The Doula Issue 39 Autumn 2020 - Flipbook - Page 6
Since March this year, most NHS Trusts have
instituted a one-companion policy for all births, in
some cases requiring that birthing women choose the
attendant from within her household. These policies
have effectively barred doulas from their workplace,
causing us to scramble to find new ways of working
with our clients.
In these uncharted waters, different models for doula work
have emerged. In this article, we explore the realities that
are happening, examining the benefits and drawbacks
of each model, rather than suggesting which is best. It
is outside our present scope to consider the benefits
and drawbacks for anyone but the doula and client (for
instance, the risk of COVID transmission to healthcare
professionals or the wider community). Case studies have
been fictionalised, with names changed, but are based on
Virtual Doula Practice: Move All Support Online
When lockdown was insituted, doula Bea and her client
Em moved all their meetings to Skype. This was Bea’s
first time offering virtual support, so they talked through
the practicalities and made detailed plans for birth. Bea
implemented some suggestions from an online training she’d
attended, including five-minute comfort breaks away from her
computer every hour during labour.
One night, at 41 weeks, Bea received the call from Em saying
she thought things might be warming up. Bea got up and
went to another area of her flat with her laptop, earbuds,
water bottle and snacks. Em’s partner Stan set up a Skype
meeting on his phone and placed it where she and Bea could
see one another, which mostly worked. At times Bea couldn’t
understand what was being said, but in between surges
she was able to offer encouragement and suggestions. Bea
remained online with Em until her baby was born with the
help of a ventouse in the middle of the next morning – with
the exception of a long hour-and-a-half offline in the middle
of the night, while Em and Stan gave their full focus to the
journey and transition into hospital.
Bea found some things frustrating compared to her usual
practice. She missed the simplicity of in-person work, where
she could easily communicate her support non-verbally, with
a gesture, sound or touch. She had to describe (rather than
show) some massage techniques for Stan, so she found
herself talking much more than she felt was optimal. She had
to speak quietly so as not to disturb her own household, and
make extensive use of the mute button, in case there were
unexpected sounds in her home. Several times the video
call dropped and Bea was reliant on Stan to notice this and
fuss with the tecnhology to get a new connection. She found
herself much more in the role of consultant/resource person,
rather than an equal member of the birth team. And by the
time Em’s little girl was born, Bea was more exhausted than
she would normally be.
However, Em and Stan were delighted they had worked with
Bea, saying their ability to turn to her during moments of
decision-making gave them tremendous reassurance.
6 The Doula | Autumn 2020 | © Doula UK
Even though they hadn’t planned
for a ventouse birth, they felt
they had made their own wellinformed decisions along the way.
Their ability to take Bea into the
hospital with them, even if only
“in their pockets”, gave them the
familiarity and comfort they prized
so much as they brought a baby
into the world in such uncertain
circumstances. They also referred back
to the support Bea had provided during pregnancy, which
helped them consider new birth choices and ultimately to
experience the kind of empowering birth they had not known
Parents experience continuity of carer (dodgy WiFi
Doulas are “present” during the whole birthing time.
This arrangement is unambiguously within COVID
guidelines and therefore requires no additional
conversations with healthcare personnel.
Doula care on this model is available in or out of hospital.
This model disposes with the doula’s physical presence
and the advantages that brings.
Virtual doula support is essentially an uncontrolled
experiment, unbacked by evidence. It may be as
beneficial as in-person support, but many aspects
inherent to virtual work, such as exposure to blue light
from electronic devices, stimulation of the neocortex
from verbal interaction, and the feeling of being watched,
as known antagonists to straightforward birth, may
negate the protective benefits of doula “presence”.
There are privacy issues with online connections of this
type. Accidental breaches of privacy may happen as
birth is broadcast into the doula’s home space. There
is also no scope for private moments of interaction
between the doula and other individual members of
the birthing team, such as a whispered suggestion to a
partner or eye-contact with the midwife.
Because this model is entirely reliant on technology, it
can be unreliable and subject to hiccups.
There may be screen fatigue for all members of the