You may have heard about Doulas from your friends abroad or you may have read about it in any book/resource providing updated evidence based facts about birth. And now that you are expecting a baby, you are curious to understand how Doulas fit into the Luxembourg birth scene. Pour yourself a cup of tea, Marise from the Luxmama Club & ParentPrep asbl is going to fill you in on all the details.
What is a Doula?
The term Doula in Greek is literally translated as “servant to women” and is in essence a comeback to the female support and companionship that expecting mothers have been gathering traditionally during the time of childbirth. Maddie McMahon explains in Why Doulas Matter – “the mother-to-be chose these confidantes carefully to uphold her birth instincts, support her intuition, hold her birth space and protect her “babymoon”.
A Birth Doula today is an independent, non-medical, trained professional providing information, advocacy and continuous emotional and physical labour support in all birth settings which depending on the family may include physical comfort measures during labour, like massage, counter-pressure, gentle touch, movement, affirmations, relaxation & breathing techniques, music, involvement from your partner, aromatherapy, rebozo-techniques, acupressure, water, adjusting lighting to facilitate optimal birth hormones etc.
A Birth Doula is handpicked by the family, gets to know the family during pregnancy and provides a continuous, round-the-clock compassionate and reassuring presence to both the labouring woman and her partner without judgement or pressure which helps build their confidence and feeling of safety and decreases their anxiety significantly, a gift that families remember all their life.
It’s not surprising then that Birth Doulas:
- Are described as “one of the most effective tools to improve birth” by the American Congress of Obstetricians and Gynecologists in 2014.
- Are recommended by the World Health Organisation,
- Are recommended by the Baby-Friendly Hospital Initiative
- Are recommended by the International Mother-Baby Childbirth Initiative (in fact, the recommendation is that care providers inform families of the option due to the whopping benefits observed in studies).
It is important to understand that the Birth Doula doesn’t provide any medical care and wholeheartedly respects the medical team (obstetrician and/or midwife) and when the role of the Doula is properly understood, greatly complements the work of the medical team to provide the birthing family with the best possible birth experience.
A Post-partum/postnatal Doula
- is a professional support person trained to help not only the baby, but the family as well, in the days or months after birth
- may also offer support with the practical side of things: Laundry, dishes, housework, partner and sibling support, cooking, errands etc so the mother can recover, rest, bond and breastfeed.
- essentially, mothers the new mother, nurturing her so she can nurture her precious new baby.
- can reduce the incidence of perinatal mood disorders
- does not interfere with the role of the sages-femmes liberale/independent community midwives in Luxembourg providing postnatal care financed by the national health-system. These visits are shorter and also to solve specific problems e.g. feeding, monitoring baby’s weight etc, mom’s healing.
But nothing stops families in Luxembourg to hire a postpartum doula (not refunded by the public health system or other health insurances) to help them cope after birth, especially since many families do not have their family support here with them.
Benefits of Birth Doula Support
The benefits of Birth Doula support is well established and supported by high quality clinical evidence. Over twenty-six scientific trials involving over 15,000 women, examining doula care demonstrate remarkably improved physical and psychological outcomes for both mother and baby. Birth Doulas have a positive impact on the well-being of the entire family and the tangible beneficial outcomes have been studied more than any other intervention currently used in hospitals!
Overall, studies show that people who receive continuous support are more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans. In addition, their labors are shorter by about 40 minutes and their babies are less likely to have low Apgar scores at birth. There is a smaller amount of evidence that doula support in labor can lower postpartum depression in mothers. There is no evidence for negative consequences to continuous labor support.
