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Journalism of Courage
When Pankhuri Kapoor and Devank Kapoor, a Hyderabad-based couple, were expecting their first baby as a nuclear family, they wanted the best facilities for the mother and the child. Devank soon realised that even if he would be present with his wife throughout, she would still need someone who can understand the female body and the process of pregnancy. As such, the Kapoors hired a doula who, they say, provides adequate support, like doctors provide expertise. “Just like an accountant can not construct a building, similarly, best and most skilled doctors can not replace what a doula provides — an emotional connect,” Devank told indianexpress.com.
A doula — an ancient Greek word meaning a ‘woman who serves’ — is a trained non-medical professional who supports a woman and offers non-clinical care through pregnancy, childbirth, postpartum, miscarriage, and stillbirth. “Doula is a woman who is trained to help an expectant mother through labour. As a doula at Fernandez Hospital, I support mothers prenatally, during labour, and postpartum,” Celestina Maria Cavinder, a certified doula said.
But, how does a doula help a woman through these significant phases? Dr Pooja Shenoy, a former obstetrician turned doula who found her life’s calling in being one, said that as a birth doula, she offers continuous 1-1 physical support to a pregnant woman through massages, helps her with movement and mobility, and provides different positions that help in the progress of labour. “I use various techniques of relaxation that help a pregnant woman cope better. I also take care of her basic needs and offer different comfort measures,” she added.
Agreeing with Dr Shenoy, Cavinder said that a doula helps the mother psychologically and physically through movement and mobility, which helps shorten the labour process and massages. “A doula guides them to focus on their breathing, ensures the mother is hydrated and eats properly as she needs energy for her labour.”
Emphasising the many ways an expecting or a new mother benefits from a doula, she said, “expectant and new mothers need a lot of support so that they are aware of every small detail that is beneficial for birthing, including breathing pattern, labour process etc. A doula is always there with the mothers from the start to the finish,” she said.
Dr Shenoy cited evidence showing that continuous support during labour improves outcomes for mothers and babies, including increased spontaneous vaginal births, shorten duration of labour, and decreased cesarean births. “Also, there is a reduction in the need for pain relief during labour. All of this translates into women having increased satisfaction with their birth experiences. I play a nurturing role and provide that physical and emotional support that every woman needs during labour and childbirth,” Dr Shenoy said.
A study, titled ‘Impact of Doulas on Healthy Birth Outcomes’, found that doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.
Dr Gayathri D Kamath, Senior Consultant, Obstetrics and Gynecology, Fortis Hospitals, Bannerghatta Road, Bangalore said that deciding whether or not one needs to hire a doula depends on the place where the baby is being born. “Having a supportive companion, who is a non-clinical entity, can boost the morale of a parturient. Women who have this kind of support are more likely to have a natural birth and less likely to ask for a c-section. These companions can be a husband, a good friend, or a family member other than her parents. In Indian society, mothers may not be good companions during birth because they feel sad seeing their daughters in pain. If a good supporting person is identified and trained during the antenatal period to be a companion or coach during birth, there may not be a need for a doula,” she said, on the need to hire a doula.
Apart from providing the much-needed physical support to women during and after their pregnancy, doulas also support them emotionally “through reassurance, motivation, and making them comfortable”, Cavinder said. “Sometimes, a partner is unable to support his pregnant wife in ways a wife needs and this is where a doula works as a team and makes sure that a mother is not left alone and provides informational support,” she said. Dr Shenoy concurred that providing emotional support is “a critical component” which involves encouragement and handholding through labour and childbirth.
Through his experience of hiring a doula for his wife, Devank found that a doula is not only for female support but a guiding counsel for men, too. “My lack of confidence was covered up by the expertise of a doula. It is quite beneficial for having the doula who can really connect, support and be trusting every second,” he said.
This emotional support, provided by a doula to a woman during these phases, is crucial as pregnancy indeed largely affects the psychology of the woman, Dr Jyoti Kapoor, Senior Psychiatrist and Founder, Manasthali said. “Appropriate emotional support during pregnancy and after must be considered essential. In recent times, post-partum depression has started gaining attention and people are taking it into consideration. However, many times the emotional assistance that comes from the family for the pregnant woman isn’t sufficient to deal with a turbulent emotional state. And, there comes the role of a doula who can professionally cater to the pregnant woman’s emotional needs, including assistance in physical support,” she said.
Agreeing, Dr Gauri Agarwal, Founder and Director, Seeds of Innocence, said that the role of doulas has evolved into that of essential physical and emotional support for women, with growing awareness. “People are now more informed about their needs and understand the importance of emotional and physical well-being. Since, doulas help throughout the journey of pregnancy, including labour, delivery, and postnatal care, the assistance empowers the pregnant woman to take conscious decisions about childbirth and postpartum care,” Dr Agarwal explained.
However, when hiring a doula, one must know the support that falls outside the purview of a doula. “As a birth doula, I do not give medical advice or diagnose medical conditions. I do not work clinical work such as internal checks, checking the baby’s heartbeat or doing any procedures,” Dr Shenoy said, with Cavinder adding that areas pertaining to medical or clinical intervention or advice are not in the scope of a doula.
As such, if you choose to hire a doula, ensure that they do not interfere with the clinical judgement of an obstetrician as the science and the safety behind the same is dealt with by an obstetrician, Dr Kamath explained. “Since the concept of doulas is not very popular in India barring some areas, when choosing one, make sure to be cautious to identify one with the right training and background. Doulas cannot conduct deliveries or address any clinical concerns and, hence, would have to liaise with a maternity unit to ensure a safe outcome,” she added.
As for training, there is currently no regulatory body for doula training in India with many independent bodies carrying out doula training outside the country. “Fernandez Foundation has recently collaborated with the University of Hyderabad, and we will soon be offering training for birth doulas. Doulas are non-medical professionals, and the basic prerequisite to becoming one is the passion for working and supporting pregnant couples on their journey to parenthood,” Dr Shenoy, who did her doula certification from DONA (Doulas of North America), said.
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