Trudi Dawson is Director of Engagement at Doula UK, the non-profit organisation of doulas in the UK. She has been a doula since 2007 and has worked as a birth doula as well as a postnatal doula. You can find Trudi via her website or on Instagram.
What do doulas do?
The first thing to say is that we’re not medical. We are not responsible for any medical processes or procedures. Having said that, we should be pretty well informed on the medical side, if only so that we can help our clients navigate what's going on for them.
So what do we do? A birth doula is there for the birthing family. Being a doula is often described as mothering the mother. I’m not there for the baby, unless the mum needs me to be there for the baby. I'm not there to see her birth. I'm there to be with her. And so that's a really clear distinction, I think, from a midwife or a nanny or a night nanny or a maternity nurse. We are really there for the parent, however that looks. We are sign-posters, advocates, supporters, an experienced pair of hands. It is quite hard to pin down because it looks different for everyone, depending on what is needed. If you ask somebody who has had a doula they probably wouldn't be able to explain exactly what she did, but they often would report something like “I couldn't have done it without her”.
On a practical level it involves supporting a family from about halfway through a pregnancy, being available to go to a birth at short notice and then being there throughout.
Postnatal doulas might support families for six weeks after birth, or three months, or a year, it just depends on the individual. Postnatal support could be anything including cooking nutritious meals, emptying the dishwasher or making sure the postman doesn't wake the baby up. It might be wearing your baby whilst you go and have a nap. It's a real extra pair of hands. We all know that we used to live in close communities and now we don't see so much of our networks.
Even if we do live near family and friends, the relationship is very different. It's unlikely your friends will come round with a hot dinner, empty your dishwasher, sort your laundry out, support you with breastfeeding and go again having not held the baby. A doula would do all of those things. So it's filling that gap that our lack of community has left wanting.
Another way that people describe the work of a doula, which I really like, is drinking tea intelligently.
Sometimes my job looks like I'm just sitting down having a chat. But I've made my client her tea just the way she likes it, and I'm listening with no judgement, and I might even have a really good tip up my sleeve. And if I don't, then I can show empathy and understanding in some of her most vulnerable moments.
How does being a doula in the UK work? Can anyone just decide to do it?
Yes. It's pretty much unregulated in the UK and anyone can pop up and say they're a doula which would not always be a good thing. That's where Doula UK comes in and where I think we're quite different.
We maintain a list of external course providers that meet our requirements and offer a thorough, well-rounded and evidence-based course. We have a really thorough mentoring process- we make sure that a new doula is always paired with someone more experienced so that through the process of becoming a recognised doula (which might take a couple of years) she has someone else she can bounce ideas off and also debrief with.
Doula UK also has a resolution process, which makes us quite unique. We’re not the doula police but if anything did go wrong (which is incredibly rare and usually comes down to a communication issue rather than anything bigger) we do have a mechanism in place to help resolve issues for the affected families.
We’re a bit like a stamp of assurance or quality, and that’s not only beneficial for families who are choosing a doula. It’s also the midwives, the GP's.
We would hope that everybody that the doula would come into contact with would also feel reassured by the fact that they have reached a requirement and that they have experienced back up behind them to support all the glorious rainbow of situations that birth and postnatal can present.
I always thought of doulas as quite American, are they now becoming more in demand in the UK? Why is that?
Yes. Although doulas in the UK only currently support a small proportion of births there’s big year on year growth- 40% more births supported by doulas in 2022 compared to 2020 and 50% more families being supported postnatally.
I’m sure there are many reasons but one of them is that we've got more information thrown at us from so many different places than ever before. Despite that, birth and the first year are still awash with misinformation. There are so many different stories out there now, and whilst it’s awesome that people are sharing, it can also lead to a general feeling of being overwhelmed and needing help deciphering what it all means for you. That's where a doula comes in.
We all know that the NHS is pressed and often gets a bad rap. We've seen maternity units closed because of lack of midwives. There's a midwife shortage and whilst doulas definitely aren't midwives, we are back up for the birthing family.
More people might be feeling like they need backup, that they need a bit more assurance.
Birth trauma is another massive factor in choosing to have a doula for birth and the postnatal period. If people suffer from PTSD, postnatal anxiety, postnatal depression or birth trauma then when they are preparing for a subsequent birth they may want to have an extra person by their side, helping them through. For people coming to doulas to help with a subsequent birth it’s often either because they had a really good experience with a doula the first time around and want to repeat it all, or because they experienced birth or postnatal trauma the first time and want to try things differently.
More happily, we also do a great job! So word gets around, and that contributes to demand. Sometimes people decide to try using a doula for subsequent births not because they had a terrible experience the first time around but simply because they’ve learnt that they just need someone else there for practical support. Maybe it’s to run and put money in for the car park, or sort out some snacks. Having someone beyond your partner just ‘on hand’ can be a real source of comfort and reassurance.
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