There is some information online about Doula’s in New Zealand. This site explains what you might expect from a Doula as follows:
For childbirth doulas may:
• Prepare a birth plan in advance Midwives are required to do this in NZ
• Help you understand what is happening Midwives are required to do this in NZ
• Support your partner
• Be an advocate in liaising between you and the (other) health professionals Midwives are required to do this in NZ
• Stay with you throughout the labour and until the baby is a few hours old Midwives are required to do this in NZ
Postpartum doulas may:
• Help you to successfully initiate breast feeding Midwives are required to do this in NZ
• Assist you with emotional and physical recovery from childbirth
• Teach you to care for your baby
• Help you with other children in the house
• Do some housework
• Prepare some meals
• Do other tasks around the home that may be required
Doulas will work alongside (but not replace) the work of your midwife or doctor. They can work with you for as long or short a period as you want in the postpartum period.
The italics are my own the rest is copied from the web site. Most of the work of a Doula is a requirement for midwifery practice in New Zealand (see italics). Also Midwifery care is free and Doula's will charge. According to this site about $500 flat fee or $30-50 per hour. (As a locum midwife I am not paid this much!). The difference is that the government pays my fee but women will have to pay for their own Doula.
Hannah suggests a Doula service may be a better option than a midwifery assistant service as recently proposed by the Midiwfery Council of NZ as a measure to address a national shortage of midwives. Midwifery assistants might be responsible for clerical work or house housekeeping duties which might take up the midwives time.
I do believe that for some women, mainly very young women or those who have little personal support, a doula would be beneficial in NZ. However these women are the very women who cannot afford such a service. I have a problem with midwives delegating midwifery responsibility to others and worry that this might be more likely with a doula service than with a midwifery assistant. However it does appear that in some parts of the country something needs to happen to ease the workforce shortage. I wonder what others thoughts are on this issue?
More importantly do others believe that a doula service in NZ would help to reduce unnecessary medical interventions in childbirth? If so how would it be different to the midwifery service we currently?
Photo from Fuschia's photos at flickr.com
37 comments:
I think this is a fascinating question and likely to put a lot of midwives' noses out of joint.
Thanks Sarah. I do hope others comment as I do think it is a topic worth debating.
Just wanted to say I am not intending to put anyone's noses out of joint, just interested in your opinions. This is a topic which I have not seen thoroughly debated in New Zealand.
Hi again :)
I found this very interesting.
I had not even considered that the evidence comes from countries with different maternity systems. And now Im not so sure.. I found it interesting that NZ midwives are required to do many of the services doulas offer anyway.
The main reason I think doulas may be better (than midwifery assistants) for women is continuity of care. Women would choose a doula and get to know her, just like with a midwife. Comparing that with a midwifery assistant, I presume women wouldn't have this luxury. I think for midwives, and considering the shortage of them, the midwifery assistants would be better than doulas.
Regarding midwifery assistants - in your response to my 1st comment you asked who would want this work anyway? I think its a good option for women considering midwifery but not sure or ready, or those who, for whatever reason, wont 'cut it' as a midwife. And of course the healthcare assistants that are already working in womens health.
For women with little support, student CBEs are an option for FREE support!
If you are interested here is the link to the doula I know, also Carolyn. www.doulabeginnings.co.nz I had trouble with her website but I dont know if it is my computers or her websites fault.
Hannah
Thanks for your comments here Hannah. It will be interesting to see what others think. It would be good to get some comments from midwives. I wonder if any midwives have experience of working with doulas and if they have found this to make a difference or not. I think I tend to agree that, for midwives, having midwifery assistants is probably a better option. Perhaps what women in NZ really need is home help and childcare for older children, nanny services might be more useful to women than doula services. What do you think?
Regarding who might be a midwifery assistant. I tend to agree with you, it might be those who want to try out a role in this area of women's health or who would like to but cannot commit to midwifery for some reason. There would need to be a clear job description with clear boundaries and understanding of the role and responsibilities.
Also, yes trainee CBEs are great free support for women as are first and second year midwifery students. Particularly first year midwifery students who, in our program, are totally focussed on supporting the women.
