Ilithyia Inspired Birth Servant: Birth Servants: Mortal Ilithyiai

A birth servant is a professional birth attendant, often referred to as a "doula". The word "doula" is derived from the Greek word for "female servant" or "handmaiden" (Kitzinger 2005: 156. See also; Targett 2006: 144; England & Horowitz 1998: 207; * ). Her role involves providing emotional and physical support to a family during pregnancy, birth, and the weeks after birth.

A birth servant is employed and paid by the family as a private birth attendant (*). She has no medical training and cannot give medical advice or administer any medical treatment, her role is purely supportive. In her book A Labour of Love (which is endorsed by the Australian College of Midwives) Gabrielle Targett states:

A doula is often referred to as the "missing link" in maternity care, because the medical care providers often don't have the time to offer the sort of care and comfort that a doula can, as they may be looking after other women at the same time. As well as this, medical staff often can't provide massage for the labouring woman for hours on end, or simply be in the birthing room as emotional support. p.145.

Today's birth servants are what midwives of old were: women who are with women during birth. They occupy a totally different space to those at birth with medical training, they're focus is not on all the things that can go wrong in birth. Rather the birth servant's focus in on serving the woman in labour, making her as comfortable as possible and assisting her in getting the birth experience she wants for her and her baby:

Typically, a Doula will meet with the family on a number of occasions during the pregnancy to build a strong and trusting relationship. The Doula listens to the mother and empowers her to seek out any relevant information so that she can make informed birth choices. When the woman goes into labour she will contact her Doula and they will arrange to meet at the hospital [sic]. The Doula is not responsible for any medical care, as this is entrusted to the hospital staff [sic]#. She will undertake many comfort measures [as] requested by the mother during her antenatal consultations. The Doula will then remain with the woman throughout the labour and into the immediate post-partum period, until the mother feels comfortable and ready to rest with her newborn. The Doula is a professional support person who understands the processes of labour and nurtures the mother, enabling her to have the optimum birth experience. (*)

For some pregnant women a birth servant is seen as superfluous because they assume they will get all the support they need from their partner, or a friend, or a relative, or the staff at the institution where they have chosen to birth. But there is a vast difference between the kind of support a birth servant will bring to your birth experience compared to any of these people.

Birth servants provide women with continuity of care. Unlike an obstetrician, or a nurse, or hospital midwife, a birth servant provides constant support to the labouring woman during birth, as well as ongoing support in the weeks after birth. Research in the United States shows that nurses only spend 6% of their time providing support to women in childbirth (in Kitzinger 2005: 156). No matter how supportive they might like to be, they simply do not have the time.

The importance of continuity of care during birth cannot be underestimated. Kitzinger (2005: 157) writes:

There is strong research evidence to show that continuous support in childbirth reduces the use of pain-relieving drugs and lowers the epidural rate. It makes stimulation of labour with artificial oxytocin less likely, shortens labour, reduces the likelihood of forceps or vacuum extraction, cuts the caesarean section rate, reduces the chance that the baby may have health problems after birth and need to go to the special care nursery, reduces fever and infection in the mother and bleeding after childbirth, and reduces levels of anxiety and postpartum depression. Mothers have a more positive experience of birth and feel more in control. Having a doula increases the chances of breastfeeding successfully, even when there has been no discussion about breastfeeding.

Throughout pregnancy the birth servant and expecting family have regular meets to get to know each other, exchange important information (birth servants each have their own set of resources such as books, CDs, DVDs etc. which they loan to their clients as part of their services), and plan for the birth ahead together. Individual birth servants may have additional skills that the expecting family can benefit from, for example one of the birth servants I hired to attend my partner and I during our freebirth was a bach flower essence practitioner. Another example would be formal training in massage or breastfeeding consultancy/counselling.

While a supportive partner is a fantastic asset to a woman during childbirth he or she could become a liability once labour really kicks off. It can be hard work for someone who cares about the birthing woman intimately to watch her endure the natural challenges of labour, and it is not uncommon for these loved ones to suggest unnecessary interventions in order to ease their own concerns about the woman they love. But a birth servant does not replace the partner/father in birth, Targett (2006: 145) writes:

A concern that fathers often have when a doula has been asked to attend a birth is, "What is the doula's role and where do I fit in?" In no way does a doula replace the partner - if anything a doula is present to reassure the partner that the birth is going how it should be and to keep the partner informed and educated about what is going on. This ultimately helps fathers to feel more relaxed and calm about seeing their partner in labour.

She quotes one father's reflections on having a birth servant present at the birth of his child:

Initially I was reluctant to have an "outsider" at our birth. In hindsight, however, I am incredibly grateful to have had Gaby's intuition, skill, sensitivity and support, which she brought to every aspect of the birth. It took an enormous amount of pressure off me and allowed me to enjoy the whole experience in a way I don't think would be possible had we not had a doula. (Targett 2006: 145).

