What Meghan Markle can expect from a doula

Early morning yoga, twice-daily meditation,  we know that the Duchess of Sussex is a fan of all things holistic. So it’s not beyond the realms of possibility that, as has been rumoured, a doula is the latest hire to team Markle.

A doula, or birth support partner, is a non-medical helper who’s there to provide practical and emotional guidance and to advocate for the mother (as well as soothe the nervous partner) pre-, during and immediately post-birth.

“News that the royal family maybe hiring a doula for their baby's birth is wonderful and just shows how mainstream birth and postnatal doulas are becoming in the UK,” says doula Jay Urquhart  45, Director of  Doula UK .

Given that royal family is not short of help, it may be that Meghan is drawn to the wealth of positive medical evidence in favour of specialist doula support. Even though a birth helper doesn't take a clinical role, having a doula can result in a better birth experience and less medical intervention, according to research. Benefits can include a reduced risk of Caesarean and instrumental  birth  (e.g. forceps), reduced need for painkillers or epidurals, a shorter labour, more successful  breastfeeding  and lower incidence of  postnatal depression.

We asked Jay what the royal couple and anyone who’s thinking of hiring a doula, can expect.

With the Royal Family said to be engaging a doula, what can a doula bring to a birth that other people can't (however many staff you have access to)?

“A doula brings unique support in that the doula has no objective other than to support the birthing woman and her partner, in the way that they wish. There is no pressure to conform to the well-meant advice of family and friends or follow an employer’s protocol. A doula doesn’t assume to know what the parent wants and doesn’t judge their decisions. The doula will listen to them, share evidence-based research to inform them and support their choices, rather than advise them what to do!”

What are the most common reasons for hiring a doula?

“I’ve had people booking for lots of reasons, sometimes because they have no family nearby, sometimes because they have had a negative birth experience before and realise the value of doula support. Some women choosing different routes, which don’t exactly follow medical advice may want doula support, for example for a vaginal breech birth, or a vaginal birth at home if they’ve had a  Caesarean  in the past. I’ve been able to offer support to women asking for this sort of personalised care, helping them to communicate with their caregivers to plan a safe and supported birth.”

How do you go about choosing a doula?

“It’s very common for women to meet several doulas before choosing the right one for her. I think it’s important to meet up and see how you get on – it’s vital to feel comfortable with your doula – we literally need to be part of the furniture! It doesn’t matter what you ask, as long as you can feel honestly relaxed in each other’s company!“

What did your doula training involve?

“I felt a real calling to do this and trained with Kicki Hansard at  BirthBliss  (one of Doula UK’s nine  accredited doula courses ) and then became a mentored doula with  Doula UK . During my first year of working as a doula, I worked alongside a mentor who I could check in with and debrief each experience. She ensured I was able to navigate different scenarios and was well versed in the Doula UK code of conduct, resources and support before I became a recognised doula.”

How much does a doula cost and what does that provide?

“Prices vary from £300 to £3,000 depending on location and experience. I charge £900 for Birth Support that comprises two antenatal preparation sessions, each a couple of hours long. At approximately 38 weeks (earlier if it’s twins) I’d go on call for the mother, which means 24/7 availability by phone and is ready to attend her birth at any time.  I remain on call until the baby arrives. I attend the birth and support the mother throughout, whether for three hours or 40. I’ll leave once they are settled and return to visit postnatally to check how everybody is, help with breastfeeding and debrief the birth.”

How can a mother get the most out of her doula?

“A doula is led by the mother’s wants and needs, so the best way to get the most from your doula is to share how you’re feeling and what you are aiming for so that you can prepare together to create the best possible environment and support for you.”

What's the most important quality of a doula?

“Doulas should be non-judgmental and not make assumptions – but most importantly they should support YOU! Whether you’re looking for reverence or humour, facts or the best ever panpipe CD – or a healthy mix of it all, there is a doula for everyone and the most important thing is that they learn about and support you.  Doula UK  has 700 doula members and can help you find your doula or become a doula!”

Will a doula see me naked and go down the business end?

“That’s up to you! More often than not, yes, nudity is commonplace, but your doula will always be mindful of how you feel about that. Most don’t give a hoot, but I have supported mothers before who needed a high degree of modesty where we planned exactly how many people would be present and their position in the room – for one mother I held up towels and blankets each time she moved to protect her modesty. It’s rare for doulas to see the business end – that is the role of the midwife. “

What can't a doula do?

“A doula cannot give medical advice - we are not medically trained. I have said no to attending a free birth [without a medical professional in attendance] although I fully respect women’s choice to do this, it’s beyond my personal boundaries.”

How can a doula help prepare for birth?

“Antenatally, a doula will help the mother to identify, explore and research birth options and the many choices she may be given, so that she feels prepared, relaxed and familiar with how she feels about the most common decisions, like what is the best birth environment for her – whether that’s at home, in a midwife-led unit or in hospital, and how natural or medicalised she’d like her birth to be. It’s important to know that you can choose how and where to have your baby and whether or not you’d like to give informed consent to any of the help on offer. You are the expert of you!

“Birth physiology is really important to understand because the hormones and endorphins your body makes go such a long way to promoting or preventing birth from unfolding as it should. Your love and bonding hormone - oxytocin - is a big one for  birth  and is produced when you feel really relaxed, safe, warm and protected. Fear and the corresponding release of adrenaline is at the opposite end of the scale. Focusing on breath-work usually features highly because it can connect you to your parasympathetic nervous system and relaxed restful birthing state.

