Mums-to-be find support and guidance from their birth assistants.
Two years ago, Kylie Ferguson found herself alone and pregnant in Bluffton, South Carolina, the United States.
Ferguson had supportive family and friends, but they were far away. The father of the baby lived in New York. Her parents were in North Carolina. She had a brother in Washington DC, and a best friend in San Francisco.
“I was here by myself,” Ferguson said. “I had no one to advocate for me.”
So Ferguson turned to Ifetayo White, a doula.
Already seven months pregnant, Ferguson travelled to meet White for the first time at her home. White offered Ferguson a seat and a plate of dinner. Soft music was coming from the porch of her country home, and White asked the soon-to-be-mother how she was feeling.
Ferguson came to the realisation that between working two jobs and preparing for single motherhood, she had failed to take care of herself.
“It was the first time I felt someone was taking care of me,” Ferguson said.
A doula is a non-medical birthing coach, there to support and educate mothers throughout the birthing process – prenatally, during labour and postpartum. There are about a dozen doulas practising in Beaufort County, South Carolina, who were certified by toLabor, a national organisation of labour assistants, after a training weekend. Their fees hover around US$500 (RM1,630).
Women enlist the help of doulas for many different reasons. Shayla Sanders had a Caesarean section with her first child and hired White to support her in having the more complicated VBAC, or vaginal birth after Caesarean, for her second. Women whose husbands are deployed might turn to Meaghan Bird, a doula and military wife herself.
“When their husbands are away, I’m often the sole support person,” Bird said. “They depend on me more than typical mums. As a military wife, I can relate. I was lucky my husband was there when our two sons were born, but I’ve done single parenting and know the struggles.”
White has been a doula since 2007 and was present for the birth of more than 100 babies. Prenatally, she meets with mothers to make a birthing plan.
“I always explain to the mum that these are your desires, but let us hold in our minds that we’re going to be flexible, because you never know that’s going to happen,” White said.
Ferguson’s plan included having a natural birth without pain medication.
“I wanted that experience,” she said. “We’re made to have children, and I wanted to participate fully in that and feel it.”
During labour, White provides physical measures of comfort – a cold washcloth on the forehead, hot compresses on the hips, light massages – as well as emotional support. Ferguson had the father of her child holding one hand, and White holding the other.
After eight hours, the doctor said he needed to go in manually to manipulate the baby. He explained the pain would be tremendous and recommended Ferguson get an epidural.
“I couldn’t imagine being in any more pain than I already was,” Ferguson said. “On a scale of 1 to 10, it was a 20.”
But an epidural wasn’t part of the plan, and Ferguson was conflicted over the decision she had to make.
“I’m so stubborn and I was being so hard on myself,” Ferguson said. “(White) stepped in to tell me it’s OK. She made me feel at ease about getting an epidural. She made me understand sometimes the plan changes, and I don’t have to feel guilty about that.”
White talked to Ferguson in the moment, asking her what she wanted to do, reassuring Ferguson of her continuing presence and support.
“Her discussions with me were only to help me make a decision for myself, never pushing her opinions or values onto me,” Ferguson said.
As a doula, White is there to help mothers, not push an agenda, which is sometimes the reputation doulas have.
Sara Edwards, who has worked as a doula since 2012, knows how doulas are seen in the medical community, as she was once part of it. Before this, Edwards worked as a certified nurse assistant in labour and delivery at a hospital. “Believe it or not, I used to make fun of doulas and people who wanted to have natural childbirths,” Edwards said. “We’d laugh and take bets on how long they’d make it before they were begging for anesthesia.”
But then Edwards had her first son.
It wasn’t a pleasant experience. In fact, she calls it one of the worst experiences of her life.
Her long labour started when her water broke early. At the hospital, Edwards was given two epidurals because the first one didn’t take.
Her mother was on her way, having to drive up the coast from South Carolina. Her best friend was there, holding her hand and searching for the right words to say, the right ways to help. Her son’s father was pacing around the room, talking on the phone and cracking jokes.
“I wanted to kill him,” Edwards said. “In hindsight, he was doing the best he could, but I just wanted someone to shut him up.”
His aunt, who was a registered nurse, was there, telling Edwards that it wasn’t that bad, that she sees people losing their limbs and all Edwards was doing was having a baby.
“I needed words of encouragement, not for what I was going through to be minimised,” Edwards said.
Little progress was made in the first 10 hours of excruciating labour, and by that time, Edwards’ emotions had spun out of control. She was sobbing uncontrollably.
Edwards had taken Lamaze classes, but all that went out the window when she was in labour – she could barely remember how to breathe.
“I just thought, ‘These people are crazy, and they’re going to kill me,’ and I just wanted my mum,” Edwards said.
Her doctor came in, saying he was sure she was tired, that it was time to get this taken care of, and recommended a C-section.
Edwards was in the hospital she worked in and understood how the process worked. She didn’t want to cause a fuss by saying no when her doctor said she needed one. She didn’t want to seem difficult or unintelligent by questioning what he’d said.
“I didn’t want to buck the system,” Edwards said.
But with the C-section came overwhelming guilt for Edwards. In the aftermath, she felt she had given up on her son, had given up on his birth, and was somehow less of a mother.
“I didn’t feel like I had a choice or that I had made an informed decision,” Edwards said. “In the end, I felt like something had been done to me.”
Studies show that the presence of a doula or birthing coach does decrease the chance of having a C-section by helping mothers understand when it is medically necessary and when it is not. Edwards believes her experience would have been different if she’d had a doula.
“Had they given me the opportunity or had I spoken up for myself and said ‘Let’s wait,’ I believe I could have had a vaginal delivery. I really, really do,” Edwards said.
It’s the main reason she became a doula herself. During the training, she watched a video of mothers who had C-sections.
“I was crying like a baby through the whole thing because I thought I was the only one who felt less-than, that I was less of a mum because I didn’t have that experience, who felt a sense of guilt, even though the kids are healthy,” Edwards said.
As a doula, Edwards is there to walk with mothers through their fears, to support them with whatever happens and let them know they are not alone.
“I’m here as an added support to make it a pleasant experience,” Edwards said. “Even if the plan changes, that mother will know that she made every informed choice possible and know why things are happening, so she never feels like something was done to her.” – The Island Packet/McClatchy-Tribune Information Services