support at birth and perinatal period

1. What is a Doula?

In many cultures, women are present to support future mothers during their pregnancy. The doula is a woman who accompanies, supports and informs the couple and the mother during a birth but also in all the moments preceding and following childbirth. This support is provided in addition to the medical follow-up chosen by the parents (clinic, liberal midwife, hospital).
The doula, who is neither a midwife nor a doctor, provides a non-medical support. She is present alongside the pregnant woman and her relatives, she is for them a stable reference point, available, listening to her desires and needs. The doula represents for the couple of future parents a support and a valuable source of information.

Support is not limited to childbirth alone. It begins long before, sometimes even before conception, and can continue throughout the postnatal period, from birth until the child is 3 years old.

Helped by her experience (the doula is generally a mother herself) and her training, the doula seeks to create a relationship of complicity between women. Her personal experience is supplemented by knowledge of pregnancy, childbirth, newborns, listening and communication techniques but also in breastfeeding, carrying and mothering.

On the same subject

The word “doula” From the ancient Greek “doúlê” means “servant”. In the United States, where doulas first appeared about 40 years ago, the word “doula” has entered the dictionary and refers to a woman who accompanies the mother during the perinatal period. In France we sometimes use the term birth aid, perinatal aid, birth attendant. Although these birth attendants are still little known in France, doulas are used in large numbers in Anglo-Saxon countries; one even accompanied Meghan Markle during her first childbirth in 2019.

2. Why be followed by a doula?

Midwives, nurses, obstetrician, nursing assistants, gynecologist: there are many stakeholders around pregnant women. It is difficult to establish a relationship of trust in continuity. Having recourse to a doula makes it possible to overcome this lack of follow-up. The gradual closure of small maternity hospitals accompanied by a lack of midwives and medicalization poorly supported by some women all contribute more to this need for comfort and additional support in the continuity.
With her, a long-term relationship of trust can be established. The future mother feels listened to and safe with a referent present at each of the important stages of her pregnancy.

The book “The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth” by Marshall H Klaus shows some benefits linked to this accompaniment by a doula:
• Delivery easier,
• 50% reduction in cesarean sections,
• 25% reduction in working hours,
• 60% reduction in the use of epidurals,
• 40% decrease in the use of oxytocin to speed up labor,
• 30% reduction in the use of analgesics to relieve pain,
• 30% decrease in the use of forceps,
• Prolonged breastfeeding and higher breastfeeding rate.

3. Deciphering the services of a doula

Daily prenatal tasks: From the start of pregnancy, a doula can also take care of the daily tasks of a pregnant woman such as looking after another child, cooking, cleaning …

Google, the best friend, and the spokesperson for the family: In general, the doula remains available before and after childbirth to answer any questions about the baby and birth, as well as to soothe parents in times of stress. The doula also makes sure that the mother never feels pressured into accepting medical treatment in the rush of childbirth, such as an epidural, by talking to her well in advance of all the possibilities. It serves as a link between the parents and the medical staff in order to establish a “birth plan” which will be done with full knowledge of the causes.

Accompanying persons from birth: Following childbirth, the doula continues to support the mother for several months or even years by doing relaxation exercises and providing moral support.

3. What training does a doula receive?

There is no official and recognized training for doulas in France. Doulas are therefore formed through organizations and associations specializing in perinatal care, help, listening and relaxation. Training and skill can therefore vary greatly from one doula to another. When choosing your doula, ask all of your questions to make sure it’s the right companion for you. The success of this project also depends on the choice of your doula.

Some associations and institutes provide training in non-medical support: association ALNA, L’Institut AMA, Paramana doula, Association française la 8e Mère-Veille. The training of doulas is done on site or remotely and lasts between 80 and 200 hours depending on the center and makes it possible to tackle all subjects related to pregnancy, childbirth and the immediate postnatal period. The training can also address more delicate aspects, such as perinatal bereavement. This while knowing that the doula did no medical training. She is trained to support the couple, provide psychological support and inform them so that they can make informed choices. The doula must be able to provide objective and current information. For this, in addition to her training, it is recommended that she read a lot, attend conferences and participate in a network of doulas where she can share and exchange information.

Private training organizations generally provide a theoretical part combined with practical training. This theoretical training varies from € 1,300 to € 2,600 depending on the organization in France. This training does not give any diploma recognized at national level in France.
This new profession is emerging in France, even if it is already widespread in other European countries. Some associations try to bring together all these women accompanying births.

4. How is the doula paid?

The remuneration of doulas is not reimbursed by social security and is not taken into account by any organization. Each doula applies its tariffs that it offers without any control, any professional insurance and without legal liability.

The doula generally offers between 5 and 10 visits distributed before and after the birth. Tours cost between 40 to 70 €. Presence during childbirth is priced between 300 and 450 €. Total support can therefore exceed € 1,200. In order to reduce costs, some doulas offer their “clients” all-inclusive packages ranging from € 400 to € 800. Others, even rarer, operate with a voluntary contribution system or on volunteering.

5. Is being followed by a doula risky?

The use of a doula is not necessarily obvious:
• Because they have no medical training and it is difficult for them to prioritize and find the line between (unauthorized) medical information and simple non-medical advice.
• Because there is a lack of official recognition and recognized training, or even minimum training: some can be improvised doula overnight.
• Because they are sometimes victims of sectarian aberrations.

To respond to these criticisms, it is necessary to legally supervise and create this profession, to set up training courses validated by official bodies. However, the future is not necessarily baby pink for doulas, the French National College of Gynecologists and Obstetricians (CNGOF), the National Council of the Order of Midwives (CNOSF) and the National Academy of Medicine. ‘being pronounced against the recognition of the profession of doula.