Doulas: Supporting expectant mothers give birth with love

“Before hiring a doula, I needed to confirm whether it was registered.  I even asked for contacts of mothers she had worked with to get reviews on their experience,” she adds.

“A trained doula can be more supportive to a mother in labour than some of our relatives,” Stella says adding that during her time, she was monitored regularly by her doula.

 She took her for simple exercises and attended hospital visits with her every time she needed to see a gynaecologist.

After delivery, they went home together and for the first two weeks, her doula took care of the baby and only gave it to her when it was time for feeding. “I needed that rest and I was happy she was there to support me in those postpartum days,” she adds.

The doula guided Stella on what to eat, supervised her shopping, was with her in the labour suite and offered her the emotional support she needed. 

After all the trauma she went through, Habiba Namanda says she suffered from postpartum depression for some time. She confesses she is slowly learning to love her firstborn daughter, after going through a number of counselling sessions.

Changing the game

Before she had her second child, Namanda chanced upon the word ‘doula’, which meant ‘a woman who is employed to give guidance and support to a pregnant woman during labour.

 “This caught my attention. I searched for doulas in Uganda. Unfortunately the one I found  had left the country.  This inspired me to pursue an online doula course with ProDoula  Certified Professional doulas that lasted a year. The course enriched me with skills to support mothers overcome postpartum depression,”she explains.

After training as a doula and following the birth of her second child, in 2019, Namanda founded and registered  Birth With Love Doulas and Midwifery Services, to support mothers face childbirth with love.

 Namanda, who has worked as a doula for close to four years,  says  a doula  does whatever she  can to make  childbirth an easy journey, where a mother in labour is loved and supported to walk the painful journey.

“As a doula, you definitely cannot control all the circumstances, but you do whatever you can to make sure the mother or rather the parents have the right information, support and encouragement they need to go through labour,” she expresses.

Namada says as a doula, a healthy baby and mother is at the top of the list of priorities.

Advocacy

Dora Mwima Barrack of World Mum Doulas, says she has been working in different initiatives to support mothers. However, she says the misdiagnosis, the unnecessary medical procedures done, without giving the expectant mother the right information, led her to this profession.

“It has been two years working as a professional doula and what I have realised is that having a doula by your side is like having that bestfriend who you can always call on to seek for advice, providing you with information that you may not find anywhere else,” she explains.

 She says doulas also advocate for policies that better mother’s health care system.

“If I want a better health system, then I want it for everybody. That is why birthing women should be handled responsibly whether in the village or in town,” she says.

 A doula wants a new mother to be strong and healthy physically, mentally and emotionally, and this is difficult, if she was mistreated or felt afraid or lonely during labour and birth. The doula ensures that a mother’s needs are central at every step of the journey.

Anna Verwaal, a midwife and doula says, “A woman, as long as she lives, will always remember how she was made to feel during childbirth.”

“Research shows that having a doula helps mothers to be more informed and when you are more informed you do not fear. You get to know when your service provider is not treating you right. You are enlightened with so much information that can help you have a positive birth experience. I am not saying doulas are miracle workers, but I want mothers’ birthing experience to be eased,” Mwima shares.

Drawing a birth plan and packages

Mariam Bagyenyi started the Treasure of Birth through volunteering to mothers at Kiira government Hospital. She has done this for the last three years.

“When hired, the first thing a doula does is to draw a work plan of important details about their journey to parenthood with the client,” she says.

 An expectant mother together with a doula, works on a birth plan, which stipulates key preferences. From where a mother wants to deliver from, whether or not the mother is planning for a home birth, midwife-led unit, labour ward and finally, the kind of postpartum care a mother desires.

Bagyenyi says an expectant mother can book a doula from the moment she conceives because this gives more time to plan, interact, engage through antenatal and birth plans.

Namanda says prices are set according to the plan, services and trimester of a pregnancy desired by the expectant mother. 

“In most cases the prices range between Shs750,000 to Shs4m. In my case, I start monitoring a mother at six months and during that time, we go together for the last antennal visit,” she says.

With no specific doula centres in the country, the doula monitors the expectant mother from her home, especially if it is what makes them comfortable. Namanda and the other doulas’ future plan is to build a birth centre that is well equipped.

