With regional maternity wards closing across the country and a parliamentary inquiry into birth trauma underway, doulas are rising in popularity as a source of emotional support for women during pregnancy and birth.

Doulas are non-medical support people who offer educational, physical and emotional guidance before, during and after the birth of a child.

They have no clinical training, cannot deliver babies or provide the necessary post-birth medical care — but they can advocate for women and help them to feel empowered during their pregnancy journey.

Research has shown doula care for women during labour and birth is associated with reduced caesarean births, increased breastfeeding initiation and retention, and positive birth experiences.

Australian College of Doulas director Renee Adair said she had seen an increase in the popularity of doulas over the past 10 years, as women expressed dissatisfaction with the maternal healthcare system.

Renee Adair runs the Australian Doula College, which offers  the only accredited doula course in the country. (Supplied)

She said more regional women were training to become doulas because of the increasing need for their services.

“We know that women are going home feeling broken, when in actual fact we ought to be sending families home with a really soft landing place, and a doula can really help support that,” Ms Adair said.

In New South Wales, a parliamentary inquiry into birth trauma has heard testimonies from women detailing a lack of consent to procedures, inadequate pain relief and subsequent feelings of powerlessness after being mistreated by hospital staff while giving birth.

Ms Adair said it was a situation prompting women to seek alternative sources of reliable, continuous care during pregnancy.

Woman-centred care

On South Australia’s Eyre Peninsula, the sudden closure of birthing services at the Whyalla hospital in mid-2023 has meant local women now have to make the 76-kilometre trek to Port Augusta, or travel 385km to Adelaide, to give birth in a hospital.

It’s one of many areas across regional SA, including Kapunda and Victor Harbor, struggling to retain staff and keep birthing services open.

Further south on the Eyre Peninsula in Port Lincoln, Maya Puglisi became one of the area’s first doulas when she graduated from her training in 2021.

Maya Puglisi became a doula in 2021.(Supplied: Maya Puglisi)

Since then, she has accompanied more than 20 local women through their pregnancy and birth journey.

“You do it for love,” Ms Puglisi said.

“You’re there to make sure the mother feels empowered, that is my role.

“And that through each step of the way the information has been communicated to her about why they have to go to this certain next step and she has agreed yes or no.”

The broad scope of the doula role ranges from being physically present at the birth and liaising with the medical team, to going home to feed the new mother’s dog, look after other children and bring food for the new parents.

“The nature of being a doula is you might not be there for the birth but you’re there for them in the capacity that they need in that moment,” she said.

Georgina Shirley employed Ms Puglisi as a doula for the birth of her first child in 2022, because she wanted a consistent source of emotional support.

Maya Puglisi was Georgina Shirley’s doula in 2022.(ABC Eyre Peninsula: Amelia Costigan)

“As first-time parents, we were daunted by the whole concept and didn’t really know the best way to go about it,” Ms Shirley said.

“We had read about that continuity of care model, which is hard to get in the country.

“She was available 24 hours on call so you felt like you could call her at three in the morning, no worries, and she had that advice ready to go.”

Australian researchers conducted a survey of 6,000 Australian women’s experiences of birth and found that continuity of care was a priority.

It’s a gap in the system that doulas like Ms Puglisi believe they can help plug.

Australia has one of the highest rates of caesarean births among OECD countries.(Supplied: Photo by Amit Gaur on Unsplash)

High intervention rates in medical system

One of the key reasons women employ doulas is a previous traumatic birth experience, according to professor of midwifery at Western Sydney University Hannah Dahlen.

“The main reason that doulas have risen in popularity is because we do not provide enough humanised continuity of midwifery care,” she said.

“And women are often just wanting to have somebody they know who will be in their corner for the birth.

“Doulas are a familiar face where she may not know anyone else, but she knows that familiar trusted face and that helps to reduce their adrenaline which helps to maximise oxytocin and the endorphins that make labour go well.

Professor Hannah Dahlen AM addressed the NSW Parliamentary inquiry into birth trauma in 2023. (ABC News)

“Fear is the enemy of birth. And doulas are a wonderful way of taking that fear out of the birth room.”

Another key role doulas play is advocating for women’s preferences in the birth space.

Australia has some of the highest caesarean rates of OECD countries, and interventions such as episiotomies, inductions, and epidurals have increased over the past 10 years.

The rate of labour induction has increased substantially: 44 per cent of first-time mothers were induced in 2021, compared with about a quarter in 2010.

These procedures are often necessary to ensure a healthy delivery, but women have told the NSW parliamentary inquiry that they have left their delivery experience traumatised due to being ill-informed about procedures.

Ms Adair from the Australian College of Doulas said birthing in the medical system could be an overwhelming process for women who may not understand the options they are presented with.

“Women have to understand that they can say no and they have a right to refusal for medical intervention,” Ms Adair said.

Doula care for women during labour and birth is associated with positive outcomes, according to research.(ABC News)

“Unfortunately in today’s culture here in Australia so many women are fearful of birth that they tend not to push back.”

The ABC recently investigated the trend of freebirths, in which an expectant mother chooses to have no professional medical contact at all during her pregnancy and the birth of her child.

The article looked at the role of doulas in freebirth pregnancies and recounted a tragic outcome for a baby who died. 

Ms Adair stressed that conducting a delivery was beyond the remit of a doula and could be dangerous.

“Doulas attending and pretending to be lay midwives or midwives is not cool,” she said.

But she observed that women choosing freebirth may feel alienated by the medical system or a lack access to medical care.

Regional women face extra barriers

According to the Australian Institute of Health and Welfare, increased travel time to birthing services may be associated with a higher risk of postpartum haemorrhage, an infant being born in transit and perinatal mortality.

But in regional, rural and remote Australia, women often don’t have a choice.

Birthing services were suspended at Whyalla Hospital in June 2023.(ABC News)

Professor Dahlen said the current state of maternity services in Australia treated regional women like “second-class citizens”.

She said the pattern of hospitals closing in rural and remote areas meant women were having to travel further distances for birthing.

This meant there was a higher incentive for women to opt for intervention, such as a scheduled induction or caesarean birth, in order to be able to schedule the trip.

“We’re creating something that is not in the best interests of women, and we need to treat women equally across this nation,” she said.