The Doula Issue 39 Autumn 2020 - Flipbook - Page 7
Sandwich Method: Attend Labour and Golden
Hours, Not Birth
As COVID restrictions eased, Mina met her client
Elizabeth for antenatal appointments in the park.
Elizabeth was planning a home birth with NHS
midwives as well as her husband Alex present. Local
Trust guidelines stated that only one birth companion
from within the household was “allowed” at a home
birth. Elizabeth and Alex knew their legal rights to
have whomever they wanted in their own home
regardless of COVID, but decided this was not a
conversation they wanted to have with an unfamiliar
midwife during labour. Therefore they asked Mina
to be present as labour established, and help them
summon a midwife at the right time. Then Mina was
to return as soon as the midwives left.
This is exactly what did happen. Elizabeth summoned
Mina mid-morning one day, and she spent five hours
with the couple in their home. As labour became
really challenging and transition was nearing, Alex
called the Maternity Assessment Unit. Once it was
clear a midwife was on the way, Mina slipped away.
The couple spent only fifteen minutes on their own,
and the midwife was present for only two hours
before a baby girl was born. Within four hours the
couple called Mina to say the coast was clear and
she could return.
The Sandwich method keeps to the rules
imposed by many Trusts, that only one birth
partner is to be present while they are providing
The benefits of a doula’s physical support are
present some/most of the time. And by modelling
for the other birth partner, she may leave some of
these benefits behind even after she has left.
Levels of physical contact can be adapted
according to the comfort level of doula and
parents and the current government guidelines.
This model works for a home or hospital birth.
The doula would remain with her clients until
they leave for hospital and return once they
Under this model, a doula cannot act in one
of her main roles, to provide information and
alternatives when medical interventions are
often suggested (around birth and after). She
could certainly be available by phone during her
absence, but this may be difficult to arrange at
This model assumes the doula is familiar with the
signposts of normal labour, so that she can assist
the couple as they time their engagement with
The Sandwich method is unlikely to work where
medical help is needed from the beginning, e.g.
This model relies on all parties being comfortable
with some COVID risks, and therefore may be
unsuitable for some.
Additional travel is required for the doula.
Diplomat Method: Negotiate an Exception
Based on Amanda’s previous experience, she knew just
what she wanted (and didn’t want) from her maternity
care for the birth of her second baby. During lockdown
she requested an appointment with her local Head of
Midwifery, which took place over Zoom. She made it clear
that she was planning to birth at the MLU with the help of
her doula Pari, and that, though she understood certain
COVID guidelines were in place, she regarded healthcare
providers, not her doula, as optional. Unless the Trust
would agree to allow Pari into the MLU, Amanda would
have her baby in the hospital car park. By the end of this
difficult meeting, the Head of Midwifery had signed a birth
plan including both Pari and Amanda’s partner, Jack.
Amanda had a baby boy in the MLU at 39 weeks, while
Jack held her hand and Pari took photos, both wearing
Where negotiations are successful, almost-normal
doula support is possible.
Women’s right under Article 8 of the Human Rights
Act, to birth with the support of their choice, is
This method works for in- and out-of-hospital births.
With the Diplomat approach, the burden is on the
person receiving the medical care to negotiate an
exception, rather than on the Trust to prove the
legality of a policy denying most women their rights.
This a lot of pressure on a person at a vulnerable
moment in her life.
This model requires a difficult conversation, and may
be emotionally taxing for Trust staff and client alike.
Care providers may say no to the proposal, leaving
limited options remaining.
The Diplomat method may unfairly result in a poor
reputation for doulas as troublemakers within the local
© Doula UK | Autumn 2020 | The Doula 7