“He’s such a narcissist” – a phrase you’ve most probably heard someone you know say. It is interesting to me how the narcissistic personality has come to symbolise what’s wrong with the modern world. The term has been thrown about a lot more since social media has taken over and it was possibly at its zenith just after Trump was elected. Hot on the lips of so many, but do we really know what it means and how it’s a problem?Read More
People often ask me what area of psychology I specialise in. In South Africa we get a general training and are not required to specialise. Any specialisation is really just a personal affinity to one or more subjects and a desire to further one’s learning in that field. Attachment Theory always stood out for me during my training as it is well-researched and there is conclusive evidence to back it up. I also like the idea of making an impact on early development because it is rare as a psychologist to find preventative interventions.
To this end, after gaining my professional qualificationRead More
“I have as much rage as you have
I have as much pain as you do
I’ve lived as much hell as you have
and I’ve kept mine bubbling under for you”
– Alanis Morissette
Anger is an emotion just like any other e.g. fear (worry, anxiety), sadness, joy, or disgust. We should therefore be entitled to feel and express our anger just like we would express our fears or our happiness. But take a moment to think about your experiences with anger.
How do you feel about your anger? How do you express anger? Have there been times when you’ve wanted to express anger but felt stifled? Or has someone actually explicitly told you that expressing anger is wrong?Read More
It’s mother’s day on Sunday and I am reflecting on my relationship with my own mother. It is a tradition in our family that mother’s day was celebrated more often than not with words rather than gifts. Since as far back as I can remember, my mother’s day offerings were written tributes of love. I would thank my mom, using this day to commemorate her efforts, her effect on me. How funny to think I was already writing gratitude lists long before this blog was even imagined.
And so in line with tradition, my blog today is about this pivotal figure in my world. My mother.
There are many aspects of her being that have been shared with me over the years – her generous heart, her loving embrace, her liberal nurturance, her wacky worldview – the list could go on. The gratitude list has swelled with each passing year. Her love and insights continue to be greatly appreciated. But today I want to focus on a specific element of her maternal offering, something that she probably wouldn’t even consider something that she has intentionally bestowed on me.
I want to talk about how she taught me feminism. Notice that I don’t say she taught me about feminism. She taught me how to do it. She showed me what it means to be a woman. Fiercely so. And she demonstrated that fierceness with obstinate individualism and willful independence, which was acted onto the world as a celebration of personhood.
“It’s not my responsibility to be beautiful. I’m not alive for that purpose. My existence is not about how desirable you find me.”
― Warsan Shire
My mother never taught me not to shift-shape to fit in with society’s (read patriarchy’s) heteronormative expectations. But she doesn’t shave her armpit hair or colour over her grey hairs. She didn’t need to tell me not to bend over backwards to please a man. She just demonstrated to me time and time again via her stories or her actions that she would not let anyone violate her boundaries.
It is not easy to be a perfect feminist. By some radical feminist’s accounts, my mother is not a good feminist, and neither am I. Some have raised eyebrows at ‘Beyoncé feminism’ – the picking and choosing of some or other aesthetic detail and the abandonment of certain others. But I, like my hero Chiminanda Ngozi Adiche, believe that feminism should not be like some snooty sorority but rather “a big raucous inclusive party”.
Lets accept all and every membership. Lets hold onto each and every sister’s hand that holds up the feminist flag.
And while we’re talking enrollment, let’s remember that mother is one of the most powerful roles we can play as women. Every person on this planet has a mother. It just makes absolute sense to me then that there is no better way to change the world, than to be a mother who teaches feminism.
So…this mother’s day, I would like to thank every single mom (including my own) for their powerful effect on this planet, for bringing womanly wisdom into the home and hearts of their loved ones. Thanks for teaching us to respect women and treat them as equals to men. Thank you for demonstrating that a woman’s worth is not determined by her physical appearance alone. Thank you for being the first female ally each of us had in the world. Thank you for working so hard at your job, as mother, and for working so hard in general. Thank you for teaching us that there are many ways to be a woman. You help us see this through your actions but also by demonstrating your acceptance and support for other women, who are different to you. Thank you for teaching us about men’s vulnerability, for showing us how to see and support diverse articulations of masculinity. Thank you for baring your sexuality bravely. Thank you for showing up in all these ways and more. You are shaping this world. And it is a better place because of you!
What is it about Sunday night? Are our bodies pre-programmed after years of schooling to go into automatic anxiety mode?
This Sunday, my moment of didn’t-do-my-homework anxiety came courtesy of a blast from my academic past.
In my Masters year, I wrote a thesis titled “Women Supporting Women: The Role of Doula’s in South African Birth Stories”. It was a qualitative research study in which I interviewed doulas and their clients to explore this relationship and demonstrate its relevance for modern psychology.
My big failing (oh there are so many) is that I never published this research. It was a good study. The findings were really interesting but I never bloody published. In terms of academic success I would self-diagnose myself with a serious case of failure to launch.
