Understanding the role of doulas

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Utilising the service of doulas in a birthing process is a fairly common practice in western countries like the United States, the United Kingdom, and Australia.

However, it is not an exaggeration to say that the word ‘doula’ is possibly unheard of locally or only known to a small number of Malaysians – well, at least until recently when the word lingered on everyone’s mouth after a controversial talk show interview went viral.

Seemingly overnight, Malaysians became curious about doulas and their roles after a talk show called ‘Analisis’ on TV Alhijrah went on air. It showcased freelance doula Hayati Muzaffar, and Consultant in Obstetrics and Gynaecology, Prof Dr. Imelda Balchin. The discussions revolved around how safe and qualified doulas were in their role during childbirth.

Controversial in Malaysia

This is not the first time doulas in Malaysia made the news.

Early last year, the public was angered with the viral news of a newborn baby’s death in Johor because of birthing complications while under the alleged supervision of a doula.

So, what exactly is a doula and why are they receiving a lukewarm welcome in Malaysia as opposed to other countries?

Makchic spoke to Certified Birth Doula Maira Magalhaes to learn more:

What is a ‘doula’?

‘Doula’ is a Greek word that originally means a woman who serves another woman. Basically, a doula is a trained birth partner. She is a non-medical birth professional or a birth coach.

What is the role of a doula?

The role of a doula is the role of support. She is there to support the labouring mother and the family. She does this using the four pillars of support consisting of emotional support, physical support, informational support and advocacy. Doulas are a part of the birth team but they work for their client. They do not intervene with the medical team or speak for their clients in any circumstance. Doulas provide continuous one-to-one support for their labouring clients, and stay with them to provide a calm and serene environment to give birth. This is what the birthing mother needs, especially if she wants an unmedicated, drug-free labour. If for some reason, the birth is medicated and ends with an epidural or surgery, she still needs a calm ambiance to welcome her baby. The doula always stays with her all the way until a couple of hours after the birth, making sure mother and baby are bonding well.

What makes doulas different from midwives?

These two are completely different. Midwives are trained medical professionals in birth. They know everything about physiological birth. They provide prenatal assistance, guiding and taking care of their patients from a holistic perspective. For example, during pregnancy, they can analyse tests such as the mother’s blood sugar level or blood pressure. In labour, they will pay attention to things like baby’s heartbeat and how well the mother is progressing. A midwife also receives the baby and has the medical skills to mend a tear in the vagina and perform neonatal procedures with the newborn, for instance. A midwife is basically there to make sure that mother and baby are safe before, during and after childbirth. A doula, on the other hand, has nothing to do with medical procedures.

Can doulas replace trained doctors in a birth process?

Absolutely not. Doulas are non-medical professionals. We cannot provide medical assistance to women who are giving birth. It is out of our scope. We see birth from a philosophical, emotional and spiritual perspective. We can never ever replace midwives or doctors.

What sort of training do doulas in Malaysia have?

We are currently setting up the Malaysian Association of Doulas and Childbirth Educators. Through this association, anybody who wants to be either a doula or childbirth educator, they must be under the association. And for you to be part of the association, you must get certified with international boards that are certified. To date, there is only one Doula training in Malaysia called Amani Doula. We have tried to set up the association a few times but didn’t have enough doulas to do so. Now, we decided to combine doulas and childbirth educators. The plan is to make the process of hiring doulas easier for the public. They will then be able to check whether this doula or childbirth educator is certified and recognised by the association.

What should one consider when opting for a doula?

Firstly, the expectant mother must want another woman’s gentle presence, gentle support and gentle touch during her most vulnerable moment. Once she understands what she wants, she can start looking for the doula that most resonates with her desires. Interview the doula, look for her background, find out how she works. Ask questions like how you would support me when I am in labour? The mother must find out if the hospital and doctor that she chooses to give birth allows a doula’s presence. She must not expect doulas to attend to her medically.

Photo credit: Maíra D.B. de Magalhães Doula Facebook

Doulas from a doctor’s point of view

Doulas may be a reasonably new term in Malaysia, and to understand how they work here or the procedures involved when it comes to incorporating their services in a hospital environment, we spoke to Consultant Obstetrician & Gynaecologist (O&G) and Medical Mythbuster Malaysia panel, Dr. Anna Liza Roslani to learn more.

Dr. Anna Liza said to understand the role of a doula, one has to picture the doula as the labouring woman’s husband or mother.

“So what does a husband or mother do? They keep the woman company and give words of encouragement. They help her feel comfortable by rearranging pillows, helping her change her clothes or wipe her sweat.

No medical advice

“A doula is not a midwife. A doula does not give the labouring woman medical advice. The doula should only give emotional support,” she said.

Dr. Anna Liza explained that in Malaysia, a doula can accompany a birthing mother in hospitals.

“Husbands and mothers are allowed to accompany the labouring woman in government hospitals with `husband-friendly’ facilities. Quite a large number of government hospitals have these facilities, but it may be restricted to the number of labouring women at any one time. At present, doulas other than a husband or mother, are not routinely allowed to accompany the woman. However, discretion is allowed if approved by the head of the O&G Department.

“In private hospitals, generally one doula (husband, mother or professional) is allowed to accompany. It is up to the woman to decide who is her preference,” she said.

Overstepping Roles

She said in Malaysia, the problem lies with professional doulas who are paid for their service.

“Unlike the doulas overseas, quite a number of Malaysian doulas have overstepped their boundaries. They are giving medical advice to the extent that they are seen as an alternative to medical care.

“In Malaysia, women who engage professional doulas are generally women who want to run away from medical care or have as little medical input as possible. Only a few who truly want a professional doula because their husband or mother is unable to accompany them,” she said.

She added that it doesn’t help that doulas are regulated by a professional body in countries such as the United Kingdom, the United States, Canada and Australia. A professional body ensures that standards are met, and that boundaries are not overstepped. In Malaysia, there is no such regulating authority.

No regulatory body

“In Malaysia, anybody can be a professional doula. The Health Ministry has encouraged professional doulas to set up their own regulatory body for several years now, but they have still yet to do so.

“Despite the wide acceptance of doulas overseas, they do not give medical advice. And they certainly do not deliver babies. It is the trained midwives who deliver babies. In Malaysia, there is confusion or misunderstanding that doulas are trained midwives,” she said.

However, Dr. Anna Liza said that doesn’t mean doulas are bad.

“As long as they stick to their role only to support the woman emotionally, and not interfere in medical treatment, doulas are ok. Doulas must also encourage women to go to hospital for their delivery.”

T.K. is a former political journalist who left the media industry to join the corporate communications world after the arrival of her baby. Her schedule is no less packed now as she runs after her one-year-old daughter, so she loves spending downtime snuggled up with her family on the sofa, watching baby television together.