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Why it takes so much more than just hiring a doula to have a good birth

 

As we hear more and more about doulas, it’s easy to get the impression that having a doula will somehow magically lead to having a better birth experience. It often feels like one of the things on the ‘positive birth’ checklist; hire a doula, do a hypnobirthing class, read a birth book etc. and it’s true that having a doula can significantly reduce the risk of interventions and birth trauma, but that is largely due to the work that a woman does with her doula, and by herself, during pregnancy.

What we have learnt from women

Through our years of working as doulas in Greater Manchester, we have come to realise that birthing within the maternity system can and often will come with complications, barriers and difficulties. One of the best ways to combat these hurdles is to know what’s coming. Knowing how the maternity service works and knowing their policies gives you a head-start and also shows you that there are other options, such as birthing outside of the system. Knowing your rights and your options are the first steps to having a positive birth. A doula can support you in learning all of this, provide you with information and books on the subject, they can give you information about how the system works and how you can navigate it, and tell you all about the birth process, but it takes you to make the difference. 

Women who have had a traumatic birth in the past often come to us believing that their body failed them and that they need to do something different this time. Hiring a doula is a great start because it gives them the space to talk openly about what happened last time, a place to wonder whether those things were necessary or completely unacceptable, a place to cry and ask questions. Once women learn and start to believe that the process of birth is not inherently dangerous, and is not a medical event, it leads to an awakening that is incomparable. Getting to this point though takes a whole load of courage and openness from that woman, and when that woman is heard, she can find the answers she’s been looking for. So many of the women we listen to were having a perfectly normal, healthy pregnancy and labour until it was interfered with by medical staff, and realising that sometimes complications in birth are caused by the interference is key to protecting themselves against it. Their body did not fail them, the system did.

We have been programmed to think that authority means safety, but in so many instances we have been proven that in fact, the opposite is the case. When we trust someone else’s word over our own feelings of discomfort, we are left feeling violated. When we look to someone else for the answers, especially in birth, we are handing over our control and ignoring our intuition. We often hear in women’s stories that the parts that felt the most traumatic are when they went against what their body was telling them, and just did what they were told – so far I haven’t met a woman who regretted following her body. Our intuition is what has kept us alive and safe for so long, and birth is such a private and personal event that it makes very little sense to look for external approval or guidance. When we trust women, birth is safe. A doula is often the only person in the birth room who is solely focused on you, as the birthing woman, and having someone who completely believes and trusts in your body at that moment can make a huge difference to the energy. Questioning the authority of medical staff is necessary to get the birth you want, because going with someone else’s flow will inevitably lead you down a path that makes you uncomfortable or feels wrong. You ARE the authority, and you DO know best, even if you have never birthed before. Birth is a hormonal event and a normal bodily function – if you were monitored, observed and examined whilst trying to have an orgasm it probably wouldn’t go very well, would it?

Birth is led by the hormone oxytocin – as are orgasms – and for oxytocin to be released it needs the right environment. For women to release oxytocin they need to feel safe, warm, unobserved and undisturbed, so when you put a labouring woman in a brightly lit hospital with a bunch of strangers, unfamiliar loud noises and smells, and continue disturbing her with monitoring and examinations, it’s no surprise that birth takes longer or is more difficult. When birth is undisturbed, endorphins are released to match the intensity of labour as it builds – this is what makes labour pain manageable. When we interfere with the body’s natural pain killers, we cause more harm than good. Understanding what birth needs is a great foundation for planning where you want to give birth, and who you want to be there. Doulas can be really helpful in supporting you to navigate the maternity system when you are “going against medical advice” or just declining what you are being told is “how they do things”.

What we wish women knew before giving birth

We wish that all women knew that they were in charge of their body and their birth, that they didn’t have to agree to anything that feels uncomfortable or compromise with medical staff. We wish that women knew that birth doesn’t need to be fixed or monitored or sped-up and that they have the right to say no or to seek the care they are not being offered. We wish that women who have had traumatic experiences knew that they were not alone and that what happened to them was not okay. We wish that women weren’t expected to be “good girls” and do what they are told even when it feels wrong and that it’s okay to be “difficult” or “bossy” – in fact, that shows a belief in yourself, and the ability to assert your boundaries!

The work we do is to create the space for women to ask questions, to speak up and use their voice, to take what they need and to take back their power. We listen to women’s traumatic birth stories, we help them to write birth plans, we share information and experiences, we are behind them when they are navigating the system, or choosing to birth outside of it, and we have that unwavering trust in the birth process and in the woman in front of us. 

We support their choices, we hear their voices and we are privileged enough to witness their power.

