes of them getting to the hospital.
“Everything went beautifully and we were so happy to have Mary there and we were well cared for.” They were home the next morning and Tighe helped them settle into a new routine as a family of four.
Of using a doula, Sherwood adds: “You are hiring the big sister you never had. I think the doula helps the mother and the midwife team helps the baby and that you need both.”
It is a view that is catching on here in Ireland. Although a few doulas have been practising here for the past decade, many maternity hospitals were initially wary and tended to keep them out with a “one birth partner” policy – meaning a woman could bring a doula only if the baby’s father gave up his place.
However, a position statement on doulas, issued by the Coombe Women and Infants University Hospital last August, is indicative of an increasing acceptance by the Irish maternity system of their value. Now adopting an “open door” policy, whereby women no longer need to apply in writing for permission to bring in a doula, the Coombe acknowledges that there is evidence to show the benefits of continuous support from a person known to a labouring mother.
These include being less likely to need a Caesarean section, forceps or vacuum extraction to give birth than those who don’t have such support, according to a 2012 Cochrane review of 22 randomised controlled trials involving more than 15,000 women. Other benefits include being more likely to have a shorter labour and less likely to need an epidural or report a negative birthing experience.
“Birth is not only about making babies. Birth is about making mothers,” is a quote from US sociologist and midwife Barbara Katz Rothman that runs across the home page of the Doula Association of Ireland (DAI) website.
Bonding with the baby
The emotional wellbeing of the mum is paramount for how labour progresses, how happy they feel afterwards and bonding with the baby, says DAI chairwoman Mim Moran. Even if a complicated birth is medically necessary, the doula can help the couple understand and come to terms with that, she points out.
“Certainly a doula is extremely beneficial – just having a woman who is known to you and familiar with the birthing process,” says the Coombe’s director of midwifery and nursing, Patricia Hughes. In the past, the hospital tried to facilitate women’s requests for doulas but it wasn’t always possible, until the reconfiguration of the labour suite in 2013.
Women also used to have to write to Hughes asking for permission to bring one in (in addition to their partner) but when it got to the stage where she was receiving at least one request a week, the hospital decided to dispense with this formality and women are instead advised just to mention at an ante-natal visit that they intend to use a doula and it can be noted in their file.
However, most other hospitals, including the Rotunda and the National Maternity Hospital in Dublin and the Cork University Maternity Hospital, still require women to seek written permission to bring a doula, although at the Limerick Regional Maternity Hospital this is not necessary.
People should be aware, Hughes adds, that if an emergency situation arises and an operative birth is required, staff may ask the woman to reduce her birth partners to one.
One of the earliest practising doulas in Ireland, Tracy Donegan, was inspired to train after having one at the birth of her son Jack in the US in 2003. After she returned to Ireland in 2005, it was a time, she says, of educating Irish midwives and hospital managers about the benefits of doulas for women and their babies, and reassuring them that the role is to provide complementary care to that being given by the hospital.
“They were definitely a bit suspicious initially but, when they understood what my role was and that medical advice was not part of it, we all just got on with the job in hand – helping the couple have the safest, most positive experience possible.”
Donegan has since trained as a midwife and sees from another perspective the importance of the continuous, familiar support that a doula offers.
“Midwives are under incredible pressure in our labour wards, and our maternity services are overstretched. We’re often too busy to provide the full spectrum of emotional care that all women need and we take breaks and go home after our shifts and sometimes have more than one mother to look after.”
Women seeking doulas tend to be either first-time expectant mothers who have done their research and want to stack the odds in their favour of having a positive, unmedicalised experience, she says, or they are mothers who have had difficult first births and “felt they didn’t get the support they needed on their first labour or didn’t feel heard”.
However, she stresses that a doula is not there to speak for the woman or try to “enforce” her birth preferences.
“Hopefully, in the time we’ve spent with the couple antenatally,” she adds, “we’ll have helped the couple to find their own voice and to feel confident to ask for any particular birth preferences that will help them have the experience they are hoping for.”
Anxiety going into her second pregnancy
After a traumatic first labour in 2010 that ended with an emergency Caesarean section, due to failure to progress, Jacquie Beamish had a lot of anxiety going into her second pregnancy.
“I felt really strongly that I didn’t want another section,” she says. “I didn’t want to have that same medicalised experience where we didn’t really know what was going on.”
She felt the best way to have a natural birth the second time was to inform herself and try to dispel her anxiety – and that using a doula would be a very good option. Having met Mary Tighe through mutual friends, she decided to do one of her GentleBirth workshops, as well as hiring her as a doula.
GentleBirth gave her the tools to be able to relax and keep her mind focused. During the contractions her mantra was “I can do anything for a minute.”
Asked what help did she find having Tighe, as well as her husband Graham, in the CUMH for the second birth in April 2013, Beamish recalls two incidents that really stick in her head.
“We were in the waiting room for about an hour and a half waiting to be seen and things were getting more intense. She was doing counter pressure on my hips during contractions and it just really helped me cope with it.
“There was also one particular point during labour – I’d say I was in transition at that stage and I was having a bit of a panic of ‘I can’t do this, I can’t do this’, I distinctly remember her putting her hands on my knee and looking me straight in the eye, saying ‘You can do this, you know you can do this.’ It really reset me and got me refocused: ‘I can do this, I am doing it already, there is no can’t.’ ”
It was a great support for her husband too to have Tighe there, she adds. It meant he could go off to the bathroom or go for a snack, “and not worry that I was being left with strangers, as we had built up a relationship with Mary during the pregnancy. He knew I was relaxed with her and he found it fantastic as well.”
While Beamish “just hated” the whole experience around the birth of her first daughter, Charlotte – and, indeed, told everyone for the first 18 months she would be an only child – she felt completely different about the arrival of her second daughter.
“With Alicia it was just so empowering to know that I had done it – and I was home within 24 hours of her being born, which was lovely.”
She has since trained with Tracy Donegan to be a doula herself and her first client is expecting a baby in May.
Tighe says she can’t get over the upsurge in demand for doulas. As the mother of two young children, she takes only two or three clients a year herself but refers others on.
“There is nothing more amazing than supporting a couple – it’s a real honour to be there for the birth of a baby,” she says.
She has been lucky that all the births she has attended have been great, she says, and her Caesarean rate to date is zero.
“To see a couple becoming parents and holding their baby,” she adds, “I think I get an oxytocin rush from that as well.”
swayman@irishtimes.com
If you think you want to hire a doula . . . Double check with the hospital where you’ve registered that you will be allowed to bring in a doula in addition to your birthing partner (unless you want a doula as your birthing partner and nobody else).
See who’s available in your area by checking the listings on doula.ie and irishdouladirectory.com. If you have a choice of several, look at their online profiles and phone two or three. Both you and your partner should have at least one face-to-face meeting before deciding to go ahead.
Be sure you are both going to be comfortable allowing this third party to share what is going to be a very intimate experience. She may have previous clients who can vouch for her.
If you are happy to proceed, draw up a contract with the doula about what services she will provide, such as ante- natal visits, her availability for contact during pregnancy, “on-call” period before birth, attendance at the birth and postnatal visits, and agree a fee.
