Helpdesk: Doule on how to help a woman survive childbirth
pregnancy and childbirth - a topic surrounded by a huge number of myths, and positive, and sharply negative. As a result, pregnant women are often either very frightened, or, conversely, inspired, and for many of them, childbirth turns out to be an unexpected traumatic experience. This year’s flashmob # violence_in_spring showed another problem: women in labor often face violence and humiliation at the moment when they are most vulnerable. Communication with the medical staff is sometimes difficult, and not only through the fault of women, but giving birth in addition to pain can be accompanied by feelings of fear, disorientation and loneliness. So, of course, there should not be - and one of those who seeks to facilitate this experience and support a woman in labor is doula: a professional assistant who is present during childbirth and provides psychological support to a woman.
The doula profession implies only non-medical participation in childbirth: it does not have the right to give the woman medical advice, advice about medications and make decisions for her about the future course of labor. At the same time, in Russia, attitudes toward doula are rather wary: sometimes they call themselves doules and those who interfere with the actions of doctors or even take their own births at home, sometimes with tragic consequences. We talked to Doulay and Mentor Birthing from within Daria Utkina about the profession of doula and its boundaries, maternity hospitals and medical staff and how to make childbirth as comfortable as possible for a woman.
What scare "standard" childbirth in Russia
Now several events have coincided. Flashmob #JANE I am afraidTesay was the first situation when women began to publicly talk about violence, including in childbirth. I remember that I was surprised when my post about traumatic labor on the page of Très bébé on Facebook collected 300 likes, 168 reposts and became the most popular thing I wrote about. More and more women are becoming aware of their rights to respect, in any place, whether it is their favorite job or the doctor’s office of the antenatal clinic, and they are not afraid to talk about it. Plus, over the past twenty years, access to information has become as simple as possible, and it is easy to see how routine birth management practices often do not even comply with the basic WHO recommendations.
A maternity hospital is very different, and the problem with humiliation is not only that a particular person behaves rudely. The question is also in the obstetric system. It is designed in such a way that physicians burn out emotionally, and additional support for women in most cities is simply not available. Even in Moscow, free partner childbirth, for which a woman has a legal right, in most maternity hospitals remain only on paper. In other cities this is even more difficult.
In Moscow maternity hospitals, of course, there are few chances in 2016 to stumble upon outright dirt, devastation, or completely outdated equipment. Although the differences in the capabilities of maternity hospitals are quite noticeable. There are many options for childbirth in Moscow: free of charge under the CHI, under contract, with an individual midwife, with doula, with a partner, with a personal doctor, in a ward with a bath, or in a family postpartum ward, where a partner can live. In the province, the smaller the city, the fewer options. In most small towns, there is only childbirth by CHI and the opportunity to “negotiate” with a doctor, that is, to give him a bribe for a more “individual” approach, without signing any papers with the obligations of the parties.
Why women in labor face aggression
Often the feelings that a woman experiences during pregnancy and childbirth, in antenatal clinics and in the maternity hospital depreciate, and the productive dialogue between the woman and the medical staff fails. The fact is that in consultations a pregnant woman is given fifteen minutes, and during this time the doctor fills a bunch of pieces of paper (because sometimes he does not have a midwife to help), measures weight and pressure, but does not have time to give answers to questions of the pregnant and convince her of the need for appointments. For refusal from ultrasound or tests of this doctor will then blame the authorities. It is possible to intimidate or crush with authority quickly and effectively, but one hundred times to explain why a woman with high pressure and “front sights” should immediately call an ambulance right now is sometimes more difficult.
In general, this constant fear of what will be scolded - both by the authorities, patients and even colleagues - contributes little to confidential and open relationships. Any innovation, be it at least a hundred times proved by medical research, can be a problem. Complaints to the Ministry of Health and the prosecutor's office from patients and colleagues, who need to be dealt with, sudden inspections are the standard of living for many head physicians, and against this background, all who decide to listen to the needs of a woman are real heroes.
There are no prescribed protocols in Russia, for example, vertical births, and many doctors have never seen them in their lives. When a mother comes to them and demands to take her baby on all fours, it’s scary because you have to take responsibility for what you don’t know how to do. And it is quite reasonable to refuse such an offer, and where to learn this is not clear to everyone.