After presenting my research at Cape Town Midwifery and Birth Conference last year, I was implored by the ladies of the doula community to please publish my results and yet over a year later I still haven’t.
This thought took me down a bit of a shame cycle on Sunday night but then I realised that it’s not too late. I have this platform and I should use it, if not for anything else, as a way of vanquishing my own demons. So today I am going to share my findings with you. This is the most condensed version I could manage, as I know you don’t want to read 25000 words. Perhaps this will motivate me to write an actual academic paper one day.
Here’s to failures!
I was introduced to the work of doulas by my mother and her neighbour at the time, Ruth Ehrhardt. I was fascinated by how they spoke of support being the primary tool of doulas or birth companions as they are sometimes known. I started to investigate further and discovered a huge body of scientific literature describing the medical benefits of doulas. My research was intended to explore the relational aspects of the role.
Birth is connected to and must be considered within a cultural and historical context. Historically, birth was an event in which women took centre stage. This was seen cross-culturally and around the world, in both industrialized and non-industrialized countries.
Since the beginning of the 20th century, the site of childbirth has moved from the home to the hospital setting resulting in a drastic increase in obstetric interventions such as analgesia and foetal monitoring.
The natural childbirth movement of the 1960s, aided by feminist voices, helped to bring another perspective. Since the late 1970s medical researchers have taken an interest in the benefits of having someone providing continuous support to a woman in labour.
Although an ancient role, this woman is commonly known as a doula today.
What is a doula?
Doula is a Greek term that roughly translates as a “woman who helps other women”. The role is technically defined as a woman who provides “continuous physical, emotional, and informational support to the mother before, during and after childbirth”.
A doula is not trained to provide medical or clinical care or assistance. A doula does not replace the role of the midwife or obstetrical nurse but instead offers a range of physical, emotional and social support.
Doulas in South Africa
One of the first studies done on labour support was conducted in Johannesburg in the early nineties. Currently, doulas can obtain certification through the organization WOMBS (Women Offering Mothers Best Support) in the Western Cape and DOSA (Doulas of South Africa) based in Johannesburg.
Their service includes a pre-birth visit, support throughout labour and birth and at least one post-natal visit.
Benefits of doula support
The benefits of doula support has been well documented over the last 30 years with over 16 randomised controlled trials (RCTs), at least two meta-analyses and a Cochrane library spanning over a decade of reviews.
- Shortened duration of labour
- Reduction in caesarean births
- Reduced need for medical interventions such as forceps, fetal monitoring and oxytocin stimulation, epidural analgesia and other pain relief
- Better breastfeeding outcomes
High obstetric intervention has been found to contribute to women’s experience of birth as traumatic, which can sometimes lead to symptoms of post-traumatic stress disorder. In particular emergency caesareans and intrusive obstetric interventions such as forceps, vacuum extraction as well as the use of analgesia are found to be the most related with trauma symptoms.
Research shows that women having an emergency caesarean section are at greater risk (six times) of developing postnatal depression. Mothers who undergo these invasive medical procedures and experience their birth as unpleasant may have feelings of low self-esteem and depression, impacting their relationship with their new infant.
These medical procedures, while establishing a remarkable decrease in infant mortality, are used due to the assumption that birth is a pathologic condition which must be treated, undermining the women’s body and her autonomy and diminishing her confidence.
- More positive birth experience
- Greater sense of control
- Lower anxiety and depression
- More affectionate mother-infant interaction
- Greater maternal responsiveness and competence
- NB for mother-infant bonding and attachment
- “Has far-reaching and powerful psychological consequences”
- Long-lasting effects on self-worth
The research shows that Mothers who received doula support reported having a more positive birth experience, felt a greater sense of control over their births, reported coping better, and had lower anxiety and depression scores. Doula support results in more affectionate mother-infant interaction, as well as greater maternal responsiveness and competence.
Mothers spent more time with their newborns, reported finding motherhood easy and their babies less fussy. Mothers who received doula care also commented that they felt more attuned to their babies and felt they sensed their needs better than mothers who had not received support.
This is very important for mother-infant bonding and attachment and “has far-reaching and powerful psychological consequences” (Hofmeyr et al., 1991, p. 762) for both mother and child. A woman’s experience of her birth has very important and long-lasting effects on her self-worth as a mother and a woman.
The broad aim was to investigate the nature of doula support, both what doulas do but also what is helpful and supportive about what they do.
I wanted to describe and explore the role of doulas in South Africa with specific interest in:
- The participants’ subjective notions of the ‘relationship’ that is formed between doula and client(s).
- The reasons for why and how this relationship is so helpful
I conducted a qualitative study. My sample included 8 qualified doulas, 1 trainee doula, 1 doula trainer, and 6 mothers and fathers who received doula care (3 women, 3 men). All particpants lived in Cape Town. Data collection involved open-ended, semi-structured interviews. Initially each participant was asked “what is/was your experience with doula care?” or “what is your experience of being a doula?” The data was then analysed using thematic analysis.
