Friday, 4 March 2011

Homegrown doulas, great resources

Developing Doulas
This year, we celebrate Doula UK's 10th birthday and I have been reflecting on how many of the really great doula resources available to us now originate from the UK, as well as from around Europe. It is understandable that our first reaction when looking for a doula reference may previously have been to turn to our US sisters who set the precedent for the role of the modern doula, yet I am thinking that it could be time for UK doulas to mindfully keep their eyes wide open closer to home.

We have UK doulas blogging, speaking, building bridges with midwives, writing, running courses abroad, we have Maddie McMahon's Birth Hub, Nicola Goodall's Wysewomen, Paula Gallardo's Mamaheaven, Olivia Seck's Birthing Wisdom, the film Doula! and much more. A wealth of rich and relevant experience and exciting discourse to tap into at our finger tips! Not forgetting our links with our sisters in mainland Europe, the Doulas de France, the ongoing development of the European Doula Network and the doulas at Da-a-luz in Spain.

I say 'relevant' because my feeling is that the doula culture in any particular country must to a certain extent evolve in direct response to local midwifery practice. For example, in the UK midwives are autonomous professional practitioners and therefore it makes sense that doulas remain as lay workers; it somehow validates our role as the mother or couple's chosen support person, rather than presenting as a kind of para-professional which could suggest links to the maternity care system and its politics. In the US, where hospital midwives are much less autonomous, interestingly, the doula role is more professionalised and has been known to include undertaking vaginal examinations! The French doulas on the other hand are not permitted to support their clients in the absence of a midwife, for fear they are practising underground midwifery. Doulas can act as apprentices to lay midwives in Spain, where it is assumed that all women will give birth in hospital attended by obstetric nurses and doctors, but for the few who choose not to, attendants who have not completed any formal training are accepted. Conversely, many of us will be aware of the harrowing story of Agnes Gereb, the Hungarian obstetrician/midwife who was imprisoned for supporting mothers to birth at home, yet even in that country, doulas are gathering.
Debra's DVD

There is little doubt that we owe much to the US pioneers of the modern doula role, to Dana Raphael for reminding us of the Greek women who supported the mother so that she could breastfeed, to Ina May Gaskin for sharing her inspiring journey from doula to community midwife, to Penny Simkin and her founder colleagues at DONA International for establishing a premise for doula education and peer support , and to Debra Pascali Bonaro who continues to bring DONA's courses to the rest of the world today. However, it is clear that the American doula has her own way of working, her own guidelines and boundaries which can differ considerably from the way that doulas work elsewhere.

As one of my favourite North American sister bloggers Molly Remer of Talk Birth comments

"I hadn’t realized how ethnocentric my own perceptions were about the role and history of doulas and I previously assumed that the “doula movement” was essentially synonymous with the “doula profession in the US.” Not so!"


  1. Adela, thank you for this very encouraging account of doulas in the UK and Europe. It's in many respects heartening to see all that is happening here in the UK. I'm very much looking forward to reading your book on doulas and gaining further insight into the international variances of how we work.

    I feel very privileged to have experienced thus far in my doula journey some of the best that the UK has to offer. I began by attending Paramana Doula - both Michel and Liliana were nothing less than totally inspirational. Liliana's accounts of her doula work gave me the first foundation in how to be a doula. I am eternally grateful to her and Michel for helping me to find my calling and begin my journey. I've also enjoyed being mentored in the Doula UK recognition program and attending Wysewomen's challenging workshop on Ethics and Assertiveness.

    At the same time, I wonder if it isn't a danger to go to far in asserting our differences from our North American sisters? We have so much in common, and in my opinion, a lot to gain by collaborating and learning from them.

    Misconceptions abound as well, I believe. ALACE (now ToLabor) doula training did have student doulas perform VE's on each other in training - but my understanding (which comes from a doula who participated in this training) is that this was intended for the doula's own physiological knowledge, not for use on doula clients. There are also in North America 'monitrices' who have additional training and who are qualified to perform certain tasks like listening foetal heart tones and doing VE's.

    I agree that how we doulas perceive ourselves has evolved from our individual contexts in many respects - but I believe that much of the work we do goes beyond these contexts, thus Michel and Liliana's Paramana Doula works as well in London as it does in Brussels. We have so much to learn from each other. I hope doulas in the UK can open to this exchange.

    I personally intend to - not to take on every practice, but, with open heart and reflective intellect, learn and grow from what these doulas have to offer us.

