>The doula at a turning point in the history of childbirth

(extract from "The Farmer and the Obstetrician" by Michel Odent. Free Association books 2002)

An unprecedented situation

Until recently a woman could not have a baby without releasing a complex cocktail of "love hormones". Today, in many countries, most women give birth without relying on the release of such a flow of hormones. Pharmacological substitutes that block the release of the natural substances and have no behavioural effects are widely used (e.g. epidural anaesthesia replacing endorphins, plus drips of synthetic oxytocin). Furthermore many women give birth via a caesarean section. The long-term effects of this unprecedented situation must be considered in terms of civilization.

The current situation is rooted in a widespread blindness to the basic needs of labouring women, which has always been commonplace in obstetrical circles. This lack of interest is more complete than ever at a time when we are entering the age of elective caesarean section on request. This new phenomenon, developed originally in Italy and in the largest Latin American cities, is found today all over the world. Certain obstetricians are indirectly participating in its rapid development. For example, 31% of London female obstetricians with an uncomplicated pregnancy at term claimed that they would choose an elective caesarean delivery for themselves. Similar preferences have been expressed among female and male North American obstetricians. A well-known London Professor of obstetrics claims that the human brain size represents the main challenge to the birth process and that cesarean section is a technological solution to "the conflict between the need to think and the need to run". Other well-known "experts" wonder why there are still women who want to go through the pain and stress of labour at a time when – thanks to an epidural and a drip of syntocinon – it is possible to watch the TV while giving birth. Among this generation of experts there is an understandable lack of motivation for studying the environmental factors that can facilitate the birth process.

The Doula Phenomenon

It is in such a context that the concept of a doula suddenly appeared and developed in the UK. Ideally, a doula has herself given birth without any medication and without any intervention; she is an experienced mother or grand-mother. More and more young women feel that there is something wrong in the current system. They meet a series of midwives for ante-natal care. They experience one or several shifts of midwives during labour and they usually meet other midwives for post-natal care. They feel the need to rely on one only mother figure before, during and after the birth. For many reasons peculiar to our time many women do not want to or cannot rely on their own mother. On the other hand a certain number of mothers and grand-mothers feel that they can help inexperienced women. The time is ripe for the emergence of the doula.

The doula phenomenon is thought-provoking because it appears as a resurgence of "authentic" midwifery, via lay women belonging to several generations. It is the unexpected expression of the most deep-rooted needs of pregnant women, labouring women and lactating mothers. Interestingly the doula movement started in the USA, which is a country where the midwives had almost completely disappeared. It is now reaching other countries where the midwives survived, but their role was dramatically altered by the protocols and regulations associated with the industrialisation of childbirth.

The reason for doulas – and for authentic midwives in general – can be interpreted from the perspective of physiologists. In the language of these scientists who study the body functions it is easy to explain how certain situations can inhibit the birth process. This is the case when a labouring woman feels observed, a situation which tends to activate the part of her brain (the "neocortex") that should be at rest during labour. In other words, privacy appears as a basic need. This is also the case in any situation associated with a release of hormones of the adrenaline family. This means that feeling secure is another basic need of pregnant women. The physiological perspective helps understanding why all over the world and through the ages women always had a tendency to give birth close to their mother or close to an experienced mother or grand-mother. It helps understanding the role of the doula as a mother figure. In an ideal world one does not feel observed and judged, and one feels secure in the presence of one’s mother.

How to become an informed doula

Women who want to present themselves as doulas do not need any specific training. Being a mother has already given them this training. However they need some updated information, so that young women feel more secure with them. They must be able to discuss "hot topics" such as ultra ultra-sound scans or early multiple vaccinations. They must be able to communicate basic information on pregnancy, birth and breastfeeding. A doula course should include a programme of first aid in obstetrics. During pregnancy certain situations are so exceptionally rare that there is a dangerous tendency to think of them in terms of chapters for text books and exams which can be forgotten in real life. However a good doula must know about them.

"Doula" is originally a Greek word. In fact the Greek community unanimously regards this term with aversion, because "doula" means "slave". The Greek community would prefer a term such as "paramana", which has the same meaning as "midwife" in old English ("with wife"). It can be understood as a sort of second mother. However, for practical reasons, it is probably better to keep the world "doula", which is now understood all over the world. I heard of doulas in countries as far apart and as different from each other as Hungary and Korea. I guess that the word will soon appear in the Oxford dictionary.