I am interested in what other midwives think too. There are certainly some here in Palm. North that have worked with Carolyn the doula.
I like the idea of home help too. Have you heard of pepsicles? Part of our DHBs maternity strategy is to "Support the provision of home birth services" and they plan to "Offer an assistance ‘package’ for women who choose this option" and "Fund support for women during their postpartum adjustment". (all of this is avaliable online) I am part of the Manawatu home birth association, so we are going to propose that they offer home help vouchers and subsidise the cost of hiring our birth pools. However - I think there should be something for women who dont choose home birth aswell (perhaps there is, I am not familiar with the entire 'strategy'.)
Sorry to rant on! but to quote you I 'felt inspired to leave comments'
I hadn't heard of the Pepsicles service Hannah. Thanks for bringing it to my attention, [here is the
URL for anyone wanting to look http://www.pepsicles.co.nz/]. I think it is fantastic that your DHB will subsidise this for women having a homebirth, and the payment for birth pool hire too. Really this is only right a proper and should be standardised across the country. When women birth at home they are not using hospital beds, laundry supplies, instruments, drugs etc, etc. Surely it is only right that they should be able to have some help at home which must be a much lesser cost. I love the job descrition for these workers'
Looking after mum, getting her meals, snacks and drinks
*Washing, hanging out to dry, folding up
*Do the dishes, tidy up the kitchen
*Cleaning (vacuum, dust, clean bathroom/toilet)
*Soak nappies
*Take phone calls, answer the door
*Look after visitors
*Play with older siblings
*Tidy up kids' toys
*Make list of presents, write thank you cards
*Let mum have a sleep or a shower
*Making beds, changing linen
*Tidy up baby clothes, change cot sheets, etc
*Go grocery shopping
*Have a listening ear
*Plan and prepare dinner, e.g. crockpot, peel the potatoes.
In our region, if women have a caesarean section they can get some limited home help through the district nursing service, also if they have three children under 5 and the youngest are babies. However it is usually stipulated that this is home help only, not child care.
I have always been of the opinion that women having a homebirth or leaving the hospital within hours of a birth deserve support from the state. However our DHB states that even if women are not using the service the DHB has to have hospital services there for these women. As a teaching hospital there is also concern about losing numbers of births in the local hospital which might threaten the viability of this medical establishment. So it is desirable to have women birthing there even though this is not in the best interests of women or their babies. Midwives and women have been trying for many years to get a primary birthing unit established for local women without success. Now the DHB is developing a unit which will be on the same floor of the hospital as the existing obstetric unit, through a door. It is the old story of treating women as clinical material and having enough throughput to provide medical experience for trainee doctors.
It would be truly fantastic if we could get some sort of real government recognition to support women to birth at home and to be up front that this is a good, if not the best, option for the majority of women who can expect to have a normal and intervention free birth.
I do not want to be misunderstood here. This is my personal belief but I am aware that women choose to birth in hospital for any number of reasons and I support women to make these choices. Let's also support the women who choose the safe option of birthing at home.
I don't really like the idea of midwifery assistants - i would prefer to see more effort put into supporting the current midwifery system thru better renumeration and working conditions. I think we need to make this a more appealing career option and look more closely at why it isn't necessarily attracting workers.
one of my main concerns about midwifery assistants is that introducing this third player will disrupt the midwife woman relationship - and I don't see that as beneficial - i think it has the capacity to undermine the amazing maternity system we have all worked hard to forge. If we did end up going with the midwifery assistant thing - i wouldn't see their role as being with the woman at all - I would see her role as being with the midwife to support the midwife in her role and therefore increase her capacity to be with the woman. This would be less disruptive to continuity - which i feel is really valuable. A midwifery assistant could do administrative - or porter type tasks.
As a midwife i wouldn't work with a mw assistant in any other capacity - because if a really need a second pair of hands I prefer them to be midwifery hands. As a woman I wouldn't want to dilute the relationship between myself and my midwife - I don't like a lot of people around when I'm birthing.
