Doula in Sitges
Could you define for our readers the definition of a doula and the services a doula offers women?
A doula is a woman who provides emotional and physical support to women and their families before, during and after birth. As birth is such a special but often challenging time for women and their families a doula can help support in many ways. During labour, the doula’s presence is a source of compassion and strength for the birthing woman, offering her comfort measures for the intense sensations of the contractions, and providing support and suggestions for the partner as well. Doulas help mothers to feel that they are birthing well and that they can continue even when it is hard.
Prenatally, doulas help mothers and their families to find out about practices and procedures, and assist in acquiring the information necessary to make decisions with confidence. After the birth, the doula can help the mother and the baby establish breastfeeding and help ensure that the bonding period is respected.
Doulas also advocate for their client's wishes as expressed in her birth plan during labour by encouraging her client to ask questions of her caregiver and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if and when the need arises, and tries to enhance the communication between client and caregiver.
However, doulas do not “prescribe” treatment, nor do they perform clinical or medical tasks, which are left to the midwife or gynaecologist. Although doulas do have an advocacy role, they do not making decisions for the client. It is best described as support, information, and mediation.
What percentage of your clients is from the international community?
I would say that at least half of my clients are from the international community. I think they see my name on the doula list and know that I am going to be able to speak English. Women from the international community have told me that they feel confident with me because I speak both Spanish and Catalan fluently and I have worked as a doula, lactation consultant, and pre and postnatal yoga teacher here in the Barcelona region for nearly 20 years. In the last few years I have worked with women from all over the world who have made Spain their home. Recently I have worked with Korean, Irish, English, American, Norwegian, and Argentinean, Columbian, as well as Spanish and Catalan women.
Why do they choose to work with a doula?
Currently in Catalonia, most women birth in a hospital, attended by a midwife. An obstetrician is present but only intervenes if there is a medical necessity. Often the mother meets her birth team upon admission. Hospital protocol generally allows for only one person to be with the birthing women, thus, in the great majority of births it is the father or partner and not a doula that is accompanying the mother. The trouble with this scenario is that the midwife is usually attending several births at the same time and is busy with clinical and medical tasks, and the father is often not prepared to offer the kind of labour support that provides the above noted benefits of doula support. As a result, more women are asking for the hospital protocol to be waived in order to have both the partner and the doula present, especially since the doula and the mother have established a close rapport prenatally. Although it is not as frequent here in Spain, some women choose to give birth at home. Generally speaking, homebirth is a good choice for families looking for a more conscious and relaxed birth setting and can be an emotionally fulfilling experience for the parents. A doula can be a great help in these circumstances. She is generally available to come to the woman’s home well before the midwife arrives, and as well as being a calm and compassionate presence, and assisting with non-medical tasks, she often makes meals, takes care of other children, and cleans up afterwards. Regardless of where a she has her baby, when a doula assists a woman through childbirth, her satisfaction with the birth experience and her self-esteem is elevated.
How do people go about finding a doula, and how do they know if they are fully qualified?
When looking for a potential doula, I suggest you look for someone with training and experience, but also someone with whom you feel comfortable and have the feeling you will be safe with her. Although a doula should have completed a comprehensive training course, including training in labour support, childbirth education, breastfeeding support, the most important thing is her presence and ability to transmit calm, strength and inner wisdom. It wouldn’t hurt to ask a potential doula for positive evaluations and referrals from previous clients and health care providers. The best doulas are always continuing their education.
Are there any associations for doulas in Catalunya or Spain?
Although there is currently no specific Spanish certification process for doulas, there are several groups that offer training and support here in Barcelona, namely, Doulas Barcelona, Mares Doules, Doulas Con-Ciencia, as well as a new training program offered by Mare Nostrum. Certification is currently offered through international programs such as DONA International. With so many groups, we are in the early stages of consolidating, and have recently formed Association: La asociación Española de Doulas.
When you first got involved in childbirth support, what did you aspire to provide for women and has this changed?
Before I moved to Spain I lived in a part of Northern California where home birth and natural birth were the norm. I naively thought that it was global. (I have since learned that it was rare even for California) So when I got to Barcelona I was in for a big surprise, expecting women who wanted natural and home births to come to my prenatal classes, and it turned out that only a small percentage were even aware that this was a possibility. I was shocked to discover that there was very little by way of natural birth movement, and what there was, was considered by mainstream hospitals to be radical and even dangerous. Hospital birth protocol did not follow evidence-based birth practices for normal labour; instead they consistently used many unnecessary medical interventions meant to treat exclusively pathological conditions on healthy normal births. Unfortunately, the tide is slow to turn. This meant and continues to means many unnecessary caesareans, episiotomies, deliveries with forceps or vacuum extraction, and a plethora of other unnecessary interventions. Many women I have spoken with feel traumatized by their births experiences, and I found that there was virtually no support for these women, and women wanting to birth using their bodies naturally. So, although I love having natural and homebirth women in my prenatal classes, I have adapted my approach to help women have the birth experience they want. All women want to be respected and treated well, regardless of the setting.
What advice would you give to women from the International Community who are preparing to have a baby in Catalunya?
I always tell women they should put themselves on a sliding scale with the one side representing au naturel i.e. Preference for no interventions (picture a woman birthing unassisted in a teepee in the mountains with only her partner) and on the other side super medicalized (picture a women saying put me under, cut me open and wake me up when the babe is in my arms). If you find yourself leaning even slightly toward a natural approach you will need to pro-actively find this kind of care here. It is available, but not readily so. There is a lot of lip service about letting a woman has the birth that she wants, but the reality is that this just isn’t the case in many hospitals.