“I want women to know that giving birth is not a battle field. “

 Exercise to consider

There is always so much going on during labour and your doula can help with some pain relieving exercises, which can include ball bounce, gently bouncing on an exercise ball to induce labour and assist with cervix dilation. Other exercises include warm water birth, belly lifting, massages and pavement walks.

Are doulas registered?

 According to Dr Jessica Nsungwa, a commissioner for reproductive , maternal and child health services at Ministry of Health , the  policy allows companionship while in labour to offer assistance to the mother and midwives or doctors. So doulas come in as companions.

The difference between a midwife and a doula is that midwives provide medical care for a mother during pregnancy, birth, and the immediate postpartum period.  However, doulas provide her and her family with emotional, informational, and physical support during pregnancy, birth and the immediate postpartum period.

Mwima says Uganda does not have a doula training facility but one can get the training online from institutes such as DTI (Doula Trainings International) Dona International, ICEA(International Childbirth Education Association), among others.  The duration of the course depends on the institution. The courses provided include research on the benefits of doulas and the needs of labouring mothers. Framework to help you assess the needs of a labouring woman and how to provide supportive care for those needs. This includes an in-depth look at pain and anxiety,  modes of care and prenatal health.

Namanda says unlike before, today when you google you get to find the different doulas in Uganda and what they can offer.  Asked how easy it is to trust a doulas in the labour ward, Bagyenzi says, “By the time someone lets you into the labour ward they already trust you and the two of you have built a relationship. This doula needs to meet with your doctor during the last visits to the hospital. A mother can decide to have both a relative and a doula by her side,” Namanda explains.

Why pay for a doula?

A doula’s supports a pregnant woman with information and practical and emotional care during pregnancy and birth. Doulas often continue caring for new parents and their babies in the first few weeks after birth.

It is important to note that doulas are not trained in clinical care. This means they do not order or interpret medical tests or scans, diagnose medical conditions or give medical advice. Doulas work alongside your midwife and doctor.

Bagyenyi says it is a good idea to let your midwife know that a doula is part of your pregnancy care team. Your doula helps ease pain during labour and helps you relax, massage you , aromatherapy and other things to comfort a mother. Create the birthing environment you want, help remove distractions. Reassures and encourages you, and talks a mother through emotions during labour.

Testimonies

“Initially I had an idea of birth doulas and the services offered. So when I was eight months pregnant, I went to Google and searched for doulas in Uganda. I chanced upon two different organisations offering doula services.

 That is when I reached out to Birth with Love. Being a first-time mother and the negative stories around childbirth, I needed someone who would understand me and support me. Before hiring the doula, I found out whether they were registered, I went on to ask for contacts of mothers she had worked with before and if I could meet and interact with them.

She monitored me all the time.  She would call to find out how I was doing, or sometimes send encouraging messages, and offer spiritual, emotional and physical support. She came for exercises and attended hospital visits with me.

  After birth she was home with me for three days, taking take care of the baby.” (*Jane Mukisa)

 Since it was my first child, I was scared of how it was going to be. I heard a number of stories about birth.  I needed someone away from my family that would positively comfort me. 

That is why I hired the services of a doula. A got my doula at 32 weeks, I went with her for the different hospital visits and my doctors got to know. 

My doula guided me on what to eat and what not to eat, she supervised my shopping, not just because something looks good.  She was by my labour bed and when I thought I could no longer bear the pain, and the doctors were now opting for a caesarean, she managed to talk to them and asked for more time till I was able to deliver normally.”  (Betty Babirye)   

Why you need a doula

What problem does a doula solve? If I am an expectant mother, why should I pay for the services of a doula?

A doula’s role is to help pregnant women feel confident about giving birth. She supports a pregnant woman with information and practical and emotional care during pregnancy and birth.

Doulas often continue caring for new parents and their babies in the first few weeks after birth. Doulas aren’t trained in clinical care. This means they don’t order or interpret medical tests or scans, diagnose medical conditions or give medical advice. Doulas work alongside your midwife and doctor.

Mariam Bagyenyi says it is a good idea to let your midwife know that a doula is part of your pregnancy care team. Your doula suggests positions, movements and changes that help ease pain during labour, guide your breathing and help you relax. Offer you massage, hot packs, aromatherapy and other things to comfort you.

Doulas create a condusive birthing environment and helps remove distractions. Reassures and encourages and talks a mother through emotions during labour. Helps you communicate your birth plan to the midwives and doctors caring for you.