I had never heard of the word ‘Doula’ before. As I discovered later, ‘Doula’ is a Greek word which signifies a hands-on service to a mother who just had a baby, very much like being her ‘servant’ seeing to her needs. Wasn’t I surprised when I first heard the word! I had been giving the service for many years, without a name to describe it! “No, I’m not her midwife! No I’m not her mother! I am…. kind of,…something in between!”.
There has always been a Maltese name for a midwife, actually two words in Maltese: ‘qabla’ derived from Arabic, and ‘majjistra’ leaning more towards Italian. Lately, the English version ‘midwife’ is the name given to the person who is a professional and medically trained person, usually a woman, who assists mothers in labour and birth. But while a ‘doula’ service was very much present within the community, as most mothers would be providing it automatically all the time, it was not recognised as a profession. They didn’t even have a name for it.
Dedication and Experience
Until seventy or so years ago, the midwife was simply an experienced mother who loved doing the job with so much dedication that she made herself available to assist births in mothers’ homes at all times, whenever she was called. She may have had an assistant friend of hers to help her, but mostly, all mothers had women friends who would promise to be there for them at whatever time they were needed. This network which proved successful for thousands of years, was made up by the ‘unqualified’, but definitely highly experienced women who were the forerunners of midwives and doulas of today. Come to think of it, though unofficial, the accepted midwife profession and the unrecognised Doula role has been going on since time immemorial. Mothers assisting mothers to give birth was the most obvious thing, a most reassuring part of life within the family, within the community.
Mothers helping mothers
In time, the roles of mothers helping mothers morphed into two categories:
1) a midwife who was the person associated with the physical birthing of the mother and catching the baby at a home birth. In a close-knit community, the midwife met the mother more than a few times during pregnancy, probably at the grocer’s shop or at church. Then after attending the birth which happened on the day the baby ‘knocked’, she would visit the mother for the first couple of days, to check that all is well. If not, she would refer to the village doctor. Having been present in a most intimate part of her life, the mother would honour the midwife for the rest of her years.
2) the ‘doulas’ who were the women within the family, or friends who usually lived in the proximate vicinity or even within the same house where the pregnant mother resided. Some would immediately be there for labour, call the midwife, assist during the birth and then continuously see that the new family is attended to, birthing room cleaned, bed linen and towels washed, the new mother fed and cared for, baby fed and generally doing well, siblings ‘adopted’ by nearest and dearest for the first few days, house organised and all was well.
The first 40 postpartum days
For many a time did I hear my own mother say that the first forty days after birth were considered crucial for caring for the mother. She referred to this time as ‘sacred’, even to the point that new mothers would be considered ‘one foot in the grave for the first 40 days after birth’, so had to be treated with special care. Indeed, the unofficial doula’s job within the community was on-going and never-ending. Babies were born practically every day somewhere in the village. Every family helped each other with women being there for each other, not only for 40 days but for months and perhaps years as the need arose. The extended family and the close-knit community was indeed a blessing, the best thing that could happen to mothers. This worked for hundreds, indeed thousands of years with nature, as always, seeing the survival of the fittest unfold with success, while sacrificing a number that sadly would not make it.
From Home to Hospital
Then society changed. Births were taken into a hospital, with the premise that it was safer. It may have been safer for some, but certainly not for all. Births were suddenly turned into medical events. All mothers were admitted within the hospital birth ward, alone with no one familiar anywhere near. The change not only affected the physical aspect of birthing, but more drastically, it changed the psychological, emotional and social aspect for the mother.
Mothers lost their identity and their supporting team of familiar mothers around them. All the women they met in the hospital were unknown to them, were medically trained, even referring to the mother as the ‘patient’ in bed no. 10. Hospital gowns were worn by mothers for ‘better’ hygiene. From the warm, loving, familiar and homely atmosphere of births at home, birth became a clinical, cold, strange and fearful experience happening in a place usually associated with disease and deaths.
With this turn of events, birth became simply a case of getting an alive baby out of a ‘container’ that had held him for nine months, no matter how. No one familiar to the mother was allowed within the birthing room. She had to face the birth experience all by herself. With the old and the newest vision of birth today, this can be described as utterly ‘inhumane’. Sad to say, I come from the generation caught between the two experiences as a birthing mother myself, forty-six years ago.
I had the first experience of birth in the public hospital, for the reason that, to my perception, that was considered the safest. Induced by artificial rupturing of membranes, continuously lying in a bed for many hours moaning and groaning, at a point in time I was asked to turn to my side and immediately was surprised by a prick which resulted in me not knowing what happened after that. Then hours later I had to wake up and “PUSH!” to the loud calls, which I did as best I could. Stitches resulted with loads of discomfort in many ways. Convinced that it was how it should be, I accepted it as my launch into the mission of motherhood. Ignorance is bliss! My firstborn lovely baby girl was somehow born.