How do you feel about using pain medication during labour?
My personal feelings about pain medication are somewhat irrelevant since my main interest is to help women have a safe and respectful birth, not to choose how they birth. The presence of a doula can be beneficial no matter what type of birth you are planning. For women who know they want a medicated birth the doula still provides emotional support, information and comfort measures and help understanding procedures and possible side effects, since rarely does medication take all of the discomfort away. Many women find they need less pain medication than they had expected because of the constant presence of a doula.
That said I truly encourage women to approach childbirth with an open attitude. The inner strength, courage, and wisdom that a woman taps into during uninhibited labour are of paramount value to herself as a woman and as a mother. The euphoria that accompanies un-medicated birth is one of the greatest experiences a woman can have. It is also one of the greatest secrets. Not many people are talking about it. Yet if you ask women who have experienced it, they will tell you how wonderful birthing is. You have to ask yourself, Why not go for it?
What labour coping techniques do you like to use?
The labour coping techniques I teach in my prenatal yoga and birth preparation classes consist largely in learning/remembering how to move and adapt to the uncomfortable and intense sensations of our body in labour. We have a huge array of movements, breathing responses, sounds, touch and relaxation responses that we can use in labour. These tend to be very spontaneous and sensual in women who are free to move and change positions, but it is great to have some practice with them before labour begins. In my partners workshops we spend a great deal of time talking about the role of the partner in birth; specifically helping them to feel at ease in their role as a calm protective presence, and as a spokesperson for the birthing woman.
I also teach partners non-verbal communication techniques, mirroring techniques, massage, and birth positions.
What is your opinion of the pre- and post-birth services for women in Catalunya?
Fortunately, pre- and post- birth services are getting better. This is a response to the growing demand for these services. I would like to see more available through public services, but at least there is a growing list of services available. As a society, Spain, or at least Catalonia is becoming more conscious. I have recently put together a comprehensive list for Sitges and Barcelona, in Spanish and English of A-Z resources for my clients, which is available on my website www.pregnancysitges.com and I’m always interested in expanding and updating my list.
There has been concern about the number of Caesareans performed in Spain – do you think the concern is justified?
I do think that concern is justified, but there is good news too. The World Health Organization states that no country should have a rate of caesareans over 10 -15 percent. According to the platform, El Parto Es Nuestro, until 2007 the rate of caesareans in Spain rose steadily to a full 25 percent in public hospitals and up to scandalous 42 percent (58 % in one particular clinic) in the private sector as recently as 2008. There is however, some reason for hope because since 2008, the combined rate has dropped and at last count hovered around 17 percent. But before we get all excited about these lowered rates, understand that they seem to correspond with a rise in instrumentated births with forceps, vacuum and episiotomy, and this is not be a win-win situation –we’re not after a vaginal birth at all costs. What we hope to see are these rates continuing to drop as the hospitals update obsolete protocols and follow evidence-based practices as outlined in the “la Guía de Práctica Clínica sobre el Parto Normal” del Ministerio de Sanidad which was published in 2010.
What percentage of mothers opt for a natural and/or home births?
Unlike Holland, Germany or the UK, homebirth is not covered by social security system in Spain. Here about 2,000 babies are born at home annually, less than 1% of all births, but this number is slowly rising, especially here in Catalonia where the demand for homebirth midwives is quite a bit higher than in other communities.
If a mother opts for a home birth do you deliver the baby or do you work alongside a midwife? If so do you have specific midwifes with whom you work?
I am DONA international certified doula, I belonging to the Spanish Association of doulas, Barcelona doulas, and I have done extensive training with the original group of Mares Doules, all of whom have similar standards of practice, which limit the scope of what we do and don’t do. Therefore, I always work alongside a midwife or a doctor who are responsible for the safe passage of mother and baby, and while I have training in emergency care I don’t do clinical or medical procedures. I appreciate working along side caring professionals so that I am free to do my job of attending to the emotional and practical needs of the mother. I have “caught” the baby twice; and both times were magical moments that I will always treasure as favourite memories. Both times were completely unexpected and happened so quickly that there was no time to do anything but act. One was a planned homebirth and the doctor didn’t get there in time, and it was an experience that “made me a doula”. The second was a planned hospital birth turned homebirth, --the baby came minutes after I arrived. Precious! Luckily, when birth is so quick like that it tends to be pretty trauma free.
How do you help mothers after the birth? Do you feel there is adequate support for mothers in terms of caring for the baby and breastfeeding?
Directly after birth, I help assure the mother/baby pair can have skin-to-skin contact and are not separated unless there is a medical necessity. In this way they can just get on with bonding with the partner close by and other siblings if that is appropriate. If circumstances require a caesarean, I help advocate for Kangaroo Care, which essentially means skin-to-skin contact with the father/partner while the mother is in post-op recovery. I help establish breast-feeding and advocate for baby friendly maternity ward practices. I also have experience in supporting families though bereavement, birth trauma, postpartum depression, and other tough situations. When their needs fall outside of the scope of my practice, I refer women and families to other appropriate health care professionals There are two postpartum visits included in my birth services. I also offer separate postpartum services, which cover the first few weeks, and some families opt for continuing weekly care for the first few months. These sessions include processing the birth, lactation consultation, basic baby care, postpartum recovery, pelvic floor recovery, natural family living, and conscious parenting. As yoga instructor I also offer mother baby yoga classes which are really fun! I welcome any inquiries. My email address is firstname.lastname@example.org