“Whatever type of birth you choose you can work with a doula to maximise the love! Traditional approaches like massage, oils, use of a bath, shower or birth pool,  Mexican Rebozo techniques  (using a Mexican scarf to help the baby get in a good position) and many others are familiar to us as doulas and we can share them with you at an antenatal session so that you can request it in labour if you want to. We can also explain the pros and cons of all the medical interventions and pain relief methods and share research about topics which matter to you so that you can stay informed and in your power even if asking for help.

“Your doula will be able to signpost to NHS and private services such as hypnobirthing, local groups, breastfeeding support and a whole raft of resources.”

What are the most common fears about childbirth?

“Lots of people have some fears around birth, much of which are based in a cultural perception that it's hard and horrible – the TV tends to sensationalize fear elements, when in fact it can be very peaceful and empowering and a true rite of passage. Most fears, like will I poo? Will it hurt? Will I be able to do it at all? fade away the more you learn and grow to believe in your ability to birth your baby. It’s not always easy, but that’s where you can derive enormous satisfaction from achieving it – however it happens.”

When do you have to speak firmly during childbirth?

“I may give firmer and more focused support during transition, a brief moment in labour that tends to be the most difficult as hormones surge, and which often happens shortly before the birth.

“I might speak up for the mother if she needs a little time to consider advice she’s been given, or if she indicates to me for any other reason. Feeling empowered to make your own informed choices can mean that even a challenging experience can be really positive. I have only had one instance when my client needed me to be very firm and insist that a doctor responds to her questions to explain what they were doing and why. Part of our role is holding a safe place for the mother to birth her baby. Sometimes we need to ensure that space is protected and at an optimum so she feels supported and safe in her environment.”

What's the relationship between doula and midwife?

“This is a question that comes up all the time, and the answer is when a midwife and a doula work well together, it’s the ultimate dream team! We have distinctly different roles and both are passionate about supporting women and their families.”

Do dads need support too?

“Often! Lots of people really benefit from being introduced to helpful ways to support their partner during labour and birth, and as a doula, I would never get in the way of this core beginning of a new family, rather support both parents so that they can really be together through labour and birth.

"Even when the family’s plan is for the dad or partner to not be present at the birth, for example, if there’s a cultural reason or other siblings that need caring for, things change and support is fluid and flexible. It’s easy for dads to worry and often the mother is just as concerned for her partner as herself, so it also helps her to relax!”

Can a doula help a woman manage the pain of childbirth and even avoid pain relief?

“Yes! There are lots of extremely effective ways of managing pain, and it is possible to avoid medical intervention completely – your natural hormones and endorphins when uninterrupted are powerful and strong! I have also supported women who have opted for a Caesarean as the right option for them and seen some women do really well on pain relieving drugs in hospital.

"The main point is to find whatever is right for you, and you are uniquely the best person to know that. I would add about how when a mum feels supported and well informed, the outcome of a positive birth is more likely. We have a toolkit of physical, emotional support and advocate so a mum can manage the pain better for instance if a hospital is insisting a mum lay on her back, a doula might facilitate the conversation by asking mum what she would prefer rather than being told what to do.”

Can a doula help after the birth?

“After the birth, a doula can help to maintain a protected, calm, dark environment for the first ‘Golden hour’ of bonding between mother and baby. I also tend to help tidy up a bit, and later give tips for breastfeeding and sleeping which soon become the top considerations!”

Are there things that women don't realise a doula can do for them?

“Yes, especially with a postnatal doula, whose role is to mother the mother and help her to both rest and recover, and to find her feet as an able, confident mother. I used to be a chef, so love cooking nourishing meals for families, listening and reflecting with mums and dads, supporting breastfeeding and doing shopping and light housework or whatever little jobs help the family. I am terrible at ironing, so only do this for comedy value!”

Have you ever attended a difficult birth or a stillbirth?

“I’ve never attended a stillbirth, although I have supported a mother with a live birth following a stillbirth, which was exceptionally moving. There are doulas who specialize in loss, and lots of help available from organisations run by people who have a good understanding of what you might be going through and the support that you might need.”

What do women say about their doula experience?

Here's some of the feedback I have had...

* “To anyone thinking about having a doula – do it! It will make the whole experience much more positive. I have done with and without and would definitely go with next time. Worth every penny!"

* "Having someone who has supported others through birth before is incredibly helpful. For me, it meant I didn’t end up with a Caesarean and actually had a positive experience of induction."

* "Jay was incredible encouraging me and helping me feel as comfortable as possible and ultimately I had no interventions because of the help and support of Jay. During labour she was there, she literally held my hand throughout and helped me have a very positive pool birth without any drugs!"

* "She gently but firmly held my corner, exactly what I wanted and was expecting. I was glad Jay was there to gently assert my concerns and wishes. She mirrored my rhythm. She preempted what I needed and was alert to my signals (i.e. massage, refreshments etc.)”

“I can’t think of anyone better to have at my side – she’s patient, caring, fun, thorough, considered and emotionally intelligent enough to respect in the moment! I can imagine her being a valued asset to a birth team whatever the circumstances.”

Find a doula near you on the  Doula UK  register

References

Reduced risk of Caesarean birth † *

Reduced risk of instrumental birth † *

Reduced need for painkillers or epidural during birth † *

Reduced rate of induction of labour † *

Shorter labour †

Increased parental satisfaction with the birth experience. †

Increased likelihood of initiating breastfeeding *

Increased likelihood of successfully establishing breastfeeding & breastfeeding at 6 weeks *

Lower incidence of depressive symptomatology †

* Brigstocke S.  MIDIRS Midwifery Digest , vol 24, no 2, 2014, pp 157-160

† Hodnett ED, Gates S, Hofmeyr G, Sakala C.  Continuous support for women during childbirth . Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5

and

† Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A.  Continuous support for women during childbirth.  Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6.