For most outcomes (designated with asterisks*), the best results occur when a birthing person has continuous labor support from a doula– someone who was NOT a staff member at the hospital and who is NOT part of their social network. When continuous labor support is provided by a doula, women experience a:
- 31% decrease in the use of Pitocin* (synthetic oxytocin used to speed up or induce labour, frequently used in Luxembourg)
- 28% decrease in the risk of Cesarean* (which is an important benefit as the average rate of cesarean sections in Luxembourg is over 30% like the US and only 6 other countries in the EU, a great cause for concern according to the latest EU Perinatal Health report. Further to note is that planned/requested cesareans contribute a very small % of the overall 30%.)
- 12% increase in the likelihood of a spontaneous vaginal birth*
- 9% decrease in the use of any medications for pain relief
- 14% decrease in the risk of newborns being admitted to a special care nursery
- 34% decrease in the risk of being dissatisfied with the birth experience*
When we take a deeper look at why these beneficial outcomes are observed, we see the following reasons as explained by Evidence Based Birth.com:
- “In most developed countries, ever since birth moved out of the home and into the hospital, laboring people are frequently submitted to institutional routines, high intervention rates, staff who are strangers, lack of privacy, bright lighting, and needles. Most of us would have a hard time dealing with these conditions when we’re feeling our best. But people in labor have to deal with these harsh conditions when they are in a very vulnerable state. These harsh conditions may slow down a person’s labor and their self-confidence. It is thought that a doula “buffers” this harsh environment by providing continuous support and companionship which promotes the mother’s self-esteem. (Hofmeyr, Nikodem et al. 1991)”
- “Doulas are a form of pain relief in themselves (Hofmeyr, 1991). With continuous support, laboring people are less likely to request epidurals or pain medication. It is thought that there is fewer use of medications because birthing people feel less pain when a doula is present. An additional benefit to the avoidance of epidural anesthesia is that women may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring (Caton, Corry et al. 2002).
- The attachment between the birthing person and doula can lead to an increase in oxytocin, the hormone that promotes labor contractions as proposed by Dr. Amy Gilliland: “I believe the Doula Effect is related to attachment. When the mother feels vulnerable in labor, she directs attachment behaviors to suitable figures around her, who may or may not be her attachment figures (parent, mate). When the mother directs attachment seeking behaviors to the doula, the experienced doula (25 births or more) responds in a unique manner. She is able to respond as a secure base, thereby soothing the mother’s attachment system. The accompanying diminishment in stress hormones allows for a surge in oxytocin in both the mother and the doula… theoretically, oxytocin is the hormone of attachment, and it is released during soothing touch and extended eye contact, which are habitual behaviors of birth doulas.”
- Swedish oxytocin researcher Kristin Uvnas Moberg writes that the doula enhances oxytocin release which decreases stress reactions, fear, and anxiety, and increases contraction strength and effectiveness. In addition, the calming effect of the doula’s presence increases the mother’s own natural pain coping hormones (beta-endorphins), making labor feel less painful (Uvnas Moberg, 2014).
Further benefits for expatriate families giving birth in Luxembourg are that the Birth Doula can help to bridge language gaps as the medical staff in hospital will not necessarily speak the mother-tongue of the birthing family and having trouble communicating properly could add more unease.
Another important aspect to understand is that the Birth Doula is acutely aware of how the environment affects the body’s birthing abilities:
- Labouring women aiming for a non-surgical birth need to be able to relax enough to shut out any mental stimulation (neocortical inhibition as per Dr Michel Odent) to be able to access the primitive brain parts allowing for instinctual, undisturbed birthing.
- Labouring “Mammalian species need to FEEL private, safe and un-observed to facilitate the optimal hormones for labour and birth”, as Dr Sarah Buckley explains.
And having someone by your side 100% of the time that you have personally chosen, that you became acquainted with during pregnancy, that has seen birth in all shapes and forms in different settings and that understands what’s important to you helps to alleviate the famous fear of the unknown so tension in your body can melt away and you can literally relax being fully supported in birth..sigh…
Lastly it is important to note that Birth Doulas are not just to support families in natural drug-free birth (though they are highly effective in that endeavour). That’s a myth! They are unbiased and support families in any choices they make e.g. a planned cesarean, a birth with an epidural etc. They do however encourage families to make informed choices and are able to point them in the direction of the latest evidence based research to help families make these choices themselves after discussion of course with their care providers.
