Response to the Consejo General de Enfermería (General Nursing Council, Spain) ‘Dossier de prensa – La verdad sobre las doulas’
The European Doula Network (EDN) is a non-profit umbrella organisation with a membership of over 30 Doula associations and training courses organisations across 19 different countries. The network supports doulas across Europe in establishing formal, accountable organisations in their countries and shares an ethical philosophy on the role and boundaries of a doula as a non-medical support person for women and families in the childbearing year.
The EDN is astounded to learn about the ‘Informe Doulas’ Report and website from the Consejo General de Enfermería (General Nursing Council) in Spain. The Report and website contain allegations against doulas which could be considered as defamatory, falsley accusing them of engaging in harmful activities. The report links doulas to issues that are outside of the scope of practice of doulas, without providing any real evidence.
We are shocked and saddened to see that the Council did not consult any Spanish Doulas Organisations, or the parents and the medical professionals who have been working with doulas for several years now, in preparing this report. Neither did they examine the medical evidence and publications available from international studies going back over decades.
Doulas: evidence based support for women and families
Doulas provide continuous emotional and practical support, for mothers and couples, through pregnancy, birth and immediately postpartum, also providing flexible practical and emotional support postnatally for new mothers and families in their own homes. Doulas are usually experienced women and mothers who have undertaken a doula preparation course.
Doulas support women and families from all ethnic, religious, social backgrounds, including couples and single parents, same sex parents, low income families and executives, students, lawyers, midwives and doctors etc.
Doulas spend time building a relationship with the families they are supporting. They offer space and time for parents to discuss and reflect upon their own situation, their needs, past experiences and options in childbirth to enable them to move towards a positive experience. Doulas are not there to take the place of a father-to-be or partner during a birth, unless parental choice, circumstances or cultural pressures mean that the mother’s partner is unable to be with her during labour and birth.
Doulas do not take a clinical role, they work alongside their client’s care providers, supporting clients in their own choices. At all times a doula is led only by her client’s wishes and does not make specific recommendations, though may signpost to evidence-based resources and information.
The evidence from research (Hodnett et al. 2013. Brigstocke S, 2014. Goldbort J, 2002) is that support from a doula can mean:
- Reduced risk of Caesarean birth.
- Reduced risk of instrumental birth.
- Reduced need for painkillers or epidural during birth.
- Reduced rate of induction of labour.
- Shorter labour.
- Increased satisfaction with women’s experience of birth.
- Increased likelihood of initiating breastfeeding.
- Reduced risk of, or severity of, postnatal depression.
- Increased likelihood of successfully establishing breastfeeding and breastfeeding at 6 weeks.
Furthermore, the 2013 Cochrane Review on continuous support for women during childbirth concluded that:
“all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training [i.e. a doula], appears to be most beneficial.” (Hodnett et al, 2013)
The 2012 commentary by The World Health Organization Reproductive Health Library ‘Continuous support for women during childbirth’ states:
“Considering all the advantages and possible lower costs to the health system associated with the presence of a doula (less likelihood of cesareans sections and analgesia use), covering the cost of doula services should be considered by policy-makers.”
In the UK, doulas are an accepted part of maternity services. Some National Health Service (NHS) hospitals employ doulas and other have doulas as authorised volunteers, coming onto wards to support new mothers. Doula UK (founded in 2001 and the main organisation for UK doulas) has regular meetings with the Royal College of Midwives (RCM) and is represented at Parliamentary Group meetings. Doula UK and some charities provide a free service of support for vulnerable women in the UK. In Poland, doulas are “regulated” and recognised by the government since January 2015, with the Doula in Poland Association being registered in the National Court Register as a Non-Governmental Organisation (NGO) created to unite and educate doulas.
In the USA, DONA International, the world’s oldest and largest organisation of doulas, was founded in 1992 by a small group of some of the foremost experts in childbirth. DONA International now has over 7000 members around the world.
Around Europe, laws, policies and practices vary that affect a woman’s ability to choose where she gives birth, with which medical attendants (or none) and with whom to support her. In France, a doula can be at a birth at home only if a midwife or doctor is present and in other countries, birthing at home with midwives may not be possible. In contrast in the UK, women have the legal right to birth at home if they wish, either with midwives or unattended, whether or not a doula (who is not a medical attendant) is present. In The Netherlands and some European countries, it is standard to allow at least 2 birth partners for a woman in labour, whereas other countries, including Spain and Poland, often make a woman choose only 1 birth partner. Sadly some public hospitals in Turkey will not allow anyone to support the birthing woman.
The 2013 Cochrane Review stated that “in many countries… continuous support during labour has become the exception rather than the norm. This may contribute to the dehumanisation of women’s childbirth experiences. Modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour.” (Hodnett et al, 2013)
The European Convention on Human Rights offers protection to all individuals making choices in childbirth. In recent cases the courts have asserted that Article 8 of the convention protects a woman’s right to decide the circumstances and location in which they give birth. Women should never have any medical procedure performed without consent, should be able to decline unwanted interventions however minor they may seem to staff and should always be provided with sufficient, objective and unbiased information to make an informed choice. In extreme cases disrespectful treatment during childbirth may also violate Article 3 of the convention which relates to cruel, inhuman or degrading treatment.
Concerns about restrictive or non-evidence based policies, and adverse outcomes, may cause women to choose a birth place and situation that is out of the norm for their locality.
The EDN are calling on the Consejo General de Enfermería of Spain to rescind their ‘Informe Doulas’ report, and remove the website, immediately, and conduct a proper consultation, including a balanced consideration of all the evidence, before producing a replacement. The EDN would be very happy to participate in such as a consultation.
The EDN will be supporting the Spanish EDN members to seek legal guidance regarding steps to take in response to what we believe to be defamatory, false statements contained in the report and on the ‘Informe Doulas’ website.
The European Doula Network.
26th February 2015
Additional Information & References
The European Doula Network (EDN)
The European Doula Network (EDN) was created in 2011. It is a non-profit umbrella organisation with a membership of over 30 Doula associations and training courses organisations across 19 different countries.
The network supports doulas across Europe in establishing formal, accountable organisations in their countries and shares an ethical philosophy on the role and boundaries of a doula as a non-medical support person for women and families in the childbearing year.
Doulas in the UK, a charitable purpose
In the UK, there are organisations, such as Birth Companions and the Doula UK Access Fund, which enable vulnerable women, such as those who are, have been or are at risk of being detained, those in a domestic abuse refuge, refugees or those in financial hardship, to access doula support for free. In some areas, doulas are also employed by the National Health Service (NHS).
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