Rae
I agree with your Rae and where there are enough midwives to do the job I see no need for midwifery assistants. We have a reality however where, in some regions, midwives are not able to meet their legal obligations to women because of staff shortages. I was speaking with some midwives who said that in their area they can only guarantee two postnatal visits to women, then they are handed over to Plunket. This is not because the midwives don't want to do the job, they just are completely unable to. I have worked in rural areas for most of my midwifery career and in these areas I have always worked with registered nurses, enrolled nurses or obstetric nurses who have provided some of the facility care for women. I think this has always been the case. Some of the staff in the base hospital postnatal areas are also not midwives, so midwifery assistants do exist, they just do not have a title as such and do not have a specific regulated job description or educational requirements. There might therefore be some advantages in having this arrangement more formalised nationally so everyone is aware what they can and cannot do within their scope of practice. I totally agree that they should not be taking on a midwifery role as such but should do clerical or housekeeping tasks which free the midwife up to do her job.
I agree carolyn that the state could do more to support women as they become mothers. I wonder what form of support is ideal to put in place?
In terms of state support we do now (at long last!) have paid parental leave - which supports families (both men and women)in the transition to parenting - and to engage with their parenting - by allowing them to take a break from work responsibilities. I think this is a good start - but I also think it should be hugely better funded and for longer - to be really valuable. Of course there will always be men who choose to opt out of their home / family life and for these families no amount of govt support will solve that issue.
Women parenting alone should have access to even greater support in some form - given that they probably wont be receiving the support of a partner.
I think there is a case for a system based on need - but thats a bit murky as some who have genuine need may miss out by not meeting set criteria. How do we set inclusive criteria? On a purely physical level - theres the obvious - women who had their babies following surgery clearly have additional physical needs.
Another perspective is that for a lot of women birth is normal and healthy so they may not necessarily be high need in a physical sense. I have to say i feel quite wary of the idea that we are in need because we have just had a baby as it seems to buy into the whole medical perspective of birth - based on the concept of this time being one of disability versus wellness. In reality many women come through this event perfectly well and healthy and functional - and many households manage the transition to parenting as well as any other normal family time.
There have been times when i have thought - I really need a cook, cleaner and receptionist at home - but I have to say this was never after the births of my babies. I can't imagine where a home helper would have fitted into our world at that time?
I may be a domestic optimist but I think if men are going to get better at being partners and dads then we need to leave a space for that to occur. i worry that if we assume that they won't or can't do the domestics and provide basic support for their partners - and so we put in place a home helper (stereotypically a poorly paid woman) aren't we just inhibiting social change? But yeah yeah - some women need help....
Rae
hi carolyn - yes I agree about the scope of practice needing to be clearly defined - and I think a clear job description for midwifery assistants (should we go that way) - will be necessary.
Do you think we have too many midwives engaged in obstetric roles? Is reviewing how midwives are currently spending their time a potential solution?
I wonder where the group og midwives who are due to retire are retiring to? Do people still retire to small rural areas - or is that a trend of the past? Maybe we will end up with more midwives edging towards rural areas?
Rae
Thanks for these comments Rae. It is good to have your input. and Happy New Year by the way.
Regarding supporting women at home after birth. I do not think we do really do this very well as a society. I do agree that we should not displace the woman's partner from this role when he is able to provide this support to his family. Many men are great in this role but many are not able to do this, for whatever reason. Despite parental leave many still rush back to work. When I first was a midwife, back in the 1070s it was not uncommon for a womans relative, usually mother to come and stay and provide support. Or maybe just hover in the background. This is increasingly rare now as most grandmothers work. (I can hear your feminist screech as I say this.) Mothering is a female role though is it not, and who can mother a mother quite like her mother?
The state has assumed the responsibility for providing care and support to women who are birthing, and in the early postpartum period through the institutionalisation of birth. What I am suggesting is that women who birth at home should have similar support if they need and want it.
Regarding your second point about where midwives work. I think that women do need midwives in secondary care settings as well. I would be very reluctant to say that this care should be provided by nursing staff, although in reality, with increasing caesarean section rates, much of the work is nursing work.
Some parts of the country are very short of midwives while other parts of the country have more than enough. Can we dictate how and where people live and work? I don't really think so.
oops 1970s I meant. Had I been doing this since the 1070s it would be b---dy miracle would it not? I might also be a wee bit tired.