But isn’t a Doula the same as a midwife?
It is very important to understand that the role of a Birth Doula is not to replace or interfere with the role of the midwife in birth or any other birth professional for that matter.
Traditionally trained midwives are the experts in physiological birth (and provide the best outcomes for mothers and babies with low-risk pregnancies accounting for around 85% of pregnancies) while obstetricians are trained to be the experts at using medical treatment to fight pathologies and manage medical crises.They go to school for many years to learn the complexities of pharmacology and the intricacies of surgery which we are very thankful for in those high-risk cases.
What about Luxembourg?
In Luxembourg though, due to inequality between the midwifery and obstetric profession sadly, midwives are not trained or legally mandated to work autonomously in birth with low-risk pregnancies like you may have heard in other countries. The independent midwives (sages-femmes liberales) provide in-home state-funded postnatal short-visit care and the delivery midwives in the hospitals are responsible for clinical care under direction of the assigned obstetrician, like monitoring the baby’s heartbeat, mom’s blood pressure, doing cervical examinations, inserting catheters etc. They care for several birthing families at a time and a family will not be able to choose the midwife during pregnancy that will care for them during birth (to develop a relationship before the delivery). Each birthing family may also see a number of different delivery midwives as they relieve each other following shift changes.
The Birth Doula will offer non-medical care, constant encouragement and love continuously (without changing shifts) to one birthing couple at a time wherever they may find themselves (at home, hospital, the birth center etc). Families carefully choose and get to know their Birth Doulas before the big day. Birth Doulas also help parents become better medical consumers, reminding them of their rights, and the best outcomes are observed when Birth Doulas are independent (not employed) from the hospital/birth setting or from the family’s social network or family so they can remain emotionally stable, unbiased and objective.
Birth Doula Love in Luxembourg
Birth Doula love may sound wonderful and if you are pregnant you may think, great – where do I sign up for this?! Yet, in Luxembourg – the concept of Birth Doulas is still quite unknown and/or not well understood among care providers and consumers. The good news is that there are certified and experienced Doulas in Luxembourg! Yay!
Even though nothing in local law prevents families from having Birth Doula support and Art 8 of the EU Convention on Human Rights affirms a family’s right to choose the conditions of childbirth, the challenge is that the current Luxembourg maternity care system is just not yet at the point where hiring a Birth Doula is straightforward. We dream of the time in future when the national healthcare system acknowledges the benefits that Birth Doula support offers to consumers and their babies as well as the savings from less medical interventions required in the birth process. This is indeed the case in some countries around the world already where healthcare insurance companies finance Birth Doula costs. Along with that vision we also dream that consumers will be able to choose where they give birth with the full range of options supported and to be able to choose between the midwifery model OR obstetric model of care like universal human rights in childbirth outlines. Sadly this deeply entrenched inequality between the midwifery and obstetric profession (stemming from the late fourteenth century) is not making the entry of Birth Doulas into the system easier either…
The Luxmama Club & ParentPrep asbl have launched a campaign #choice2haveadoula with support from Initiativ Liewensufank to help advocate for the Rights of Families in Birth (one of the awareness pillars of the organisation being Human Rights in Childbirth or Birth Rights).
If you are interested in the topic of Birth Doula support, Human Rights in Childbirth or the #choice2haveadoula campaign you can:
- Visit www.luxmamaclub.com/choice2haveadoula for further information.
- Join a Facebook group here on the topic of Birth Doulas in Luxembourg.
- Join a Facebook group here on the topic of Human Rights in Childbirth and advocacy for birth.
- Join an upcoming monthly Luxmama Positive Birth Meetup as part of the global movement to come and discuss more in a safe space.