There is, it seems, a celebrity trend towards natural birth. Gone are the days of Posh not pushing and Zoe Ball electing her Caesarean. First Kate Winslet went for it with only acupuncture, positive thinking and a now-famous midwife to get her through. Then Kate Moss had a natural birth in the much-sought-after hospital of St John and Elizabeth, London. And last week Big Brother presenter Davina McCall had her second daughter at home, a drug-free, midwife-attended festival of feminine power. Could it be that masked surgeons are going out of fashion?
There is certainly growing evidence that one-to-one support from another woman during childbirth is hugely beneficial. This is good news for the gradually increasing numbers of British women who are forking out to hire a birth doula - a medically untrained childbirth companion who gives you emotional and practical support during your pregnancy and birth. (Doula, pronounced "doola", is a Greek word meaning "woman servant or care-giver".) A comprehensive review published recently by the Cochrane Library, the biggest source of evidence-based healthcare in the world, concluded that having a doula (or other non-medically trained woman present at the birth) is the best guarantee you can have these days of a natural, untraumatic experience of childbirth.
The Cochrane review examined 15 research trials involving almost 13,000 women. Those who had continuous support throughout labour from a woman trained to give it needed less pain relief, had fewer Caesareans as well as fewer other interventions, like forceps or ventouse during the birth. These women also reported a far more positive experience than those who were cared for by overworked hospital midwives.
Childbirth certainly worked this way for me. I had my first baby at an NHS hospital - a typically traumatic first experience. I was in painful labour for 24 hours, attended by five or six midwives (I lost count) who came in and out occasionally to tell me I wasn't progressing. I had all drugs known to human kind, and, finally, a Caesarean. When I got pregnant with my second baby I was living in the US - a country renowned for its interventionist approach to childbirth. I was terrified that I would end up with another unnecessary Caesarean. All the switched-on American mothers I confided in gave me the same advice: hire a doula.
So I hired Julia Guderian. Julia is my age with two young children of her own and was not - as I had feared - remotely hippyish. I chose her because I liked her, and because she has 12 years' experience. She helped me choose the right Seattle hospital with a low Caesarean rate. She talked me through my fears and built my confidence. She was like a therapist, friend and mother rolled into one. Most importantly, she never tried to persuade me to give birth in any particular way.
Her job was to help me prepare for, and get, whatever birth I wanted. Hers was the first face I saw, when, on hands and knees, the lift doors opened at the hospital. She was there throughout the five-hour labour - keeping the room quiet and dimly lit and stopping the chatty nurse from disturbing me. In the end I did not need any of her pain-relieving techniques because my son's birth was totally manageable. I believe this is because she had done so much in the previous months to build my confidence, get me over my first birth, and to make me feel safe and unthreatened by the hospital surroundings.
Traditionally, of course, it is a midwife's role to do all this. But increasingly this can be impossible for our beleaguered NHS midwives to achieve. "There are currently 5,000 fewer midwives practising than there were 10 years ago," Dame Karlene Davis, general secretary of the Royal College of Midwives told this paper earlier this month. "Despite the fact that people are training and entering the profession in record numbers it simply doesn't compensate for the number of midwives leaving."
The consequences of this shortage can be scary. One report in the British Medical Journal this month found "accidents waiting to happen" in our maternity wards. Researchers, who investigated seven maternity units in the north-west of England, estimated that a "near miss" - that is, an incident that could have harmed the labouring woman or her baby - occurred every 2.5 to five days. Working in these conditions, our midwives are simply unable to give us the one-to-one continuous care we need (and they want to give).
Celebrities, of course, do not have to worry about the NHS - they can afford to hire private midwives, give birth in exclusive birth centres and receive one-to-one care from a person they know and trust throughout their pregnancy and birth. But for those of us who cannot afford the £2,000 it would cost to hire an independent midwife, or the £5,000 you would pay to use a private birth centre, the Cochrane review is really very good news.
"Women through the centuries have had other women with them while they are giving birth," says childbirth expert Sheila Kitzinger. "Not specially trained women, just women who have had babies and can be there with them during labour".
Nowadays most of us expect our male partners to do this job. Men can, of course, be a huge source of support during labour. While I was having both my children, I would not let my husband out of the room. But when he said to me: 'Don't worry', I could not help thinking: 'What do you know?' Julia's reassurance, on the other hand, had an authority born from attending hundreds of births. This worked on both of us. "The doula is not in competition with the guy," says Kitzinger. Indeed, "She can show him how to give his partner the support she needs."
Having a doula will not eradicate risk from childbirth. But it may well change - for the better - how we give birth in Britain. The Caesarean rate has doubled here over the past 20 years, and it is now, for the first time, the norm for birthing Brits to have medical interventions. If doulas become more established here, perhaps we will start to see the trauma and expense of unnecessarily medicated births decline.
In the States, doulas are trained and accredited by a central organisation called Doulas of North America (DONA), which has 4,300 members. Here there is currently no centralised training organisation or standards. One group, Doula UK, is now training doulas, and working with a "doula council" of senior midwives to establish codes of conduct and complaints procedures. Midwives can be suspicious of doulas but, says Hilary Lewin, chair of Doula UK, "this is largely because many midwives have not yet come across doulas. In two years we have had no complaints from midwives, and in my personal experience they are incredibly positive about doulas".
Doulas, then, are no longer the province of wealthy north-London mums (or celebs). "We have doulas all over the country," says Lewin. "We even work in Holloway prison." They can cost as much as £600 in the home counties, but prices elsewhere vary widely and there is huge scope for negotiation. "Some experienced doulas will work for free if necessary. We also have a hardship fund at Doula UK, and many doulas who are building experience will also work for free."
If you cannot find a doula in your area, don't give up. Research has shown that merely having a female companion sitting silently in the room - not even actively involved - can lower the rate of intervention and surgery in childbirth. Julia has this advice for choosing a friend or relative to be with you in labour: "Ask yourself whether she will have your best interests in mind or whether she will be playing out some past birth scenario of her own. She should be able to support you in whatever kind of birth you want, without interfering. She has to understand that the pain you are in will be natural and not scary and you need to know that you can be naked and moaning in front of this woman without inhibitions."
Julia saw me huge, naked and bellowing. And I have now returned the favour by being there when her second son was born. There is nothing like a bit of blood and nudity to seal a female friendship.
· Lucy Atkins and Julia Guderian are writing a book about preparation for childbirth. To find a doula, see: www.doula.org.uk
