In my post More about VBAC: Your input wanted. Hannah commented that she felt that the services of a Doula would help to reduce interventions such as Caesarean section. There is some evidence which supports this perspective however this has been conducted in countries other than New Zealand. In New Zealand women have access to free midwifery care for the duration of the pregnancy, labour/birth and postnatal period.
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