The Doula Issue 39 Autumn 2020 - Flipbook - Page 8
Carry on Regardless: Attend the Birth and Hope for
May hired Orla, a former midwife, as doula for her second
birth. Throughout the pregnancy they grew so close that
it became unthinkable for May that anything, even COVID,
should prevent Orla from attending her birth. The local
Trust’s guidelines said that if you chose a home birth,
your one companion had to come from your household,
but, ironically, if you went into hospital you could bring any
person of your choosing. Yet May didn’t feel safe going
into hospital. She joined a Facebook group for people
interested in freebirth and started some research.
She booked in for a home birth, but thought she’d wait
until labour to decide whether to call in the NHS midwives
or not. Orla was comfortable with this decision, and willing
to attend the birth even if she ended up being the only
one there. Sure enough, May’s labour started strong on
her due date, and Orla rushed over to fill the pool. May
never felt like anything was missing, so she never rang the
hospital. She caught her own baby in the pool after three
hours of labour. Orla showed her how to rub her tummy
firmly to slow her bleeding, and all was well.
Natalia was expecting her fifth baby, and was very upset
to learn that her local Trust’s COVID guidelines said she
could only have one birth companion. She regarded the
presence of both her husband, Marco, and the doula, Bev,
who had helped at all four of her previous home births,
as equally non-negotiable. She especially wanted Bev
to be there for her four children. After talking it through,
Natalia and Bev decided they would act as if they were
blissfully unaware of the guidelines. As it happened, no
conversation was necessary. When the on-call midwives
arrived, labour was in full swing, and the midwives simply
got to work setting up their equipment as if everything was
normal. The atmosphere was very pleasant, and nothing
was ever said about the COVID guidelines. Shortly, their
baby was born into Marco’s hands, while Bev and the
other children looked on. It was one of Bev’s favourite
The Carry On method may result in full normal doula
support. This is likelier to happen at home, where
care providers are entering the family’s space, than in
hospital. Healthcare professionals refusing to care for
a woman calling for medical help have a duty of care,
even when service users are not following guidelines.
This method can be applied both to in- and outof-hospital births. In the case of hospital birth, the
birthing woman would simply go in with her chosen
companions, and refuse to be admitted without them.
Benefits will vary from case to case. For some people,
there will be no medical or psychological draw to
freebirth. Others will perceive the freedom to act
entirely according to preference and instinct
(including perhaps inviting multiple attendants) as a
There is no need for any special negotiations with
A difficult doorstep conversation may result when a
client attempts to engage medical care with her doula
present. Care providers may ask the doula to leave
her client’s home, or say the doula cannot enter
This approach is likely the least considerate to the
care providers who attend the birth. The staff on duty
will have no notice of the proposed arrangement and
no opportunity to object to a doula’s presence.
The uncertainty of anticipating how care providers will
react to a doula’s presence at the time of birth may be
unsettling to all.
For each of us doulas, the decision as to which (if any) new
practice models are viable will be very personal. However,
the questions that are raised by these rapid changes are
common to us all, and our answers to these questions may
well be highly formative to the future of our profession. What
does it look like to “work from home” as a doula? Is doula
support that happens only online really doula support? What
does it mean to “be” at a birth? Is our physical participation
a necessary part of our work, or is a virtual connection just
as good? In the time of COVID, can doulas still claim to offer
continuity of care? How far are we willing to work outside
Trust and government guidelines to serve our clients? How
can we be sure our makeshift solutions are evidence-based?
Does our chosen working model contribute positively to
straightforward birth and client satisfaction, or could it be
causing more problems than it solves?
8 The Doula | Autumn 2020 | © Doula UK
Freebirthing brings all the risks associated with a birth
without medical assistance (which are different to the
risks associated with birthing with medical assisiance).
There will be a greater delay in accessing medical
help should the need arise than there would be if
healthcare professionals were already present, and
this may have serious consequences.
Clear conversations must take place in advance about
each person’s role at the birth. In order not to be
legally liable the doula will need to be very clear that
she does not act as a midwife, and know what that
All birth attendants need to be willing to take on
full responsibility for their choices, including for
the doula’s possible financial responsibility, as her
insurance might not cover her to attend a freebirth.
Freebirth is not available in hospital.
Laura Jansson is a doula, mother of four and the
author of the book Fertile Ground: A Pilgrimage
Through Pregnancy(Ancient Faith Publishing,
2019). She has been attending births for fifteen
years in several countries, and helps facilitate
the Oxford NCT Home Birth Group, which is
currently meeting online.