We are celebrating World Doula Week which runs 22-28 March, so it's only right that today Karolina Lewis is speaking to Kicki Hansard, an experienced Birth and Postnatal doula, doula course facilitator, hypnobirthing practitioner, founder of the BirthBliss Academy and a wonderful advocate for a positive birth experience. Kicki is also the author of “The Secrets of Birth: What every woman should know about birth and motherhood” and her second book “Supporting survivors of sexual abuse through pregnancy and childbirth” will be published in January 2020. Kicki offers a FREE online antenatal programme called “Your Birth – Your Way”, packed full of all the information parents-to-be would find helpful in planning for the birth of their baby.

KL: It’s great to speak to you Kicki – thank you for the opportunity. We have been following you on social media for a while, I also had the pleasure to meet you briefly at the Doula UK Conference in London in March last year.

Here at Bumpkyn we genuinely care about the woman’s wellbeing in pregnancy and beyond. I personally feel a maternity brand needs to stay close to all things birth-related and I deeply care about how women feel when they are about to bring another life into the world.  Even though I am not a Doula myself, I am a member of Doula UK and it’s a privilege to support such a wonderful cause. In an era when women regularly research every aspect of pregnancy and birth online, I often get a blank look when I ask whether they have considered hiring a doula. What’s the reason for this?

KH: It saddens me to hear that but it seems that we are not doing enough to get the information out there. I think that part of the problem is that most pregnant couples do not understand birth physiology and that the environment that a birthing woman is in during labour is the most important thing. Everyone is focusing on ‘safety’ and whilst this is important, there needs to be more understanding of how our bodies work and what is required for labour to unfold in a straight-forward way, as this is often overlooked. 

Doulas have been proven in study after study to ensure women and couples have positive birth experiences and having a postnatal doula has been shown to prevent postnatal illness.

KL: People take different approaches to antenatal preparation. Why is a doula the best birth partner?

KH: All studies show that in all the possible ways birth outcomes could be improved, the most important and basic need for women in labour is continuity of support. The Cochrane review concluded that the best results occurred when this continuous support was provided by a trained doula – someone who was not part of the staff at the hospital or the woman’s personal social network. A woman needs to feel safe and protected during childbirth on a physiological level, i.e. it’s outside of her conscious control.

It's similar to when a child is scared and can’t go to sleep at night. Often, all it takes is for a parent to lie down next to them and maybe stroke their hair, to disengage their thinking brain and promote the physiological process of sleep. The parent protects the safety of the space, encouraging the child to let go and drift off. Falling asleep is a physiological process which happens when the right hormones are produced - just like childbirth! This is exactly what a doula does: we protect the safety of the space, to help a woman let go and birth her baby. This is our primary role.

A woman’s automatic protection system, the flight or fight response, needs to be suppressed during labour otherwise the right hormones that makes the womb contract and allows the baby to be born won’t be produced in high enough levels.  This is the key to a straightforward vaginal birth, if that is what the birthing woman wants. I wish that everyone would get this education at school so that it was better understood. Birth is a physiological event, just like breathing, coughing, sneezing, going to sleep and digesting food.

KL: You have recently written an open letter to Meghan Markle, the Duchess of Sussex, where you command her for exploring different birthing options, including hypnobirthing. I also believe women should feel empowered to make these choices and focus on their own needs in pregnancy. I think  doulas are great at shifting the woman’s attention from the baby onto her own wellbeing and choices. We know babies will be fine and well looked after, however we forget to look after ourselves.

KH: Yes, I think because all the focus is on the baby being safe and well, which is of course very important, women might find it difficult to communicate how they are feeling.  Most women want to do what they think is best for them and their baby but worry that they are not allowed or that they might be seen as a difficult ‘patient’. Doulas help women get the information they need to make informed choices and also acknowledge the feelings that many pregnant women have. We don’t give advice and we certainly don’t tell anyone what to do but we do present all the information.  I can totally understand why the Duchess of Sussex has hired a doula as this will ensure she gets a balanced view and the support of someone that will be 100% on her side.

