The American College of Obstetricians and Gynaecologists (ACOG) and The Association of Women’s Health, Obstetric and Neonatal Nurses support the work of doulas; (AWHONN), “doulas are an important part of the care team and provide informational and emotional support as well as comfort measures for patients during birth.” Numerous clinical trials show that when doulas are present for families, healthier outcomes are possible. https://www.awhonn.org/news-advocacy-and-publications/awhonn-position-statements/
According to the Cochrane database, “Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute APGAR score and negative feelings about childbirth experiences.”(2017, Bohren et al. ”Continuous support for women during childbirth.” https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full
Doulas are an integral part of maternity care. The word “doula” comes from ancient Greek, meaning “a woman who serves”. Today, “doula” refers to a professionally trained person who provides emotional, physical and informational support to women throughout their pregnancy, birth and the postpartum period. Doulas are trained in the knowledge of perinatal support of mothers and babies, providing constant non-medical, physical and emotional support to their clients. WOMBS doulas within their own right, deserve, through their professionalism and commitment to their clients, the support of medical staff and to be welcomed as part of maternity care in ALL hospitals in South Africa. Over the last 2 years, many hospitals have excluded the presence of doulas due to Covid regulations. This has impacted severely on the mental and emotional state of many mothers who desperately needed support.
Doulas in private and public hospitals:
Over the past 20 years, doulas have become recognised as an integral part of the birthing team, providing compassionate care and support to mothers, their partners and their new babies. In the private sector, Discovery Health, Momentum and Fedhealth medical aids have recognised the value of WOMBS doulas and are now paying towards coverage for private births. This is notable progress for doulas, who have strived for many years for recognition in their field.
As doulas, we build a relationship with the birthing family sometimes from quite early in the pregnancy. Being on call anywhere from 37 to 42 weeks in case the mother goes into labour. The Scope of Practice prohibits any nursing or medical actions. Certified doulas may ONLY offer physical, emotional and psychosocial support (providing massage, touch, comfort measures and encouragement) to women in labour, birth and in the first few hours after birth.
When women experience personal support during labour they manage the pain during contractions, utilise positions that promote physiological labour, work more closely with the midwives during the birth, require less medical interventions and have more positive birth experiences, which improves their ability to adjust to motherhood and take care of their newborns.
Labour support has also been shown to increase the early initiation of breastfeeding and longer continuation of breastfeeding. The doula calms the mother and helps her to follow the midwives’ instructions during the second stage of labour. During the third stage of labour the doula can assist the mother with skin to skin contact and help initiate early breastfeeding. (Encouraging a surge of oxytocin to contract the uterus) After the birth, the doula may assist the midwife in helping the mother clean up and move to a postnatal / recovery bed, support continued skin to skin or help the mother.
Benefits of doula care, according to research indicates that mothers who had a doula present, reported their birth as less difficult and painful than mothers who did not have a doula present. Here are some further statistics highlighting the potential benefits of having a doula (Hodnet et al, 2012):
- Less likely to have a caesarean.
- Less likely to use synthetic oxytocin to speed up labour.
- Less likely to use any pain medication.
- Less likely to rate their childbirth experience negatively.
Independent studies such as this one, done throughout the world, including a study undertaken by Prof Justus Hofmeyer in South Africa, proved convincingly of the benefit of doula care. All doulas trained through WOMBS must write an exam to complete the course, set and moderated by Dr. Barbara Hanrahan (WITS) an aspect that has resulted in good Medical Aids coverage of trained WOMBS doulas. WOMBS has a strict Code of Ethics and Scope of Practice, which we have attached to this document.
Some important things to know about WOMBS (Women Offering Birth Support)
- WOMBS has a Peer Review process, so that should you ever feel the need to report one of our doulas, you are encouraged to do so. Please see under Grievance Procedure https://www.wombs.org.za/contact.
- Our training is conducted by trained and registered mature Midwives. They are pedantic about us keeping within our Scope of Practice and Code of Ethics. We are recognised by Discovery, Momentum and Fedhealth Medical Aids as a result.
- Each year, we expect our Doulas to sign their Scope of Practice and send it in together with their Membership Application Form. I personally issue each doula with a Membership Certificate for the year applicable, and put their name on the website: wombs.org.za/for-parents/find-a-doula-2. I am also happy to send an updated list of doulas in each Province should you require one for easy reference.
- Medical Insurance. Our doulas are also required to take out Medical Malpractice and Professional Indemnity with Indwe Risk Services who specialise in this type of cover.