On the occasion of World Doula Day this Wednesday, March 22, RFI looks at this still little-known profession in France, which is nevertheless on the rise. Accompanists in maternity, childbirth, or abortion, they listen and support in a non-medical way. While some health professionals are worried about possible confusion, the doula profession is trying more than ever to assert its usefulness, and its place.
They are there to help think about the birth more serenely. This word may not mean anything to you, but in Anglo-Saxon countries, doulas are increasingly popular with families. The term doula, derived from ancient Greek, means ” the woman slave, servant ” Or ” the one who serves the mother “. Generally exercised by a woman, this function, born in France in the early 2000s, consists of providing emotional and physical support in life experiences, most often during the perinatal period and after childbirth.
” A doula is a person who will nurture the mother and provide a listening space in which the couple can talk about anything they cannot discuss with the health personnel following the pregnancy. “, indicates Virginie Franqueza, doula for fifteen years and member of the board of directors of the association Doulas from France (DDF), created in 2006.
These guides often draw on their personal experience, like Juliette Aïssa, 30, a doula for more than two years: ” I wanted to bring to others what I may have missed during my first pregnancy. It’s not just to store information that we need, but also to feel listened to, supported in the face of the changes that occur in this moment of our life when we are a little lost and stressed. »
In an era marked by the return to nature and fears of obstetrical violence, doulas offer to be alongside women and take time for them. A non-therapeutic accompaniment which intervenes in addition to medical care, as explained by Yanick Revel, doula in Lyon since 2005: ” During pregnancy, we are used to a lot of medical appointments. French society does indeed take care of us, but sometimes we only see birth from that angle. While it is a very strong human experience. »
The doula, between the confidante » and the « baby planner »
In practice, the doula intervenes at home, for sessions of two to three hours. She ” respect people’s privacy », and more simply, « offers a presence to reassure “, describes Yanick Revel. A doula also provides practical helping hands to relieve the mother. A helper in the kitchen, to watch over the children, to fold the laundry, to consult a maternity catalog… “ We sometimes find ourselves like a baby-planner, organizing what is needed to welcome the baby “, depicts with a smile Juliette Aïssa, creator of the Instagram account Wecandoula.
Doulas can also answer the doubts of fathers and guide them on the words to adopt with their spouse. Virginie Franqueza and Juliette Aïssa support heterosexual couples as well as lesbian couples and transgender people, more and more single women, but also people who wish to have an abortion. A fact that may seem surprising: accompanying both childbirth and voluntary termination of pregnancy. “ In the medical sphere, abortion is only treated from a practical and technical point of view, but there is no space to accommodate the emotions that arise after the decision or the procedure. So I am going to carry the bag of the woman who is having an abortion, hold her hand during a curettage, stay at home after a medical abortion… Because there is no device to monitor that she does not lose too much blood if she aborts alone at home “, punctuates Virginie Franqueza.
Another important detail: the price. The services of doulas, an unrecognized profession in France, vary between packages of 350 to 600 euros during pregnancy, and between 40 and 70 euros per visit, according to the Doulas de France association. ” We must not hide our face, it is a service that remains mainly consumed by people with a minimum incomeconcedes Juliette Aïssa. Also because the majority of disadvantaged families do not know that it exists and how to access it “. The solutions, according to the 30-year-old: free initial support when the doula is in training. Then once formed, they can set up scholarships or pots for more modest people.
Doula and midwife, two diametrically opposed professions?
The exact number of doulas in France is impossible to specify. In 2021, the DDF association counted 137 in its official directory, distributed throughout the country. In the United Kingdom and the United States, these companions are recognized as being of public utility, and are even sometimes employed by certain maternities. However, in France, the climate towards them is much more hostile. ” Since doulas have no real skills or medical training, performing them can be dangerous for women and pregnancy care. Due to lack of knowledge, doulas may misinform or fail to recognize when there are medical issues. “says Anne-Marie Curat, treasurer of the National Order of Midwives. For her, support is inseparable from medical follow-up, and both should be provided by the midwife.
So to avoid any confusion, Yanick Revel, Juliette Aïssa and Virginie Franqueza insist heavily on the semantics to adopt: the doula is not a ” guide », does not give « advice “, souldn’t ” impose no choice “. And above all, is in no way intended to replace the midwife. ” We may have the same public, but our two functions have absolutely nothing to do with each other. The midwife is a caregiver, with technical medical skills that a doula does not have and certainly does not pretend to have. insists Juliette Aïssa, who systematically refers her clients to doctors as soon as they have complex medical questions. For her part, Virginie Franqueza has chosen to accompany only people who already have medical follow-up, “ to clearly distinguish the role of each “.
In 2006, when the profession had just emerged, the Interministerial Mission for vigilance and the fight against sectarian aberrations (Miviludes) alerted in a report on the lack of supervision of the profession and on the ambiguity of their function. The same year, the Doulas de France association published a charter to establish this framework: “ We are not therapists and do not perform any medical act. Doulas have no competence to dispense a consultation, give a medical opinion, establish a diagnosis or a prescription, carry out an examination or a delivery. We are working to create a link between all medical and social workers. »
For the time being, there is indeed neither official training nor specific regulations around doulas. The Doulas de France training institute nevertheless offers a course, the most complete » according to the DDF association, consisting of 27 days of lessons.
Work to recognize the profession
Faced with this mistrust, the Doulas de France association is trying to make the reality of the profession better known. “ There is a gradual awareness of what a doula brings. All the caregivers I work with increasingly understand our complementarity “, reports Yanick Revel. This is for example the case of the maternity hospital in Nanterre, one of the rare French establishments to openly welcome these companions. ” Every six months, one or two women come with their doulas. And it goes very well when they are members of the Doulas de France. They are used to working with midwives, they are very discreet, always offer to go out when the midwife enters the room », explains Dr Benoît de Sarcus, head of the gynecology-obstetrics department, for whom the association’s charter is a guarantee of seriousness.
According to him, the doula makes it possible to ensure that the labor before childbirth goes well, gently, “ where the midwife does not have time to be present continuously “. On the other hand, Dr. Benoît de Sarcus admits having encountered difficulties with certain independent doulas, who took up too much space or interfered with the work of the midwives.
In recent years, as Virginie Franqueza points out, social networks have popularized the profession, for better or for worse. ” In the past, we have been required to report certain doula organizations and practices to Miviludes. They are often associated with sectarian aberrations », denounces Anne-Marie Curat, of the Order of Midwives. “ When you’re a doula, you don’t have to bring spirituality into the home, especially by presenting it as scientific fact. Care must be taken not to fall into the illegal practice of medicine. But I insist, it only concerns a small minority in the middle of the doulas “, tempers Juliette Aïssa.
“ We can improvise doula overnight. Except that a clumsy gesture, an ill-adjusted word, can have important consequences “adds Virginie Franqueza. This is why the latter, with the association Doulas de France, works to have the profession and its training recognized, with a better framework and support for their services by the State. But “ especially no reimbursement by social securityasserts Virginie Franqueza, since it would create confusion with health professionals “. She imagines rather a device with the CAF, or a reduction on taxes. A way to democratize this profession and enhance its primary vocation: offer people a benevolent listening and moral support in each stage of their life.
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