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Protecting human rights in childbirth

BLOG: Second birth partners – are doulas a middle class luxury?

Many people have an image of doulas working with middle-class women who can afford additional support. However doulas also work with women facing difficult and complex circumstances.  In the third blog post in our series on second birth partners, we hear from Jo Doherty, Group Leader for the Happy Baby Community (HBC) a pan-London community supporting pregnant women and women with babies and young children who have fled trafficking, violence, trauma or abuse and who are seeking international protection in the UK. Jo explains why doulas make such a difference to the individuals they support… 

Over the last year of multiple lockdowns, which have been hard for everyone in the UK, for the amazing women in the Happy Baby Community, their daily challenges have been multiplied a hundred-fold.  There are few places where this has been more evident than in the birth environment. 

The women in our community, due to their past and present experiences, as well as their ethnicity, are at higher risk of traumatisation or re-traumatisation during labour and birth (with the concomitant risk of developing or intensifying post-traumatic stress disorder), have a much higher incidence of general perinatal mental health issues, and are at a higher risk of adverse birth outcomes for both themselves and their babies. 

Prior to the pandemic, when possible, the Happy Baby Community offered birth companion support even if women already had a first birth partner.  Since the pandemic began, maternity units, in keeping with every other organisation across the UK, have had to adapt their practices in order to minimise as far as possible the risk of spreading covid-19.  For maternity units, as for the rest of the NHS, this is not as simple as closing their doors, or moving online, as many of us have been able to or had to do.  

To minimise the spread of covid-19 as much as possible whilst also remaining operational, maternity units across the UK have limited the number of birth partners a mother may have to one birth partner only, unless there are exceptional circumstances.  Happy Baby Community members, almost without exception, have exceptional circumstances.  Nevertheless, there have only been a couple of occasions over the last months where these circumstances have been thought significant enough that a second birth partner, in the form of an experienced Happy Baby Community birth companion, was permitted. 

This has left many of our community members facing agonising decisions about who to choose as their birth partner. Alone in a country where they don’t speak the language or have the understanding of the systems that they would in their home country, women who are lucky enough to have a partner or a friend, need that partner or friend by their side during labour and birth.  This does not however, negate the need for an experienced, trauma-informed HBC birth companion to support them as well. 

Our evaluation of our original pilot birth companion project clearly demonstrated that women from the Happy Baby Community who had birth companion support from us felt significantly safer during labour and birth1.  For those women who had both an HBC birth companion and another birth partner, it was the HBC birth companion who created the feeling of safety.  It was clear that the two birth partners fulfilled very different, but equally important, roles for mothers during labour and birth, ‘Doula and husband together is good. If no doula, I can’t do my baby.’ HBC mother who gave birth in January 2020. 

Over the past few years, I have come to believe that maternity services in the UK are set up with an unacknowledged assumption that women will bring at least one birth partner with them during labour, and that this birth partner will be a consistent presence in the birth room, in addition to the midwives and other healthcare professionals who are on hand, but not actually present for much of the time.  And most of us, by the luck of our circumstances, do indeed bring this essential birth partner with us. 

It is a travesty that in the 21st century in the UK there are mothers, who are usually amongst those facing the most significant challenges of all in our community, who go through labour and birth without this essential birth partner by their side. 

However, it is, beginning to feel an equal travesty, that, at a time when our restaurants, pubs and other social events are re-opening, women across society are still in some cases being denied access to two birth partners.  Any woman, whoever she is, who wants two birth partners by her side during one of the most important events of her life, has already decided that, for whatever reason, for her as an individual, two birth partners are essential.  

This is the story of one of our community members, who was supported to have two birth partners during the pandemic. 

My baby son was born in January.  My midwife arranged beforehand for me to have two birth partners, my friend and a doula from the Happy Baby Community. 

When my friend and I arrived at hospital, the midwives said I was only 3 cm dilated and they sent us home again. We came back two hours later and they said I was 7 cm dilated. They asked me, ‘why didn’t you come earlier?’ I didn’t say anything because I didn’t have the power at that time. 

I have not told anyone this before, but before my doula arrived and came into the room, the midwives did not care for me that much. When my doula came, they changed completely.  My friend turned to me and said in our language, ‘What happened?!’ 

But they did not want to let my doula stay as well as my friend, even though she had a letter from the hospital to say she was allowed and my notes said I was allowed two birth partners.  I was begging them, ‘Please, please let her stay.’ My doula and her supervisor had to fight with them a lot in that time for her to be allowed to stay.  Eventually though, they agreed that my friend and my doula could both stay with me. 

I needed my friend to be with me. She has helped me with everything since I came to the UK and she is part of my heart. We prepared my hospital bag together and chose the baby clothes.  The doula is different. She understands labour and birth and is a professional, but, unlike the midwife or doctor, she is there to take my part and to care for me. I needed my doula there too. 

With my last birth, when I had my daughter, I knew nothing. I was alone in the hospital screaming. I do not like to think about this experience. 

But this time, my friend was there to hold my hand and be by my side.  My doula was there to help me all the time with everything.  She helped me with my breathing, and different positions and to think positive.  It was completely different from the last time I gave birth.  Together, they gave me so much strength in myself that I didn’t need pain relief. 

It was a hard time to give birth, in a pandemic, but I was lucky that I had both my friend and my doula there.  I needed them both – for my mind, for my mental health. If your mind is good, you can do anything. 

In only the gravest of societal circumstances should we be assessing whether any individual woman’s reasons for needing two birth partners are valid enough to merit her being allowed them. With our children back at school and our pubs, restaurants, hotels and leisure activities open, any reasonable justification for this additional restriction upon women is fast disappearing. 

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