AN EVER-GROWING number of Scottish women are paying up to £600 for extra help during childbirth because they feel let down by NHS maternity services.
Figures show that in Scotland there are now 31 doulas - women who provide one-to-one emotional and practical support during pregnancy, birth and the postnatal period.
But the news has led to warnings that the role of a father in the delivery room
and after the baby has been taken home could be undermined.
In the past year, doulas have overseen an estimated 52 births in Scotland, compared with 32 in the previous year. The trend demonstrates increasing dissatisfaction amongst women over NHS midwifery services, according to the Scottish Doula Network (SDN).
During pregnancy, a doula will typically meet the woman several times to get to know her fears and concerns from any previous birth experiences. She will help the woman during the birth with advice and medical knowledge.
At the birth, the doula will provide comfort, encouragement and practical support. After the birth, women can talk through the experience with the doula. Some doulas specialise in postnatal support, helping the woman with breast-feeding, household chores and providing emotional support.
"A negative experience of birth is prompting many women to seek the support of a doula for the birth of their next child," said Adela Stockton of SDN.
"Many women don't feel they get the support they need from maternity services, particularly emotionally. They feel shunted around from pillar to post during birth, often seeing several midwives. Some are left alone in the early stages.
"Midwives do their best. But they're caught between a rock and a hard place, acting on behalf of the NHS and the woman.
"This can leave the woman feeling ignored, powerless and stripped of dignity. Having a doula by her side, particularly in hospital, gives her some of that back."
However, some are concerned that the traditional role of the father or other family members could be put to one side.
Margaret Davidson, chief executive of the Scotland Patients' Association, believes the service is little more than a luxury.
She said: "The father and the midwives are already there to help her. What happens if you don't have the money to pay for the services of a doula? This will lead to a two-tier system where only those who can afford it can hire one. Everyone should be entitled to the same treatment."
In Edinburgh, the city's two experienced doulas are already fully booked. Three new doulas have arrived in the city since January, with four more due in May. In the Glasgow area, four new doulas have emerged since January to complement the existing two.
While demand is highest in Scotland's cities, women in other areas, including Dumfries, St Andrews and Helensburgh, are also hiring help. In Inverness, the arrival of a new doula in May will complement the existing two to meet demand.
The word 'doula' derives from the Greek for 'woman caregiver'. Unlike midwives, doulas are not medically trained. Their role is to provide emotional and practical support.
While packages can cost up to £600, a typical hire costs around £300. This includes two antenatal visits, attendance throughout birth, one postnatal session and unlimited contact via phone and e-mail.
"The growing popularity of doulas reflects the shortages of midwifery staff and the fragmented services in many areas in Scotland," said Nadine Edwards of the Association for the Improvement of Midwifery Services."
A report published in January by NHS Quality Improvement Scotland gave midwifery services a glowing report, with 14 health boards providing one-to-one care.
But experts warn Scotland is on the brink of a severe shortage of midwives. While the problems are more acute in England, where shortages are compromising one-to-one care, health professionals agree that Scotland is heading for a crisis.
"The problems in England are creeping north. Meanwhile, many midwifery staff are approaching retirement. We urgently need more staff to fill the gap," said Valerie Fleming, professor of midwifery at Glasgow Caledonian University.
"It saddens me that women are turning to doulas. It shows that midwives are concentrating too much on technical issues rather than supporting the woman emotionally."
Extra support during childbirth that helped give confidence and control
Linsay Spry hired a doula, Kim Bradie, for the birth of her second child, Jocelyn, in September. The Edinburgh mother-of-two says the extra support transformed the birthing experience.
Speaking about her first birth, Spry, 30, said: "Evie was breached at 35 weeks. I wanted to go into labour before having a caesarean section. But the midwife told me this was dangerous and irresponsible. She said they wouldn't be able to fit me in and it could have serious repercussions.
"I broke down in tears. I respect the medical judgement. But the midwifery staff could have involved me more in the decision-making.
"I wanted a water birth for the second birth. I also didn't want any drugs. I met a lot of resistance from the medical staff. If it hadn't been for Kim, I wouldn't have been able to stay at home for as long as I did. I also know I would've most likely had drugs if Kim hadn't been there.
"The doula gives you the confidence to take control. I had an amazing birth, without drugs or intervention. Without a doula, I doubt that would've been possible."
Bradie, an Edinburgh-based doula who has delivered about 33 babies in the last three years, said: "Linsay was keen not to go into hospital early as that can increase the chance of intervention. For her the key was having the confidence to be at home with support."
Helping hand
Doulas originated in the US, where they now help out at around 5% of births.
In the UK, where registered doulas complete a training programme, celebrities such as Davina McCall have endorsed their help.
Hiring a doula costs around £300. This includes two meetings before the birth, attendance throughout, a postnatal session and unlimited phone and e-mail contact. Prices can rise to £600.
Research shows doula support can reduce the need for drugs, forceps or even caesarean section in childbirth. It has been shown to encourage breast feeding and avert post-natal depression.
The full article contains 1055 words and appears in Scotland On Sunday newspaper.