KL: In pregnancy, women tend to invest heavily in all things baby. Some of the Mums I speak to admit the budget is heavily spent on gadgets and equipment pushed on them by magazines and pseudo experts as “must-haves”. I remember being persuaded to buy things I didn’t need, while I should have invested that time and money in making my birth journey a lot calmer and controlled. Is the service provided by doulas costly and does it suit everyone?

KH:  I couldn’t agree more! So much money is spent on things that are never even taken out of its box and ends up in the ‘nearly new’ sales across the country.  Let me put it this way, women and couples who receive continuous support during labour and birth are more likely to have a normal vaginal birth and less likely to have pain medication and artificial hormones drip. Because of this, they lower their chances of having a Caesarean birth and they are less likely to have negative feelings about childbirth. In addition, their labours are shorter and their babies are less likely to have complications at birth or be admitted to a NICU as they are born with higher APGAR scores.  This improves family bonding as postnatal mental health issues are rarer, the new mum feels more confident and has less anxiety, which means we see more breastfeeding over a longer time. The health benefits for the baby and the mother are life-long.

So, my question is, what would you pay for that? What’s that worth to you and your baby?

Because the impact a doula can have is not fully understood, the doula’s fee might seem like a huge investment when what you need to look at is what you get for that. The average spent on a wedding in the UK is over £27,000. A doula offers a complete birth package, which includes antenatal sessions, an on-call period, the birth and a postnatal visit, and prices start from £600 up to £3,000, depending on the doula’s experience.  In London, you’d expect to pay around £1,400 for a Doula UK Recognised Doula.  New doulas who are being mentored by a very experienced doula charge from £600.

Doula UK is also in the process of turning its Access Fund into a charity where women who can’t afford a doula can apply. Many doulas will also do pro-bono work so it’s always worth speaking to a doula if you have genuine financial hardship.

KL: When speaking about a positive birth experience you often quote reliable research and present supporting evidence in a digestible way. I can see how modern women trust this first-hand, reliable approach, they seek this sort of reassurance when they are due to give birth, however, I am still staggered how many women are afraid of labour…?

KH: Yes, and I think this has a lot to do with the way childbirth is portrayed in films and television, as well as the newspaper headlines we take in on a daily basis.  It all starts with a scary film at school, usually with a woman screaming and in a lot of pain and this continues every time childbirth is covered. Again, if women understood that the sensations of childbirth cannot be compared to anything else because physiologically and here I mean the hormones in our blood stream, such as oxytocin and endorphins, make childbirth unique. The closest it can be compared to is making love as the same hormones are involved.  This is simply not understood by the majority of pregnant women.  Basically, the best environment to give birth to your baby is the same environment that you made the baby, semi-darkness, privacy, warmth and safety.

Birth is 99.6 per cent safe if you have a complication free pregnancy and it not one of the most dangerous and painful events in a woman’s life. These are the kind of myths that we must dispel!

KL: I remember I learned so much by attending the Doula Conference in 2018, I was really impressed with the professionalism and also the tenderness of the doulas there. Speaking to them had a calming effect on me and I wasn’t even expecting! How do women find a suitable doula for them, given we are all so different in our approach to birth?

KH: Awww, thank you, that’s so lovely to hear! I think the answer is in your questions. It’s really important to not simply choose a doula because she seems to have a lot of experience and have a lot of diplomas in various things. Anyone looking for a doula should arrange to meet with at least three different doulas. That feeling of calmness or connection with someone else is the most important thing!  Doulas do not have an agenda so our approach to birth is generally that we believe that all women we look after have the potential to birth her baby physiologically and we will listen and support our clients in whatever they want to do. We are not experts but we are able to provide evidence based information, the pros and the cons of everything, so that our clients can make strong choices for themselves.

KL: Thank you Kicki, this has been an amazing insight into such an important and much-needed role. I hope the answers to our questions will pave the way for our readers to consider the help of a doula. After all, we all want a positive and calm birth experience!

KH: Thank you so much for asking me to take part and I do hope more women do their research into doulas!