Doctors work in the mode of twenty to forty births for the day and year meet with very different women. Most of them did not attend courses for pregnant women, did not know anything about childbirth, were very afraid and completely alone. They are hurt, scared and want support, but the midwife and the doctor cannot stay with one mom, because several others are waiting for their medical participation nearby. Therefore, it is easier to take a detached position, to see the "expulsion of the fetus", and not the moment of birth of the child. This is a normal defense mechanism of the psyche under chronic stress. At a meeting with the doctors of a Moscow maternity hospital, when we talked about what a doula actually does, one of the doctors said: "And we? We also need our own doula." And it is true.
This does not justify the rudeness and violence with which women in childbirth are met - it is important to talk about them, as much as possible and louder, without hiding. But it is important to see and hear the other side too. Because cooperation is possible where there is mutual respect.
About birth abroad
In Western medical practice, violence against women in childbirth also occurs, and the term "birth rape" - "violence in childbirth" - appeared in America. In general, obstetric practices in the twentieth century reflect so much the attitude towards women in society that they deserve a separate study. I like the monograph by Rebecca Dolls, where there is a lot of talk about how culture influences the attitude to the female body during pregnancy.
Of course, many things that are considered something obvious in Europe and America, in Russia, still need to be specially organized for themselves. For example, in other countries, no one makes an enema and shaving anymore, and all family members, including young children and close friends, can attend childbirth. You can bring your own clothes and your own food, and you don’t need to sign the permission of the head physician to give birth to a partner - this is a woman’s right, and no one can forbid her to do so.
About doulah
The official version says: Doula is a woman who provides continuous physical, emotional and informational support for mothers before, during and after childbirth. Most professional doles are certified sooner or later, which includes learning offline and online, which takes from a few months to a couple of years. But many become douloy simply because there is a woman who asks them to be near in labor and she does not care how many certificates this woman has because she is warm and calm next to her.
Between ourselves, we sometimes say that our job is “to keep space”. Doula knows how to create an atmosphere in which childbirth will be easier, and this is confirmed by research. Doules come from different spheres: my journey began from clinical psychology, and for someone it is yoga, massage, or just my own childbirth experience. The experience of childbirth is not obligatory, although for most dole it is he who becomes the beginning of the path to the profession. More important here is the ability to empathize, the ability to trust and love for women, babies and childbirth. As in any living profession, learning never ends: there is always something else that I want to add to my skills.
When it comes to doulah, a chain usually arises right away: home birth, natural parenthood, anti-vaccination. In fact, doules work with very different families - there are those who are planning to give birth with epidural anesthesia, give birth with a planned caesarean section, or start working in the first six months after birth - and rely on the principles of evidence-based medicine. There are many more combinations, and I am in favor of my parents having a conscious choice.
My job is not to give universal recommendations on how to be a "good mom" or a "good dad." I always try to create a space in which parents will discover their strengths and find support on the path of global changes in their lives - after all, because they have to continue to live with the child, so it would be good to understand how this life can be organized. Someone needs a lot of reliable information for this, someone needs acceptance and support, and someone just a place and time to dive into the topic. My task is to see what will be important for this family and this woman.
About the difference between doula and midwives
The midwife is a medic, and she is responsible for the medical outcome of the birth. Doula does not diagnose, does not prescribe medications and usually does not have a medical education. Although I know several doles who were originally obstetrician gynecologists or midwives, but consciously decided to focus on non-medical support during labor. If we talk about the midwife of the maternity hospital, then in addition to one unfamiliar woman, she usually has twenty to forty new mothers a day. An individual midwife pays all attention to one mom. Nevertheless, many Moscow midwives have already appreciated the advantages of childbirth in the presence of doula, because it is more comfortable and quieter for everyone.
The task of the doula is to support a woman at any stage of labor, whatever they are from a medical point of view. In childbirth, there are usually times when a woman needs psychological support, and they do not always coincide with medically difficult situations.
In 2016, the Association of Professional Doles appeared. We are united by the observance of the ethical code and the boundaries of the competence of the doula, as well as the ardent desire to make humane labor accessible to any woman in Russia, regardless of her income and social status. In the maternity hospital you can recognize us by a special badge. Professional doula complies with the ethical code and is ready to answer questions from pregnant women. However, a professional doula is not equally suitable for all or just you: apart from the basic standards of the profession, it is important that you and doula have mutual sympathy and trust. This is usually a question of the first minutes of intercourse, and it's great to meet with a few dowels to figure out.
About the dialogue between doula and doctors
Doula is a relatively new phenomenon for Russia. On the one hand, this person should morally help a woman during childbirth, and on the other hand, should act as a mediator between her and the hospital doctors. Such a dialogue is not always easy to establish, there are different cases. A doctor recently told my colleague at an expensive Moscow maternity hospital right from the doorway that “she’s not working with crazy people.” Fortunately, the bosses of the doctor held a different opinion and the conflict was resolved, but, of course, "the sediment remained."