  2. I totally agree that the American Doula Profession is a very limited view of the fuller role of the doula in birth.
    I learned vaginal exploration in my American traing almost 18 years ago. The training was intended for people going on to midwifery, but more importantly, this exercise was intended to both to faciliate a more tangible knowledge of something that will always remain a nebulous concept to doulas...the feel of a cervix, ischial spines, mobile coccyx, etc. It is also an exercise in being "doula-ed" and "doula-ing" someone through a potentially uncomfortable situation, giving real practice in understanding what our clients go through and how to assist them in becoming more comfortable. It also examines how comfortable we can be in the presence of another woman's privates, as doulas must always be able to mirror back complete approval of the sacredness of another woman's body. If shame or disgust arise in this exercise, this creates a perfect opportunity to explore our own emotional challenges. One cannot possibly learn how to check dilation by exploring a non labouring cervix, therefore the common fear that this knowledge will cause doulas to feel like it's their right to check their clients vaginally in labour is completely unfounded. The American fear that the vulva, vagina, perineum and cervix "belong" to the clinician, this idea expressed by rules stating that doulas should not being allowed to even place a warm wash cloth over a labouring woman's perineum if this is what she wants, even if the midwife or doctor are happy with that, shows that this perceived para-profession lives in fear of the eternal witch hunts. Not that any doula should perform a vaginal exam, as to do so is to "diagnose"..but to be paranoid about tending to a woman fully, like wiping her if she's soiled herself or guiding her to touch her fingers to her baby's emerging head if this is what she wishes, demonstrates fear of how we're perceived by Medicine and a need to "fit in" through sometimes self limiting compliance.

    While it's true we need to toe the line in terms of refraining from giving any kinds of diagnoses (as that is not within a doula's scope...we're all about the support), women tending to other women in intimate ways is at the root of a doula's role, and to clean it up so Medicine doesn't get mad at us and kick us out of the birthing room, perpetuates the whole "profession with restrictive rules" thing, which doesn't lend well to the fluid, nurturing, dynamic role of a doula.

    Doula trainings have also become very corporate, focusing very closely on scopes of practice and business plans. The doula training I promote includes apprenticeship in the spirit of the traditional way women learn. Giving someone a two day workshop then sending them off into the jaws of the beast without support is creating unprepared doulas who have to use defensiveness as a mechanism to protect themselves instead of learning wisdom and diplomacy through observation and receiving critical feedback. I am a hands on mentor, and teach other experienced doulas how to mentor.


  3. There are many paths to enlightenment, and all hold incredible value. The American approach has done wonderfully to promote the doula and provide the research stats, and for this I am immensely grateful. That structure has provided us with a foundation. But like birth, the role of the doula in incredibly dynamic, and every birth needs to be looked at and approached differently, not in a cookie cutter style. I have the blessing of having a huge and varied practice, which has allowed me to be present for the births of surrogate mothers, mothers adopting, lesbian mothers, mentally ill mothers, mothers having been exposed to intense and horrific sexual abuse and rape, mothers who experience cancer and other life threatening illnesses, mothers who have lost children, Muslim, Hasidic Jewish, and Christian mothers, mothers who have been left in late pregnancy by their partners, mothers in the throes of emotional abuse....rigid rules cannot always come into play in sensitive situations. Our relationships with our clients is so emotional and intimate and based on such trust. This, I feel is universal, not limited to any one kind of approach.

    As long as a doula makes no diagnoses, does not provide any kind of clinical advice, sways a woman from the recommendations of her caregiver based on her own bias, or assumes a clinical role, or antagonizes a primary caregiver, we are not that scary. Just because we are not clinicians and not checking a cervix does not mean we are not experts in knowing when a baby is coming or know intuitively what word medicine to use to help a woman through her fear, as "weird" as it may sound to outsiders.
    I believe this approach transcends local customs. As women we all give birth kinda the same way. Sure, rituals and customs may be different, but we all walk through that valley and having a loving female presence to anchor onto and to reassure and support the others present is one of the nicer ways to get through it. I believe the training I provide addresses the universality of women birthing. I am a North American doula, but do not ascribe to the typical American way of doula-ing, though I do honour them very much. It may work wondefully for them, but it doesn't for me. I am very much appreciative of the diversity UK doulas seem to support.
    Thanks for your wonderful, thought provoking post.

  4. I love this post and as a Canadian doula I don't feel any affinity to the current "American" style of doulaing or training. I mirror everything that Motherwit Doula has said here and agree that although some American organizations have up until now brought the doula profession to light they have since lost sight of the essence of the doula and are failing to educate new doulas enough to prepare them to work in the current climate of birth most notably in the hospital environment. An American based organization cannot train or support doulas in other countries when they are completely out of touch with them.

  5. I am so excited to see this post generating some discussion, thank you for your thoughts!

    I wanted to add that I so agree with the comments re the 'essence' of the doula being a timeless and indeed, global attribute. But I stand firm on my opinion that the localised, day to day ins and outs of being a doula are bound to be somewhat country specific.

    While the doula is constantly mindful of and responsive to what is (or is not) available to the mother and her family from her key childbirth carer, the midwife, this will surely vary considerably depending on which part of the world we work in?


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