Theme 1: The structural elements of doula support
- the doula’s time and availability
- suggestions and help
These include the elements of doula support that ‘structure’ or ‘sculpt’ the relationship between doula and client(s) such as the doula’s time and availability, her ability to make suggestions and help plan the birth with parents and the doula’s help in planning, both before and during birth.
“…the other thing is she’s there the whole time. You know, the nurses, they’re in and out. She’s there, you’ve got a problem and she’s there, that was great…”
Theme 2: Professional qualities of doula support
- Expertise and experience
- Knowledge and training
- Neutrality and objectivity
- Insight and preparedness
- Educating about medical and hospital procedures
- Translating medical jargon
The professionalism of doula support entails the expertise and experience doulas bring to birth; their knowledge and training; as well as their identity as a neutral and objective third-party. The doula’s neutrality and objectivity offers her client unbiased and sound professional support. Having someone who is able to pass on their knowledge and experience is highly supportive
One of the other ways a doula’s knowledge and experience is found to be supportive results from her insight into the process of birth and her level of preparedness. Her role entails educating the mother and father about the medical and hospital procedures, as well as translating medical jargon used by medical practitioners.
“…why it was so good was because she kind of gave you insight into what was happening, what was going to happen…”
Theme three: The relationship
- The special qualities of the doula
- Doula as integral and life-saving element
- ‘Just being there’
- Reassurance for fathers
- Recognition and nurturing of couple’s bond
- Communication – what is said (and the doula’s words of encouragement)
- Physical comfort
- Creating a connection (eye contact & touch)
- Trustworthy and humane
- Express care and concern
- Doulas promote, encourage and affirm celebration of birth
- Feminine qualities
- Unique and special connection
- Sharing in a significant life event
- Guide into the Unknown
Doulas come across as being incredibly special and unique women who really enjoy and take pride in their work. Not a single participant had a negative or even neutral comment to make about their experiences of doulas. Participants described doulas in terms of being an integral and life-saving element that they felt they wouldn’t have coped without.
The doula ‘just being there’ provides assistance to the mother and father. The presence of the doula is also reassuring for fathers, as they seem to benefit from having a companion to share the experience with.
Fathers need to be supported as well, and that it is very important to consider his needs and how best to support and empower him through the process. The doula’s role needs to involve recognition and nurturing of the couple’s bond. By acknowledging and allowing the couple to stay connected, the labouring woman is supported by both her partner and her doula, while the man still feels he has a role to play and thus their union as a couple and as expecting parents is nurtured and supported too.
One of the most vital ingredients in any helpful relationship is communication. Participants made frequent mention of the way in which the doula’s words of encouragement or the things she said helped. Doulas seem to know the right thing to say at the right time, which helps the mother to feel assured and relieved.
Doulas refer to their words of encouragement as offering mothers positive reinforcement, which relaxes them and helps them to believe in themselves.
Doulas provide physical comfort to labouring women. Some of the things that doulas do to help make the labouring woman more comfortable include massage and touch, helping the woman into different positions, breathing techniques, and helping her to eat and go to the toilet.
Another more subtle aspect of doula support is understood by doulas as creating a connection with the mother, which is often done through eye contact or gentle touch. This is considered helpful in that it provides the mother with reassurance of the doula’s presence.
Doulas were contrasted to medical staff in that they were viewed as more trustworthy and humane. The ways in which the doula communicates with her clients expresses care and concern. Doulas do not patholologize pregnany and birth but actually celebrate birth, which encourages and affirms.
There was reference made to the benefit of the doula’s feminine qualities. The usefulness of women being able to tap into their feminine power and strength through the support of another woman. There is a unique and special connection that is formed between women and that this connection aids and facilitates a successful and positive birth experience.
When describing their experiences of doula support, participants referred to the relationship between doula and client as special and unique due to the particular kind of sharing that goes on during birth. The doula participants also communicated their recognition that birth is a particularly important and momentous event in a woman’s life.
One of the resounding and most acknowledged aspect of the relationship that is helpful and meaningful, as communicated by participants, is the notion of trust. It is through trust that the doula is able to act as a guide to the unknown and it is through trust that she is able to connect with the women she supports.
There is in fact a very close fit between what the participants put forth as the most notable aspects of doula support and what is articulated in the literature.
Some interesting insights into the more subtle and complex features of the doula/client relationship were established.
These findings help to position the work of doulas within its socio-historical context.
Birth is a highly significant event in a woman’s life. Not only is it a physical journey, an experience nobody can truly prepare you for; but it is an emotional and spiritual journey as well.
The particular hormones that are at play combine to place women in an altered state of consciousness, one that is essential yet not completely understood by modern medicine. And through this radical experience, the labouring woman is transformed.
There is clearly something unique about birth that engenders female bonding, where women require the strength, support and wisdom of other more experienced women.