But ultimately, what makes a positive birth is a woman who is ready to go deeper, to question what she is being told, and is fully supported in her decisions.

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Bodily autonomy and the information we are not given

This post is sparked by my personal experience (it’s Amy here, in case my hilarious t-shirt below didn’t give that away) and also from listening to women talk about their journeys with contraception.
 
Grab yourself a brew (and maybe some biscuits) because this is a long, winding road to a very broad but important point – bare with me.
 
 
Let’s talk about contraception (and information and consent and bodily autonomy… because it’s all part of the same point)
 
Being doulas, you might think that the topic of contraception is a little out of our remit but (as I have so succinctly concluded in the subtitle) that is not the case.
 
As doulas and feminists, we respect every woman’s right to choose what is right for her body, so naturally, the topic of being informed and choices being respected is at the very core of what we believe in. Also, being full-spectrum doulas we support women before they are pregnant and long after they give birth so it does come up a fair bit.
 
 
Let’s start with sex education
Way back in school (Elle would like to point out that it wasn’t that long ago for me), we were only ever told about two or three methods of contraception. We learnt a bit about the pill, maybe a bit on the injection and of course, everyone remembers the demonstration of how to put a condom on a cucumber or banana or any other object that doesn’t look like a real penis so that the teacher doesn’t get embarrassed. I’m guessing it wasn’t all that different for you? But this isn’t enough. If you’re going to teach young people about sex and contraception, you have to tell them all of their options and what each one entails. For example, I don’t remember anyone telling us in school that the longer you are on the pill, the longer it could take to get pregnant once you stop taking it. This might seem like a very way-in-the-future conversation to have with children, but who else is going to tell us that? Especially considering lots of women go on the pill from a very young age. “Wouldn’t that be the healthcare professionals job?” I hear you ask… the answer is yes, it definitely is, but that doesn’t mean that they will fulfil that expectation. The other HUGE gap (or if talked about at all, misrepresentation) in sex education is birth, but that’s a whole other rant.
 
My personal experience with contraception
Over a period of about four years, I tried two different types of the pill and the injection before deciding to have a detox because the hormones were having a very negative effect on my mental health. The side-effects are different for everyone but the general consensus of women I have spoken to is that there is at least one pretty rough down-side to every hormonal contraception option.
 
Condoms were the only other option (that I knew of) – our readily available, non-hormonal, trusty, 98% effective friend. However, it took one of these trusty little guys to split for me to end up seeking emergency contraception. For me (and many women have a much worse time of it), that meant I had to wait about 4 hours at a walk-in clinic (feeling alone and nervous), complete an incredibly personal face-to-face questionnaire and brush off several judgemental ‘I don’t believe you’ looks, for someone to finally tell me about the copper coil! I listened intently as they told me how it was hormone-free, had very few side-effects, could stay in for 5 years (some stay in for 10!) but can be removed any time I want, it doesn’t stall fertility after removal, and it is more than 99% effective…
 
 
…SHUT THE FRIDGE!!
 
Why in the hell had nobody taught me about this option before?! I had suffered through years of hormones messing with my brain, my skin, my personality. I got it fitted that day and four years later have not regretted it once. Now, it sounds like I’m just trying to sell you all on the copper coil, that is not my intention. It works for me and I love that, but the point of my rant is…
 
Why did it take so long for someone to tell me all of my options? Who decides which methods of contraception are offered to us first? If we are born into a religion that believes abstinence is the only way – where do we get the information to decide for ourselves? If our parents decide that sex is too difficult a topic and tick the opt-out box on the sex education form, where do we learn about our body and the changes we are going to go through? Why should other people get to decide what information we get about puberty, sex and contraception? It’s the first step towards bodily autonomy and nobody wants to talk about it! Maybe because bodily autonomy isn’t something that society wants us to have. Working as a doula has taught me that.
 
This power play continues throughout our lives, with anything to do with women’s bodies from contraception, boundaries, birth and beyond.
 
(Sorry, it took me a while to get to the point! Have another biscuit…)
 
From a friends experience
A few years ago, before I was no longer shocked by the controls put on women and their bodies, my friend was seeking the morning after pill at a pharmacy. She had gone to the only pharmacy open that Sunday morning, she steeled herself, walked up to the desk in the not-so-private supermarket aisle where the pharmacy is located and told the pharmacist what she wanted to purchase. There was no medical reason for her to be unable to access the morning-after pill, but the pharmacist said no. He said that he could not dispense the pill because of his personal beliefs.
 
