Doula

Birth doula

DOULA. She is here for us when we need her and supports us. Today's episode of our M15M series will be dedicated to the work of doulas. And who else should we interview than an expert in the field! Doula Míla Kastner Martínková told us what it is like to be a doula and about her experiences from maternity hospitals. 

What exactly is the doula's role at a birth, and why should an expectant mother want a doula with her at birth?

The cooperation between the doula and the woman always begins during pregnancy. Ideally, the doula prepares for the birth and the time after birth with both expectant parents. During labor, the doula supports the woman and her partner throughout the entire birth. She guides the parents through the whole birth process. The doula explains what is happening and what will happen next, which is often very important and reassuring for parents. The doula understands the birth process and perceives how crucial the well-being of the birthing woman is, both mentally and physically. Because the doula knows the woman better than the hospital staff, her care is better adapted to the woman's wishes and needs and is also received positively by the woman.

 

How does working with a doula work? Do you meet the expectant mother during pregnancy so that you can hear all her birth and postpartum wishes? 

Ideally, we meet the woman already in the first half of pregnancy, when we generally go through her wishes and ideas and agree on the form of cooperation. This is followed by further meetings, usually with the woman's support person present as well (partner), where we prepare for the course of labor, but also for breastfeeding and baby care.

 

How did you become a doula, and what led you to it?

My own births led me to doula work. I have three behind me, and after the first two I felt the need to understand the situation around birth more deeply and be able to actively engage with what was happening. I found that my idea that doctors would solve everything was mistaken, and that what mattered absolutely most was how I approached it myself.

 

How long is the birth doula course, and how demanding is it?

I completed the course with the Czech Doula Association. The in-person part of the course lasts one year. This is followed by supervised practice under the guidance of an experienced doula consultant, which ends with a certification exam. That usually takes about another year.

The course takes place on weekends, so it is possible to complete it even if a woman is a single mother. The course is very comprehensive in content, but it is manageable for anyone with a genuine interest in the doula profession.

 

What was your own birth story like? Did you yourself have a doula at your birth, or did you consider having one?

As I mentioned above, my births led me to the doula profession. My first birth was a very stressful experience, accompanied by disagreements among doctors and confusion. The birth itself ultimately ended in a cesarean section, followed by nine hours of separation from my son and difficulties with recovery. The subsequent birth in the 21st week of pregnancy was absolute horror, when even the hospital staff did not know how to deal with a woman whose baby was dying. The next pregnancy then represented a challenge and a desire for a normal birth, which was made possible thanks to thorough preparation and the determination of my third son. My third birth is still a source of strength and determination for me today, and it was also the impulse that led me to become a doula.

I myself only learned about the doula profession as part of my preparation for my third birth. At that time, I knew very little about a doula’s work, and I did not have a doula at my own birth. Today I would definitely invite one.

 

On your website you state that births with a doula tend to be shorter and have better outcomes - why is that?

It is because the woman is calmer and more trusting. As part of birth preparation, we go through possible situations and scenarios of how things may unfold. We are not preparing for a battle, but for cooperation with medical staff. Good preparation of body and mind is the foundation for a smooth birth. It is necessary to know that birth cannot be invented and planned, but it is important above all to respect the baby’s activity, because the baby is the one who drives the whole process.

 

Is it possible that the effect is the opposite if the doula, for whatever reason, cannot make it to the birth? Can the mother feel more stressed at the moment when she was relying on the doula’s presence?

Such situations, when a doula cannot make it, can of course happen. The doula may become ill, or she may be assisting several women giving birth at once. Proper preparation of the woman and the doula will always include this possibility. In advance, it is always agreed how the woman perceives the situation and whether she would want a substitute doula if necessary.

If everything is clarified in advance, then the woman has no problem with the doula not arriving. My goal is for the parents to be so well prepared that they can handle the situation well on their own too, because no one knows what will happen and whether, for example, Covid might come again.

 

How demanding is birth support for you?

For me personally, the most demanding part of accompanying a birth is the so-called on-call period. That means that from the 38th week of pregnancy I am still on the phone for those parents and always ready to head to the birth. I can’t go anywhere far; my family and my husband are, in a sense, on call with me. Everyone constantly counts on the fact that I may disappear at any time for however long. The birth support itself is a part of the work that fulfills and delights me immensely. Even though night vigils and late-night drives home are demanding too.

 

Has it ever happened that you got into a conflict with the maternity ward staff because the birthing woman's wishes were not respected?

Sometimes we discuss things and try to find compromises. Conflicts during labor solve nothing; on the contrary, they increase stress levels for everyone, which is something you ideally want to avoid completely.

Personally, I believe it is necessary to prepare well and go to the maternity ward with realistic expectations. That can sometimes be a problem today, because many people on the internet literally steer women toward unrealistic demands. Our job is to inform the woman about what the optimal approaches are in light of the latest research, but also to tell her where she can receive such care. The differences in the approaches of individual maternity wards are truly enormous. So it is worth seeking out a doula just for a consultation about the practice at a given facility. Many things can also be arranged in advance. Most healthcare professionals are willing to accommodate agreements once they understand the reasons why something needs to be handled somewhat nonstandardly.

 

What is the current state of Czech maternity care, and what would you see as a step forward?

I see constant changes and an effort toward mutual understanding. Some places move faster, some more slowly. I see the future in so-called family rooms, where a woman can spend the beginning of labor in privacy with her partner and perhaps also a doula, and where parents can then stay together for the following days after the birth as well. Some maternity wards already offer these services.