Now I am really worried. Ever since you added that doula post, your stats have increased over me by 100! Stop writing popular posts!!!
Ah Ha!! thought you could catch me eh?
Seriously I do hope more respond to this post. It would be great to get a broad perspective. I am really keen to hear from midwives who have worked with a woman who has hired a Doula and what if any difference they have perceived in the their relationship with the woman or in the woman's experience of childbirth/postnantal.
Good discussion starting on state support for women and families etc. Might be worthy of a further post.
Another question just occurred to me. Are there any doulas reading this who have worked with midwives who provide continuity of care? How does this affect your relationship with your client, is it easier or more difficult? Does it affect the way that you are able to work with women? Are the outcomes for these women any different to outcomes when you are working with women who do not have this relationship with their midwife? I would like to hear you perspective also.
happy new year to you too! great to see you back.
Nope, no feminist screech here - I think the point about working grannies is quite valid - as a society we have undergone quite significant social change in recentish years and women have taken on different roles in society - as have men. I think we need to consider that as we consider where needs may lay in terms of state funded social support for women and families. men are taking more of a role in the domestic arena as a natural consequence and i think policy should encourage that. Having babies at home in the 1990's with a busy working (but fab) granny on my side and an absent one on my partners side - had positive consequences for us. We had to step up and count on each other for day to day (night to night?)support.
The buck stopped at my partner taking the initiative around the house etc and there were many benefits for us and the children in that. I think a lot of men accept a lot more responsibility nowadays for themselves and their children - and have more positive family experiences with their children as a consequence. i think we should notice that as a positive social change and embrace it as we move forward.
I am not sure basing todays state support around historical or traditional male and female roles and experiences is necessarily the most productive way forward - or the most desirable. I think there is a tendency toward a core principle that mothers are disabled - when i think it is probably more correct that society or the structures in place around women are disabled? I think there is also a bias - that suggests that men can't fulfill this role - and we need to consider what the basis for that belief is?
of course i agree that not all women will have functional, willing partners - and i would like to see those women supported as well. but I think men are giving more and women are expecting more of men nowadays. Employers are beginning to learn to accommodate families more - and I see these transitions as positive and enabling for both women, men and kids.
I agree that formal support is a feature of institutionalising birth (and families).
I am loving the discussion by the way - i guess for me the question is not whether women should be supported - but in what way?
Rae.
The idea of mothering the mother always intrigues me - (and I know this is probably just a Rae thing....) but i don't think we should assume all women feel quite this needy when they have had a baby. When i have a baby I feel strong and capable and its not a time that makes me feel childish or in need of mothering (but as you know my mum's either working or thinking we will have everything under control anyway - so hard luck if I did need this - i'd have to give you a call!). When i reflect on my needs as a new mother - I like to be treated well (like adored, fed, smiled at) by my partner, given a bit of attention by me friends and family and i want some time away from my paid work. i don't actually feel like I need mothered. I am the mother - I just feel a surge of confidence and competence. Perhaps this is a consequence of non institutionalised home birthing?
I acknowledge not everyone feels so great postnatally. Thats just my perspective and only the perspective of one woman.
Not at all relevant - but I have a new car - i'm off to collect it this weekend -so cool!
before i start i feel I better apologise for monopolising the discussion - social issues for women is a favourite topic for me so I have a lot to say - is that bad blog manners? I have no idea - perhaps its got a term - bloggerboggerer? I guess other watchers are welcome to comment.....anytime...
Anyway have just looked at your questionaire re options for supporting women post birth. I want another category to select - I notice we have home help - but I think this assumes that the womans sole existence is in the home - and that does not reflect our lived or social reality any more. Can we have a category called support with paid employment - or financial support - which may allow us to take a breather from our paid work role (but not our pay packet) so we can indulge in this time with our babies, care for them, breastfeed them, stare at them for an hour or more, be near them, come to terms with this new situation, honour ourselves as mothers and our babies and the society we will be placing them in....or whatever the mother in us needs? Home help just doesn't really make the necessary contribution to my life at this time - or allow me the necessary freedom to mother. How do other women feel?
