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Necessity is the mother of invention : the birth of the Pocket Doula, and why it works so well


Wood-cut style illustration of the Oceanid Eurynome
Eurynome, danced on the primordial sea bringing order and life in place of chaos. Image credit : https://legendaryladieshub.com/goddess-eurynome/

Way back in the mists of time, in December 2019, Laura, Ruth and I had one of the busiest Christmas’s we’d ever had. Some babies were born early, some babies were born late and some babies took their sweet, sweet time to arrive earthside. Very much the normal, slightly unpredictable, business of babies.

 

Then, as we were recovering in early 2020, rumours of an illness began to surface. We all remember this arc, from a sad but distant disease, to soap shortages, to home schooling in an alarmingly short period of time. We were all floundering then, wondering what the coming days and weeks might hold, and adapting our work and lives at pace to meet vague and shifting Covid measures. We doulas were fretting with our heavily pregnant clients on the phone about what this all meant for them. Would they have to wear masks in labour? Would their partners be allowed in to support them? Was it madness to opt out of a planned VBAC and into a planned caesarean, because this seemed somehow more certain and secure?

 

Those first weeks were frankly crackers for pregnant women (and by extension for doulas). Protocols and guidelines were changing rapidly, and communication between Trusts and women was patchy – because this was uncharted territory. We doula’s were doing our best to support women, but for the first time were having to navigate how to do this without being there in person. It felt desperately sad not to be able to hold the hands of the women we’d built relationships with, and as the weeks passed and it became apparent that things were not going to ‘go back to normal’ any time soon, it looked for a while as though women wouldn’t be able to call on the support of doulas, and we wouldn’t be able to give them the support they needed, thanks to the ‘one partner policy’ instituted across the NHS. 

 

As lockdown continued, a curious thing began to happen. Even though we couldn’t offer the support we thought was our bread and butter – attending births - we started to get more calls from women, rather than fewer. Sometimes we were asked to stand in as the birth partner for women who’s partners had no choice but to stay at home with older siblings. Increasingly though we were being contacted by women who wanted someone they could rely on through their pregnancy and as they prepared for birth, even though they knew we would not be able to attend them during labour. We began offering antenatal classes via Zoom (previously unheard of, now quite common). A pattern began to emerge; women would contact us asking for our support antenatally, knowing we couldn’t be with them; we’d meet them several times in booked Zoom calls; we’d go ‘on-call’ for them via WhatsApp, available whenever they wanted, just as we would do under ‘normal’ circumstances; we’d regularly talk them and their partners through those early rumblings, the establishment of labour, arriving at triage and settling into delivery suite; and our post-natal contact continued, just via Zoom. Ruth began to call to this ‘Pocket Doula’ing’

 

So far, so covid. But how is it that I’m still offering this ‘Pocket Doula’ service now? I think because this is an example of serendipity facilitating what’s really required. Perhaps ‘necessity is the mother of invention’ isn’t quite the right title here. Maybe it was less necessity, and more that Covid had a cathartically cleansing effect, like a firestorm, and at the end, once everything had burnt down, we despatched habits we’d fallen into, and replaced them with what women were actually asking for.

 

And what women want and need – evidenced by research, and our own experience – is regular contact with a known and trusted experienced birth supported. Yes, women need to know how their bodies work, and how birth happens (because it’s information we’ve expunged from our culture and fail to provide through the institutions we’ve replaced community with). And yes, this information can be provided in four classes, delivered consistently and like clockwork. But women want more than that. They want to understand the practicalities they’ll have to navigate in the NHS. They want to know the options available to them and start to consider how they’ll make decisions, and what is realistically accessible and tolerable to them. They want the freedom to create the conditions that feel comfortable to them, and to talk about compromises and contingencies. They really do want to understand about risk and how and when birth can be unpredictable. Women are not stupid, or naïve, or idealistic. They are pragmatic, realistic and determined.

 

This is why the ‘Pocket Doula’ is so popular. It gives women the space and time they need to mull over and consider their options in a way that the NHS currently cannot (despite the personal ethics and drivers of individual midwives, and ambition for ‘personalised care’ we keep hearing about). Meeting the same person every month for most of your pregnancy means you don’t need to repeat the basics, but you can revisit a conversation you’ve already had to delve a bit deeper. You can begin to put meat on the bones of the basics learnt in your antenatal classes and adapt that generic information to your own particular set of circumstances – particularly when if those circumstances begin to change. And, importantly, you have someone to call in the middle of the night when your anxiety flares, or your waters release, or you aren’t sure whether ‘now’ is too early to get in the car.

 

My job as your Pocket Doula isn’t to be present because you’re scared - it’s to instil in you the confidence to recognise your fear and use tools you can trust will calm it. My job isn’t to tell you which is the ‘right’ decision - it’s to ensure you’ve got information, insight and a reliable framework to make appropriate decisions when and if you need to (made all the easier for having rehearsed those conversations in the preceding weeks and months). Knowing each other builds trust and gives you someone you know you can rely on – yourself.

 

I’m finishing this blog off on a Thursday morning, having just returned from visiting one Pocket Doula client, and with one eye on my phone as another gently, comfortably, confidently begins her labour. This intimate work is both a privilege and a joy, and feels like an incredibly normal and natural part of life. Perhaps that’s why it works so well.


To talk about how Pocket Doula works, and whether it could work for you, click here or email me at charlie@thegoodbirthpractice.co.uk

 

 

 

 

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