I also believe that good communication and mutual respect help everything.

 

You offer prenatal courses on your website - do you think it is necessary to prepare for birth in advance?

I definitely recommend it. Birth cannot be taught, but it can be described, and many things can be shown and clarified. It is good to have a realistic idea of what awaits me and perhaps also what I will do with the baby afterward. This is often forgotten :)

 

How do your prenatal courses take place, and what do women learn here? Is the course different in any way from other courses?

The course focuses primarily on practical experience and skills. Because I actively accompany women to births myself, I have an overview of the customs in a given maternity ward. We also discuss how to handle pregnancy well, how to prepare the body and mind, what to do during labor so that the woman can find as much relief as possible, and we also prepare the companion so they can be part of the birth process and an active helper. Of course, we also focus on preparing for breastfeeding and caring for the baby.

The courses are either group-based or we meet individually. During covid, I also prepared an online version of the course.

 

You named your website Comfortable Birth - is it really possible for the entire process of birth and the subsequent postpartum period to go smoothly? :)))

I believe it is possible. I experienced it myself and in the births of my clients. Calm does not mean easy. I would like to emphasize that. It is about how we perceive the whole process, including in retrospect. Whether we come away from the birth with a feeling of calm, empowerment, or perhaps even trauma. My goal is for parents to perceive birth as calm as much as possible.

As for the postpartum period, it is more complicated. A woman’s postpartum period is a sacred time, but here it is greatly underestimated and preparation for it is generally minimal. Maternity wards in hospitals often make the situation worse and usually discharge women home in not exactly good condition, both mentally and physically. What is completely missing here is follow-up postpartum care in the parents’ place of residence, which would be covered by health insurance. We doulas can also contribute here to increasing well-being, either through good preparation or through personal presence in the family.

 

What is your opinion of maternity wards in the Czech Republic? Is there anything you have encountered that you completely disagree with, and on the contrary, anything that pleasantly surprised you?

I have already partially answered that above. There are a few departments that perform solidly. In general, though, the standard of the ward is low. I encounter situations where women are given contradictory and outdated information, especially regarding breastfeeding. It is not uncommon for a woman to hear from the nurses that she must not breastfeed the baby sooner than after two to three hours. That is outrageous nonsense, which has long since ceased to be valid and has long been disproven by research. Unfortunately, continuing education for pediatric nurses in the field of breastfeeding is at a tragic level and often completely absent.

On the other hand, it is necessary to mention many nurses who care for mothers with kindness, attentiveness, and understanding, which are qualities that are absolutely priceless in this period. I would really like to thank them very much.

 

What would you advise women whose birth did not go as they had imagined and who carry some trauma from the birth with them?

I believe it is appropriate to work on this actively. Ideally as part of therapy with a psychotherapist, but it is also possible to start with a doula who is trained to recognize whether specialist care is needed. That applies to our doulas from the Czech Doula Association.

 

As a doula, do you also offer lactation counseling - is there any general advice on how to start breastfeeding as well as possible and as quickly as possible after giving birth? 

Ideally, she should stay in skin-to-skin contact with the baby as much as possible, maintain skin-to-skin contact even while breastfeeding, and put the baby to the breast whenever the baby signals the need to nurse, for as long as the baby needs it.

 

What would you advise a woman who decides to have a home birth?

She should look for a midwife as soon as possible, and ideally a doula too. According to research, home birth is just as safe as giving birth in a hospital, but under certain conditions. A woman must be under the care of a midwife throughout the pregnancy, she needs to be completely healthy, and she needs to have realistic expectations. A well-prepared woman for a home birth will accept that it may happen that a transfer to the hospital could be needed at any time.

 

What is your opinion on an early discharge from the maternity hospital for a mother - that is, leaving against medical advice?

It is something I definitely support, but again under reasonable conditions. It is appropriate for a woman who wants to leave earlier than 72 hours after giving birth to have follow-up care with a midwife arranged, and to always reasonably assess both her condition and the baby’s condition. If everything is fine and the woman has support arranged at home, then nothing prevents leaving, and I definitely see that as positive.

 

What would you advise mothers who do not feel well in the maternity hospital and, instead of joy over the new addition, experience more stress from the overall situation?

That sometimes happens, and it is good when those around her notice and understand the situation. It is appropriate to seek expert care again. Arrange a visit from a doula or a community midwife who can talk with the woman and her family. Alternatively, another specialist can support the woman in follow-up care. These situations are often underestimated and overlooked, but there are many women who feel confusion, sadness, and stress after giving birth. Again, I would mention proper preparation already before birth, which also includes information about the postpartum period and its pitfalls, including contacts for where to turn if the woman does not feel well.

 

Last question: what should a mother do after coming home from the maternity hospital to best manage this huge life change, postpartum recovery, and the jump into a different stage of life?

In the first few weeks, a woman should have support and help arranged in advance. She should then care only for the baby and herself, attend to the baby’s siblings only to a limited extent, eat and drink well, but above all sleep whenever possible. Everything else can wait, or someone else should do it.

In the following weeks, it is good not to be afraid to think about yourself and gradually set aside time for yourself, your hobbies, and self-care. It is not healthy to want to sacrifice yourself for the family at the expense of your inner peace and well-being. A healthy family usually has a healthy and content mother at its center. In my opinion, that is the long-term key to a peaceful family :)