Rae
Great to have your perspective here Rae, thanks for that. Feel free to contribute as much as you like. It is good to have this discussion and consider things from a perspective I have not previously considered.
As you acknowledge not everyone has a Shaun (or is he Sean I can never remember), he is a wonderful man you know. I have found that it can be very difficult for some men to try to support their partner, manage the house work and the other children and cook meals etc etc. Yes men in general are getting better at this but I think many (but not all) partners of women having home birth find this really hard and could do with a wee bit of help.
I would love to hear Hannah's (or anyone else who happens by) opinion of the issue of what kind of support women need.
Regarding another category for the poll I am running. It is not possible to change this now as it has started but I do note your comment and agree financial support should have been one of the options.
Hmmm well yeah I quite like my partner - but I don't think this issue is as narrow as him - nor do i think a man participating in the grind of his own life is that exceptional or spectacular - women do it all the time. Its probably a huge effort at times but i don't think thats a reason not to have expectations of men. I'm pretty sure babies are born to two people so that the job can be shared - and I think there is greater capacity for society to support parents to share the role and keep it manageable for both parties.
On the issue of what kind of support women need - I expect we all need different things - but a good start might be for all new parents to be given the gift of paid time - to use as best meets their own needs. Beyond that women with particular circumstances may need additional options for support such as ? domestic fairies, meals, counselling, companionship. Other roles such as breastfeeding support etc I think are the brief of the midwife and every woman should have access to that....which brings us back to the problematic shortage of those....
Rae:)
Great comments Rae. Thanks
oh I'm not finished....seems a few thoughts came to me in the night..so here are my overnight thoughts on this....
in response to your comment that some men find it difficult to support their partner and contribute to their domestic needs - I have a question...
Who is the home help for then? Does this imply the home help is actually for the men - to make their life easier? Perhaps my unease with the whole home help thing is a belief that traditionally society has been structured around the needs and desires of men (they have been the majority policy makers I guess).
Is the home help thing an overhang from the ?1950's when women were under a lot of pressure to present men with the perfect home at the end of the day? Is that still such a priority? (I know for me it isn't - I can ignore housework - but it is harder for me to ignore the demands of my employer - hence the paid leave idea for families at this time...)
Another question I have is why do some men find it difficult to support their partner and make a domestic contribution? I think we should unwrap that idea rather than just accept it - and chuck public funding at the problem. I'd like to hear from some men.... Is it difficult because they are managing the outside demands of an employer? What are the barriers for them there? - or were they just bought up badly??? I don't know...
In response to the comment about men of women having homebirths having a particular struggle with this I have to say my experience in practice does not back this up at all. I have found in practice that one of the apparent benefits of home birthing is that the transition for the whole family seems to be significantly smoother, less of a drama for all concerned and less of a hardship or disruption than when the family is separated and spreads itself between an institution and the home. One of the benefits I see in homebirth is that men are never told to leave - it is their place/space - unlike a hospital where they are excluded. I've found they mostly take up this challenge with significant ease.
Rae
On the issue of doula versus midwifery assistant - i see these roles as significantly different to each other. A doula is there to provide support and asistance to the woman. A midwifery assistant - is an assistant to the midwife - presumably to support her to provide midwifery to the woman. As a NZ direct entry midwife - I believe the provision of midwifery care includes both tending to the clincial needs of the individual woman and supporting her social needs. This is a significant part of my identity as a midwife.
Rae
I agree with you about the respective roles of doula and midwifery assistant. I agree with you about the role of a midwife in NZ which is why I do not really think there is a doula role in NZ. Perhaps women who are having obstetric care might want to have doula though?
yes - that would free up the midwives.
Unwrapping and unraveling.
I do not think that couples or singles having a homebirth have a more or less easy or difficult time in adjusting to parenting or taking care of house, home, self and family. I agree that the transition to life with a new baby often seems much easier when the baby is born at home and life progresses without interruption. I do think that those who give birth in a facility have some expenses covered for them which it is only right and proper should also be available to those having a home birth. eg, birth pool, perhaps also meals for a couple of days, whatever. I do not think such help should be a compulsory component of homebirth as many couples will not want it or need it however it should be easier to obtain than it currently is. Should this be financial help only or should there be the ability to get home help? I don't know. If you get the money then maybe you can pay for the home help yourself if you choose.