One study found that hiring a birth servant actually strengthened a couple's relationship (in England & Horowitz 1998, 209). 71% of couples in the study who hired a birth servant felt that their relationship had improved, and 85% of the women reported increased satisfaction with their partners six weeks after the birth (in England & Horowitz 1998: 209).

Unlike a sister, friend, or mother, a birth servant is hired specifically to serve the birthing woman as she wishes to be served. When allowing a close friend or relative to enter the birth space labouring women run the risk of their support people bringing their personal attitudes, experiences, and agendas with them, and the possibility that they will push these onto her. For example, I have heard of instances where a close friend or relative has acted as a support person and has previously had caesareans or used drugs in their own births and undermined the woman in labour's attempt to have her own natural birth by suggesting that she do the same as they did. A birth servant has training in how to be the best possible support to the birthing woman, and part of this training is learning to put her own agenda aside and focus entirely on assisting the woman get the birth that she wants, not the birth that the birth servant herself had. With a birth servant your birth is all about you, not your mother, sister, or friend!

Furthermore, birth servants have experience within the current maternity system. Pam England and Rob Horowitz said it best when they wrote of a loved one: "He may be smart and trustworthy, you may love him, but in the Himalayas you'd both be a lot better off with a Sherpa!" (England & Horowitz 1998: 207). Birth servants know birth and they are used to working with and within the contemporary birthing culture (unlike a grandmother or a partner). The sad reality is that "[currently the system] is too focused on the needs of the hospital rather than women" (Kitzinger 2005: 162). For example birth servants are aware of the time constraints put on labour and the methods that might be used to speed things up when it isn't medically necessary. Imagine watching someone you love endure labour for hours and then a medical professional suggest things could be going better or faster and telling you that if it were them they'd opt for intervention a), b), or c). Many people aren't aware of the massive power imbalance they will be confronted with when they enter a medical institution for birth, and how scary it can be (particularly after many hours of no sleep!) to have an expert suggest things could be going better. It's during these times that a birth servant is the greatest asset!

A birth servant can eliminate some of the fear and anxiety for both the birthing woman and her support team by asking the hospital or birthing staff to give them space and time to discuss all the options and make a decision when the birthing woman is sure it is the right thing to do (as opposed to as soon as when it is suggested). Even though she can't make the decision for the birthing woman, or recommend which option she should take, a birth servant will be able to help her discuss all her options and give her information other people present at the birth might not be aware of, or have neglected to share. England and Horowitz (1998: 207) summarise this aspect of a birth servant's role thusly:

When procedures or drugs are being considered, the doula helps parents become an active part of the decision-making process by teaching them to ask the "right" questions. Without adding her own agenda, the skilled doula assists parents in making informed decisions.

My partner and I learned one such technique from the very experienced birth attendant R hea Dempsey at one of her birth workshops. Dempsey suggested that partners take a flash card with them with the following written on it:
Benefits?
Risks?
Alternatives?
Now?

She recommended that when any interventions where suggested, to ask the following questions before making a final decision: what are the benefits and risks of the intervention, what the alternatives are and when the decision must be made? Having a birth servant present to help answer these questions and provide additional information can help a couple reach a decision (for example, a birth servant may be aware of alternative options that others present at the birth are not).

To really understand the difference a birth servant can make to your birth experience just look at the statistics. Having a birth servant present at birth has shown to:

Reduce caesarean rates by 50%
Reduce epidural request rates by 60%
Reduce induction by oxytocin by 40%
Reduce analgesia use (pethadine hydrochloride) by 30%
Reduce forceps delivery rate by 40% (Targett 2006: 144, *)

The presence of a birth servant has also been shown to reduce the length of some women's labours by a couple of hours! (see England & Horowitz 1998: 209).

Given the many forms of support birth servants offer, and their power to ease women's discomfort during birth, it can be said that birth servants are mortal birth goddesses, or Ilithyiai.

birth servant at work

Resources

Rhea Dempsey. Embracing the Intensity: Transforming the Pain. Workshop. Melbourne. December 2007.
Pam England and Rob Horowitz. Birthing From Within: An Extra-Ordinary Guide to Childbirth Preparation. Albuquerque: Partera Press. 1998, pp. 207-
Sheila Kitzinger. The Politics of Birth. Edinburgh. Elsevier. 2005, pp.155-164.
Gabrielle Targett. A Labour of Love: An Australian Guide to Natural Childbirth. Fremantle. Fremantle Arts Centre Press. 2006, pp.136-148.
Marsden Wagner. Fish Can't See Water: the need to humanize birth in Australia. 2000. Available from: http://www.acegraphics.com.au/articles/wagner03.html