 
I couldn’t believe this was legal, especially with something as time-sensitive as the morning-after pill. I furiously googled it and found that yep, apparently, pharmacists have an opt-out clause which gives them the power to inflict their personal views onto others, potentially causing an unwanted pregnancy. Technically, if a pharmacist exercises this ridiculous clause, they are supposed to offer an alternative, but what good is that on a Sunday when nowhere nearby is open and the customer can’t drive? That’s a pretty risky clause to have, don’t you think?
 
So I have a few questions; would a doctor who is a Jehovah’s witness have a clause to opt-out of giving a life-saving blood transfusion because of her/his personal beliefs? Does a doctor who is Jewish have an opt-in clause to enforce circumcision on all babies because of his/her own beliefs? Is the opt-out clause used for anything other than emergency contraception, or is it a clause solely to deny women the right to decide whether or not to have a baby?
 
Now I am wiser I know that actually, professionals impose their personal opinions on women all the time, it’s just usually less obvious. For example, during pregnancy when something is offered to you (because it is just an offer, even if it doesn’t come across that way), that midwife or doctor should be giving you ALL of the information, the risks, benefits and alternatives, for you to make an informed decision about your care. This very rarely happens, and what we can assume from this is that the person giving you the partial information is deciding, based on their personal views, which information is more important for you to know, and what can be left out. This does NOT equal informed consent. 
 
The patriarchal society that we live in has assumed that women’s bodies, and the decisions women make about those bodies, are to be monitored and controlled. Constant protesting of abortion, the hoops we have to jump through to access all types of contraception, the scare-tactics used in pregnancy and the birth room – it is all about controlling women. Strong, independent women who are able to make informed decisions and stand their ground are a threat to that control. Information is power, and withholding information (or more directly, actual medical care such as the morning-after pill), is to take away a woman’s power.
If we take away a woman’s control of her own body, we are telling her that she is not important and that her body is not hers to be in control of.
 
What does this teach young girls and women about consent? What does it teach us about boundaries? What does it teach us about our power?
 
(and yours too, if you want us to!)
 
 
 
 
 
Resources related to this post:
 
– The most recent changes I found on the opt-out clause (2017):
 
– The Lloyd’s Pharmacy article:
 
– Some fascinating for and against comments from pharmacists about the opt-out clause:
 
– The NHS contraception guide:
 
– Info on the copper coil (IUD):
fight sexism grafiti
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Dear wolf-whistler…

Dear wolf-whistler,

First of all, you’re an absolute wanker.

Here’s how it went from my point of view, in case you give a shit;

I went outside to put my cardboard recycling in the blue bin, as soon as I opened my door there you both were, hanging out of your car and staring at me like fucking vultures. I know we’re in lockdown and you probably haven’t seen another person for weeks, but that is not an excuse. I’m instantly uncomfortable and have put my defences up in case you decide you need more than just something to look at. I put my cardboard in the bin and walked back around to my front door, which is when you decided to wolf-whistle at me.

Here is why I don’t appreciate your staring and wolf-whistling;

I am not an object for you to gawp at just because you have fuck-all better to do with your time. You intimidate me by staring like that – which is probably what gives you a little buzz. Wolf-whistling is NOT a compliment, it does NOT make me feel all warm and fuzzy because, believe it or not (and I know this is a tough one to comprehend), I get my worth from me, NOT from twats like you.

Now, let me explain to you the effect that your actions have;

I hurried back inside and slammed the door, I hoped that it would show you that I was angry because I couldn’t put it into words to say to you, but in reality, you probably just thought it was funny. My heart is hammering, not because you wooed me with your charms contrary to what you think, but because you made me feel intimidated, scared and angry. I had another bag of recycling to take out, but that will have to wait now because the last thing I want to do is go back outside and be objectified AGAIN. So I’m hiding in my flat, full of rage. Is that what you expected to happen? Is that what you wanted to happen? Did you think of how I might feel before you acted? Did you fuck. You are a disgusting human. You can’t possibly comprehend the horrible effect your actions have on women, so I have no doubt that you’ll continue to do it, thinking it’s completely harmless. The sad thing is that you were probably looking for a reaction, and if I’d have said all of this to your face, you would have laughed it off and ignored it. I didn’t say anything, but even if I had the outcome probably would have been the same – you’d still be an ignorant man.

If you take anything from what I write (which I’m sure you won’t because you’re probably not the one reading this), let it be this;

I do not exist to be objectified by you
I do not want or need your whistles of “approval”
Your actions have consequences
Stop being a misogynistic twat

Pissed-off regards,

Amy

(the human being whose feelings you couldn’t give a fuck about, but whose ass you clearly took a fancy to)