Motherhood, considered by some as the oldest “profession” in the book, is not only the sole reason humanity still exists, but also a rite of passage for many women. Whilst many people do, and will continue to desire to have children, it is known that the process of doing so is not without complications.
Holding a bundle of joy after labour is said to be one of the most amazing feelings one can have, and often, the pains of labour are seen as well worth it in that moment. However, there are many provisions that need to be made to ensure that one does reach that moment of joy: consultations with healthcare practitioners and birthing coaches, hospital selection, and an infinite number of items to purchase in order to be prepared for the arrival of their child.
Across the globe, many people opt to have midwives, OBGYNs and even a birth photographer to document the momentous occasion. In some cases, couples opt to have doulas ( and sometimes all the above, if they can afford it).
Efe Osaren, a Nigerian American doula studying to be a midwife in Houston, Texas, is a third-generation midwife but she didn’t discover that her grandmother was a midwife until she was well into her own midwifery training. “For me, being a midwife speaks to my ancestral connection”, she says. “I was a teacher before going into birth work. I relocated to New York from Texas to pursue birth work after researching Black-led organizations that were the leaders in Birth Justice organizing.
Key findings from a 2020 NYS Health Foundation analysis of Severe Maternal Morbidity (SMM), show that in 2018, the overall SMM rate was approximately 324 out of every 10,000 deliveries (or 3.2%). Midwives and community-based health workers such as birth doulas have been proven to play an important role in improving such adverse maternal health outcomes.
Osaren explains that doulas are essentially birth attendants—sometimes educators—who help expectant couples in various ways. Doulas provide non-medical assistance throughout the perinatal period. This includes physical, emotional and informational support.
There are also various types of doulas that deal with reproductive health. Some are birth doulas, while others are abortion doulas or miscarriage doulas. They present a wealth of knowledge about the birthing experience and offer valuable advice on how to make choices about where and how to give birth. They also educate on the various issues that can arise post-partum.
“Always have both a Midwife and OB-GYN with a doula if you can. You should at least have a Doula for the progressive part of labour. The doula is someone you need before that,” explains Osaren.
She stresses that a doula is not a medical provider, but they do provide the kind of knowledge-based assistance you need in the lead-up to labour. “If it’s just you and your partner with no family help, I would recommend you get a doula. We teach partners how to help in birthing and educate the couple on the ins and outs of labour as well as postpartum recovery. It’s important that partners know what to do in various instances and so the knowledge we impart teaches them how to be a doula so in case of anything they can step in and provide the necessary support that their partners need.”
Images Courtesy of Efe Osaren
In Africa, it is said that it takes a village to raise a child, and this true for birth and life after birth. Many expectant mothers on the continent have the opportunity to be surrounded by family during the course of their pregnancy and birth—whether the support is provided by a grandmother, a mother or a succession of aunts. This is not always the case however, for expectant mothers in other parts of the world says Osaren.
“In Western culture family is not as readily available. In African culture you usually have a grandmother, your mother or aunts to step in and fill that role, and practice village parenting. For those who can’t have this experience, doulas kind of fill that gap by stepping into that role. We generally, as Africans don’t associate that our culture with doulas but it is common here,” she details.
South Africa is one of the countries on the continent that has seen a rise in the access and use of doulas in recent years, and whilst the rise can be applauded, effective birth work has taken a hit in light of the COVID-19 pandemic.
Hospitals have undertaken tighter restrictions to avoid the spread of infection by reducing the interactions in birth and labour wards with non-essential workers such as doulas, lactation consultants and audiologists. Many of them have had to innovatively adapt the ways they support expectant and new parents via phone and video visits. These innovations may bridge the gap in ensuring that parents pay more attention to post-partum care.
“The best time to get a doula depends on many factors but most especially the couple’s lifestyle,” says Osaren. “Most usually get a doula at around 20 weeks. But I would encourage you to get one even earlier. Some doulas only do birth work, others postpartum and others birth education, but I usually go up to 10 weeks postpartum as a Birth Doula. There’s a lot of work involved in ensuring that the new mum gets proper medical support, newborn care insights and lactation advice.”
Whilst Osaren finds birth work to be fulfilling, she also raises concern on the many gaps that exist within the industry.
“We really need to start amplifying reproductive and birth justice more,” she says passionately. “The world needs to understand that Black mothers matter. There are many injustices that are faced by expectant WOC and often doulas step in to act as a bodyguard between them and their health care providers.”
Research shows that women of colour often experience racism and discrimination during their pregnancy care, and feel uninvolved in the clinical decision-making process. Some have expressed feeling voiceless in the delivery room. This is the very space where doulas excel, and step in as superheroes.
“We act as a buffer and it’s important to help your client not only understand their health rights but to also ensure that they are taken care of. We help them find healthcare providers that will listen to them and their choices. We come up with a solid plan that will be in their best interests and ensure that if we say no to something, it’s a standing no,” Osaren adds.
Giving birth is a global phenomenon and it’s amazing to see how much birth work has been able to incorporate traditional African parenting methods on a larger scale through communal birthing and parenting practices.
It’s comforting to know that in the absence (or even presence) of a supportive family unit, there are people out there who have taken it upon themselves to create a safer environment for women to give birth in. Doulas can be an invaluable addition to one’s personal village during the journey of childbirth.
Images Courtesy of Efe Osaren