Global Midwifery

Difficult Births

Today’s doula training focused on the problem of difficult births.  In the United States, doulas in training often think they have little to do if the mother has an epidural or if she is planning a cesarean surgery. The women in the Nairobi training began with the same belief. We took them through a few exercises to recognize the needs of the mother in those situations and watched as they changed their personal definition of a doula.

We asked each of them to share a story of a difficult birth. An hour later the women were amazed at how their most difficult experiences were not the discomforts of labor, but the families who needed such strong emotional support. What do you do when a baby dies? What do you do when a mother feels she has no say? What do you do when a doctor gives no options? How do you help those mothers remain empowered?

We then moved on to the difficult birth of Kenya’s first professional doula association. We learned about some of the unique issues that will face the doulas of Nairobi.  For example, unlike the United States, you cannot just walk into a hospital and be a doula. The women needed letters of introduction to present with their certificate of training to prove they could be there. The doulas will also need to work with the hospitals to ensure policies are in place that protect the right of the family to have a doula with them during labor and birth.

One issue we identified was the lack of culturally appropriate education materials for families. Most materials that are brought into Nairobi are from South Africa and have images of Caucasian families and babies. Physicians have started refusing education materials from Johnson & Johnson if they do not have dark skinned models. This should not be too hard to fix. There are many health departments that provide downloadable brochures and information sheets with multi-cultural photos.  We just need to help the women find them.

So now we pack up the training and prepare a list of recommendations to DONA on how to best serve the doulas of Kenya. For example, getting books from overseas is not easy.  Tomorrow while we are out we plan to pick up some childbirth and breastfeeding books that have been written and published here in Nairobi with the hope these books will be accepted for the reading list. I have my own biases, and they would be to empower the doulas of Kenya to have their own certifying body. But I am not even a member of DONA anymore, and it is up to their board to make the best decisions for the organization.


Jennifer Vanderlaan (Author)