Who would home help be for? I think it is for the family, so that they can spend time together sleep when they need to enjoy being parents and siblings.
Are men badly brought up?? Is it all their parents fault??? Interesting questions Rae.
maybe society has bought men up badly - by accepting lack of equity instead of addressing it.
Personally I see a birth pool as a fairly primary and essential piece of midwifery equipment and think all midwives should have this in their kit just as they do other bits and pieces.
rae
Interesting a kind of relevant - all holidays I have been trying to get my 13 yr old son to take the initiative of putting his cereal bowl in the dishwasher instead of leaving it - dirty on the benchtop above the dishwasher. It'd be easier just to do this for him - but if he's gonna be a dad one day I think he needs to learn to cope with life. A week ago he finally started putting them in the washer. But today he didn't bother . now I'm gonna leave then there for how ever many days it will take for him to address it. Oddly my 8 yr old daughter has never had a struggle with this.
god this is fun! But my kids really want a turn with the computer now...
catch you later
Rae
crikey, I dont even know where to start now. But thanks for inviting me back. I have just emailed Carolyn (the doula) and invited her. Its saturday and its sunny so I'll check in later :)
Re Carolyns comment: Who would home help be for? I think it is for the family, so that they can spend time together sleep when they need to enjoy being parents and siblings.
Do you think it is domestic tasks that prevent families from spending time together at this time though? Isn't it more likely that one (sometimes even both) parents need to be back at work? I think an option that supports some relief from this expectation/societal norm is good - at least to give those families who do want to take time together following the birth of a baby (for the benefit of the mother and the child) an option to do so.
i like the idea of the family being together to muddle through it all as a unit. I think being abandoned at home with a new baby is a lot to expect of any woman.
Rae:)
One more thing - many couples don't blink at taking time off to spend on their honeymoon - why is it such a stretch to ask for time to adjust to the birth of a new member of the family. An equally (at least) significant moment in a relationship i would have thought?
Rae
I totally agree. We should be able to take time off work to get together as a family. I do think we try to involve men in the pregnancy, encourage them to come to antenatal classes. be their and support their partner during the birth. In large facilities they are then shunted off out the door, thankfully smaller centres often let them stay. But then someone, usually the man has to go back to work. We should be able to spend a decent of amount of time together to get to know one another as a family. How much time, I don't know but more that a week or two I think.
My experience though is that, for some, probably a few men, getting back to work is an escape from the demands of family life. I know that should not be the case but I do think it is true. Are there any men out there reading this? I kind of doubt it. Where is Leigh when you want him?
yes poor old leigh - the sole male participant - what a responsibility!
I agree for some men - they use the workplace as their escape route and the current system caters to that quite well - but they'd still be able to do that, we are not removing free will here just opening up options.
I guess it would make it harder for men to excuse themselves from home to head off to work...hmmm try explaining that to the Mrs/Ms.
Lot a men don't feel like this though - well not in my circle anyway.
I have just found you really interesting blog and even though it was written ages ago I would like to make a couple of comments. I am the doula in Palmerston North that Hannah has mentioned.
I agree whole-heartedly with Rae that a doula provides support and assistance to women, while I believe a midwifery assistant 'assists' the midwife.
The majority of my work involves emotional support for the mum and dad (and any other support person they may have at their birth) as well as helping the parents to get the information they need to make informed choices.
There are many midwives that I have worked with who provide wonderful continuity of care. I find this enhances the relationship that I have with the woman. When she is feeling confident and nurtured/cared for she is much more positive and empowered. I also believe that these women on a whole feel more positive about their birthing experience.
Having lived and worked in many different countries I know that women are blessed with an amazing midwifery service here in New Zealand. It is however unfortunate that for a variety of reasons there is a gap in the (emotional and educational) care some women receive.
For this reason I see that there is a very real role for both birth and postnatal doulas in New Zealand.
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