At the same time, I can understand doctors: sometimes daulae call themselves childbirth assistants, who give women medical advice, actively conflict with doctors, "protecting" a woman and discrediting the doula profession. After such birth, doctors are straining from the idea that a woman will give birth with someone other than a partner. If the doctor is lucky to meet the usual professional doula, then the dialogue is adjusted rather quickly. Doula helps a woman to safely and confidently live childbirth, and the doctor and midwife perform the medical part of the work, not worrying that the mother in the delivery room is torn in agony without support, which is simply no one to give, because a dozen more women give birth to it.
Doules in other cities, especially where there are two or three maternity hospitals, are completely dependent on the will of the head physician. If a person comes across a soul and a desire to make contact, there will be cooperation. And do not like doule - everything, no maintenance of childbirth. Often, when Doula comes to the hospital as a girlfriend or sister of the woman in labor, the doctors are satisfied and say: "To all such friends." But it is worth the same woman to come to the head physician and tell about her work, as a lot of obstacles immediately arise.
In Krasnoyarsk, it was forbidden to take anyone besides her husband into childbirth after one incident: at the birth, which ended in the maternity hospital, a house midwife was called doulaya - a scandal occurred. And in Ufa, for example, doula and maternity hospital actively cooperate, because both women and doctors see this as a benefit.
How to choose a hospital
A study was conducted in which they found that four factors most influenced a woman’s satisfaction with her childbirth experience: the woman’s own expectations, the level of support from the staff, the quality of relationships with the staff, and the woman’s involvement in decision-making. It turned out that these factors play such an important role that their impact on the assessment of women's experience outweighs the influence of such factors as age, socioeconomic status, ethnicity, preparation for childbirth, physical environment, pain, immobility, medical interventions and duration of medical care.
For a start, you should decide on your priorities in childbirth, and then choose the maternity hospital in accordance with your preferences. But it happens that the choice of a particular doctor is more important than a maternity hospital, because, whatever the maternity hospital, all the employees in it are different. And even in the most humane place you can meet people who will behave unexpectedly. Unfortunately, you can choose a doctor only by contract. And in the format of childbirth by OMS, one can only hope for good luck and choose a maternity hospital where they massively support the principles of healthy childbirth and follow the recommendations of WHO. Often, such maternity hospitals have the name “Baby Friendly Hospital” - this is a certificate issued by WHO and UNICEF.
Now in many maternity hospitals in Moscow there are open days, and this is a good opportunity to meet with the doctors and feel the atmosphere of the clinic. Sometimes the little nuances of the situation speak about the attitude towards women more than words. No toilet paper and soap, dirty and dark in the corridors, no chairs and water cooler? Perhaps they are accustomed to the Spartan conditions - are they suitable for you? There is a list of questions that you can discuss with your doctor before childbirth or ask some of them at the open door. Just do not rely only on reviews on the Internet. Most often they are obsolete and not very accurate.
How to minimize negative experience
You can focus on the four factors of satisfaction with childbirth listed above: what are your expectations from childbirth? It would be nice to imagine the process and conditions in which everything will happen, in some detail and to be ready that not all expectations will coincide with reality. Courses for pregnant women can be a good support if this is a place where they help you prepare for the unexpected in childbirth, give practice to work with pain and teach you to have a dialogue with your doctor. But the courses, where they talk about one "good" version of childbirth and all the other "wrong" ones, are the beginning of the path to traumatic events in the maternity hospital. Hard expectations are fraught with great disappointment and a catastrophic mismatch between the ideal and the real picture. Whatever courses you take, they will not replace support in the process of childbirth, but can help you navigate the options and choose the best one for you.
The ability to see a person in a doctor, and not just the medical staff, is very helpful in making contact. The ability to talk about their desires - too. And smile, self-confidence and politeness work - but how many women can remain so at the time of delivery? I often see how attitudes toward birth change, when parents understand how this process occurs. And then it becomes clearer why it makes sense to do everything possible to have a kind of support, to be in a comfortable atmosphere with familiar people. And I’m talking not only about the support of the doula, but about all the possible ways to make the birth space a safe place. Knowing your doctor, midwife, being close to your loved ones at the time of childbirth are all basic things that influence the process.
cover: Tootles - stock.adobe.com
