Wednesday, 19 November 2014

BIRTH WEEK: "Work out what a positive experience means to you" Rebecca Schiller, Doula

In this Q&A Rebecca Schiller, doula and co-chair & campaigner for Birthrights, tells us about the role of the doula and how they can support women before, during and after birth.

1. What do you see is the role of the doula and what skills/training do they bring to the role?

I think the role of the doula is to fit in to whatever gap exists in the woman's support team. In many ways it's an ancient role - supporting women in your local community as they make one of life's biggest transitions. Before the birth we are experienced listeners, signposters to information and resources, confidence builders helping a woman and her partner (and other children too) feel ready for birth and their new family. At a birth I find myself doing everything from sitting back, unobserved and being a comfort blanket, to practical help, emotional support and sometimes hands on help through contractions. Sometimes my most useful role is smiling reassurance at a worried partner or taking an over-zealous toddler out for a walk. Other times it's counter pressure on a woman's sacrum and explaining her 'back story' to the medical team who are usually meeting her for the first time. After birth I'm there for the 'ok what now' moments. I spend a lot of time listening to tales of difficult relatives, sleepless nights and adjusting to parenthood. I make tea, run a bath, make some lunch. I often lend slings and give breastfeeding support. It's different every time.

Every doula is also different bringing her personality and unique qualities to what she does. That's why I always suggest people meet a few different doulas. Finding the right one is a lot like dating; you need to see who is out there. I think it's important to always find a doula who is a member of Doula UK. They will have been on an approved preparation course, have undergone a period of being mentored and will adhere to the code of conduct and philosophy.

2. Why is birth experience so important? You hear people say "a healthy baby is all that matters".

When you think carefully about the phrase "a healthy baby is all that matters" it's really quite offensive. Babies are hugely important and the people they are most important to are their mothers. Women know how important babies are; they want them to be healthy and love and nurture them when they aren't. But women matter too. There are no healthy babies without healthy mothers and by that I mean emotionally and physically healthy.

To regard women merely as some kind of living tupperware - the lid of which can be prised open any which way to get to the precious contents is a terrible thing. Women matter and their experiences of birth are written on them often for life.

Women say that positive experiences of birth - whatever that means them - set them up for motherhood confidently. Those who feel upset by their birth experience often find it negatively affects how they feel about themselves, their partners and their babies.

Above all women are human beings and that does not stop because they are pregnant. Compassionate, respectful care in a system designed around their individuals needs is what they should expect and be offered.

3. What do you think about "NHS doulas"? Is this a positive move to expand access or does it compromise the doula's role in advocating for the parents?

I welcome the recognition of the complementary role doulas can play within the maternity services. I certainly think doulas need to be at the table when maternity services are being designed. After all we are super-users of the service.

NHS doulas present unique challenges as being within the system can make the role less effective. The Cochrane Review of continuous support in labour found that the range of positive benefits afforded by this continuous support diminished when the support person was a staff member. However, schemes that ensure more women have access to much needed support are to be applauded and the challenges need to be tackled.

4. What do you think is the most important thing a woman can do to prepare herself for a positive birth experience?

Work out what a positive experience means to you, outside of exactly where and how you give birth. For many women that means feeling well supported, ensuring people listen to you and that your choices are respected. Then work out what kind of care and support you need to make that happen. A doula and a named case-loading midwife is usually a good place to start whether you want a home birth or an elective caesarean.

Rebecca Schiller is a Doula UK recognised birth doula, offering support to birthing women and their families in London and East Kent. Her experiences have led her to blogging and freelance journalism on related topics. Before entering the childbirth world she completed a Masters degree in War Studies with a focus on human rights issues. She has worked in the charity and NGO sector, most recently at Human Rights Watch.

Have you ever employed a doula or would you think about employing one? Would love to hear your thoughts.


  1. Thanks Rebecca, it's really useful to hear how doulas can contribute to a positive birth experience, whatever that may feel like for each individual woman. From friends who have used doulas, it seems that doulas have a big role in helping women getting over past trauma or difficult experiences and can provide that continuity of care that may be lacking. As you say, it is hard when you meet the person who will help you deliver your baby for the first time during labour, who doesn't know you and doesn't know the "back story". I really hope we can get this support to all women so they can start motherhood on a positive footing.

  2. I totally agree that 'at least the baby is healthy' is highly offensive and destructive to women who have been through a traumatic birth. When my son was born in 2009 I suffered terribly with flashbacks, panic attacks and anxiety, much of which still exists with me today. I struggled to bond with my son after he was born while I was under GA and even suspected he wasn't mine at first. And everyone was telling me that I should be happy because he was alive (after resuscitation) and that they had had a c section and they were fine, so I should be too. When he was 8 months old I went to see the GP as I was desperate and he told me that I 'couldn't control my womb'... at that point I knew I was alone in how I felt and how I was going to get better. I wish I had known about doulas for my 3rd pregnancy and I wish I'd have had the confidence to try for a VBAC then, as by the time my 4th baby came along it was very risky and although I finally had the confidence, things were not in my favour. I think all I needed was someone to support me and help me feel empowered. If the NHS can offer that to women then how wonderful!

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