My second experience was very different. I had accidentally come across an advert for a childbirth preparation course given by a foreigner who resided in Malta for a while. I attended, and this time round, birth made so much sense. I got to know my true role as a birthing mother. Much happened in between, but suffice it to say, that after the midwife noticed me behaving very differently from the way mothers usually behaved during the ‘pain’ of birth, she began to ask me a few questions. After a little explanation on my part in between contractions, she miraculously allowed my teacher into the birthing room, more out of curiosity than out of compassion. Nevertheless, this happened within a hospital system which never ever allowed mothers to be supported by a non-medical person. I cannot be grateful enough that it had actually happened. My teacher was my childbirth educator who had offered to spend early labour with me at my home and then accompanied me to hospital, thinking she would only be waiting outside the ward as usually done by family members. Highly surprised for being called in, but without waiting for an explanation, she immediately took the role of a Birth Doula, probably the first in the history of hospital births in Malta.
The experience was all I needed to notice the value of having a familiar person in alien surroundings. This was the trigger I needed to come out into the world declaring that no woman should ever be made to go through birth without someone familiar by her side.
Fathers
I was on the forefront to see that this came to be. Years later, husbands started to be allowed to enter the birth room, but only at the pushing stage. With little wonder, not being there to be part of the build-up from early labour to transition caused a good number of husbands to faint during births. Entering the birthing room at that stage was a sudden shock. The authorities were inclined to withdraw the concession of husbands attending births. It took much explanation to show that it was not the husband’s fault, it was the system’s mistake to let the husbands in at the wrong time. Husbands should accompany the mother throughout the whole process of childbirth. Also, good preparation for childbirth was crucial for both mother and father. They needed to know what to expect and how both can give their very best to make the most of nature’s power during childbirth.
Allowing only one person to every mother does not give justice to the cause. Studies show that some men may not be the best persons to be present to support a mother at her most vulnerable, but at the same time at her most powerful moments of her womanhood. Many male partners know their role and do it exceptionally well. Others need support to be able to give their best. The role of the Doula is there to be sensitive to both the mother’s and the father’s needs. She is also the in-between person bringing together the couple she is familiar with to the medical staff who usually works on shift. Besides staff not knowing the mother before, change of shifts may happen at the wrong time and the mother will need time to adjust to the new faces when she is the least ready to do so. A Doula, familiar to both mother and staff, is the perfect person to bring the team together for everyone’s satisfaction.
Coming home with a new baby
Soon after the birth, unfortunately not all new mothers are able to come home to a family that is available to support them. Travelling from one country to the other, smaller families, grandmothers working, among other circumstances, have contributed to mothers being very much alone in the first days postpartum. This is most unfortunate as it contributes to more mothers going through loneliness, malnutrition, exhaustion, baby blues and depression. Here is where today’s qualified Postpartum Doula comes in, offering a combination of physical, psychological, emotional and social comfort and practical hands-on support as needed.
Doula service for all
I am so grateful that I have had the opportunity to be able to be present in such a situation for many a time during my forty-three years of offering childbirth education and a Doula service locally. The sad thing is that I could only do it privately, to families who could afford to pay. Over the years, as the first childbirth educator/doula in Malta, I have contributed to a number of innovative ideas locally. Among others, this includes starting childbirth preparation courses, introducing back the idea of respecting nature’s way of birthing babies, helped in the setting up a Birth centre, introduced water births, organised Mother & Baby/Toddler Clubs, set up of a School for Parents and took every opportunity to bring out the importance of Childbirth & Parenting Education through the media. The idea behind it all was to empower women and their families and lead them to a confident, generally ‘feel-good’ way of parenting. My wish is that childbirth education and one-to-one doula service would be introduced as a choice to all mothers within the public hospitals - and schools - on the island, free of charge, like other important professions, doctors, midwives and social workers who are paid by the state to provide the service to all who wish to have it. If there ever was a case of ‘Prevention is better than cure’, this is the one!
How it came to be
A teacher by profession, I never planned or even thought I would be introduced to a Childbirth educator and a Doula career in any way. I am the fifth child in a family of six. The first girl after four boys, my impression of my childhood that I carried with me through life, was that I was extremely loved and respected. Raised in my time, I have to admit I did have childhood fears of the possibility of me ending up being the Cinderella of the family as the girl whose duty was to look after everyone else in the family. As it turned out, it never was a problem as I had two parents who constantly encouraged me to move on. My first years were spent trailing behind my brothers, trying to keep up with them, as they always happily let me be a part of their numerous challenging ventures. I am pretty sure that my childhood experience shaped my character in many ways.
The only area where I could be an absolute winner in relation to my siblings was indeed, motherhood! We were blessed with a role model of a mother for whom we are so grateful to this day. From her I have heard over and over again all the lovely birth stories of me and my siblings and of the many other births of friends and family she had assisted within the village. My own birth was special in its own way. A breech, born at home, assisted by the village midwife, whom mum and all the mothers around knew well and held in high esteem. Oh yes, come to think of it, without her knowing, my own mother was a Doula! Perhaps that is where I got my inclination. The surprise is that no, I don’t mind at all being a servant for a while, a Cinderella to a new mother, until I see she can go on without me. Then it is time to move on to the next….A great satisfaction, indeed.
This story is brought to you by our honorary member, Marianne Theuma, who is considered the first doula on Malta. She is an inspiration for us all.
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