Universal Health Care & Doulas

Photo by Arteida Mjeshtri via Unsplash

Photo by Arteida Mjeshtri via Unsplash

April 7th is World Health Day. This year, the World Health Organization (WHO) theme is Universal Health Coverage.

I thought I should underline this day because the WHO is promoting women’s health in such meaningful ways. In February 2018, the WHO published a new guideline on intrapartum care. I find this very encouraging for doulas.

Why, you may ask? Because the WHO does not only promote safe labour and childbirth, but also a positive birth experience by meeting the psychological and emotional needs of birthing people.

As you may know, we, doulas, have one unique goal in mind: doing everything we can to ensure that our clients have a positive birth experience, no matter if it goes according to plan or not. It is our motto. Not just a healthy baby and mommy, but also happy baby and parents.

Interestingly, the infographic from the WHO, shown below, demonstrates in a nutshell what is needed to achieve that:

A schematic representation of the WHO intrapartum care model.  Source: WHO (2018) WHO Recommendations: Intrapartum care for a positive childbirth experience. Transforming care of women and babies for improved health and well-being. url:  https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf?ua=1

A schematic representation of the WHO intrapartum care model.

Source: WHO (2018) WHO Recommendations: Intrapartum care for a positive childbirth experience. Transforming care of women and babies for improved health and well-being. url: https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf?ua=1

Doulas discuss all of these elements with their clients. We:

  • help parents to prepare a birth plan or birth principles based on evidenced-based information;

  • discuss comfort measure options and strategies for labour;

  • offer continuous emotional and physical support all through labour and birth

  • insure that the privacy of our clients is respected;

  • make sure that the pregnant parent, and partner too don’t forget to drink, eat, or use the toilet during labour;

  • encourage the birthing person to move and try different positions during labour;

  • support our clients in getting the medical information that they need to make informed decisions for themselves;

  • are available postpartum to debrief and reflect on the labour and birth experience with the parents.


A doula is a resource person, an advocate, a huge supporter, a mother when needed, and a coach with loving hands. The doula is the person who follows the parents from beginning to end in the birthing process.

“If doula were a drug, it would be unethical not to use it” wrote Dr. John H. Kennell, a well-known pediatrician. Effectively, “continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five‐minute Apgar score and negative feelings about childbirth experiences”, conclude the authors of this paper.

Knowing that doulas have such a positive impact on birth outcomes, for babies and parents, one would wonder why it is not part of our universal health care system. I truly believe that every birthing person should have access to the service of a doula if they wish to. Doulas bring back the sisterhood that has always existed before the medicalization of birth. I am dreaming of the day when the services of doulas will be covered by the OHIP. One birth, one doula.

Meanwhile, there is the Doula Support Foundation whose goal is to provide doula services to those who can’t afford it in the Kingston area and the broader community. If you believe, like me, that this is needed and it is an important work, please do not hesitate to help us through donations or volunteer work.

We are lucky to have a universal health care system in Canada, however, the birthing person’s emotional and physical needs during labour and birth are not always met. While there are concrete medical reasons for some births to be done surgically, via a C-section,  this outcome is often preventable. “Twenty-eight per cent of hospital births in Canada were performed via C-section in 2016-2017” and in Ontario the rate was 28.4%. However, the WHO consider that the rate should be between 10 and 15%. At the Kingston General Hospital, 1 birth in 5 is done by C-Section, a rate of 20%, the hospital indicates on their website. It is a better rate than the province of Ontario, but there is still some room for improvement. Doulas have been shown to help reduce the chances of a surgical birth, as have midwives. Giving birthing people a better opportunity to have a physiologic and vaginal birth is also a hugely cost-effective approach to birth.

In my dream, there would be birth centres connected to hospitals, but physically separated from them. I will let you know more about that dream in another post.

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Josée Leduc is a certifying birth doula and a French translator. She is passionate about the work the Doula Support Foundation is doing and believes it is hugely important. She likes to think that one day, all women who wish to have the support of a doula during childbirth will receive that service. To know more about her as a doula or book a consultation click here. To know more about her translation life click here.

Laura Pascoe