TO:

Aga Khan University Hospital Nairobi (“AKUHN”)

3rd Parklands Avenue

Nairobi, Kenya

Attn: Shawn Bolouki, Chief Executive Officer

CC: Jemimah Kimeu, Director of Nursing Department,

Aga Khan University Hospital, Nairobi

30 October 2018

SUBJECT: Proposed Ban on Private Doula Attendance During Labour at AKUHN

Dear Sir/Madam,

We are writing to you as a group of concerned women residing in Nairobi that have given birth or are planning to give birth at AKUHN. We understand that the Board at AKUHN is considering to ban the attendance of private doulas during childbirth at AKUHN. For the reasons outlined in this letter we request that this is immediately dropped, or alternatives are considered that still enable the participation of private doulas during childbirth.

We would expect that AKUHN, like other hospitals, places the concerns and requirements of its patients at the very heart of its decision making on policy. We were therefore surprised that to our knowledge patients have not been consulted in the ban under consideration.

For those of us who have experienced it, childbirth is the most physically and emotionally taxing experience we will ever go through. We therefore very much believe that it should be a mother’s choice to determine who she has with her during childbirth and part of our reason for selecting AKUHN was specifically because the hospital has historically allowed the participation of private doulas during childbirth.

We note that the principal role of a doula is i) to provide training in the lead up to childbirth to help prepare the mother and partner as best possible, ii) to be present with a mother throughout the childbirth, iii) to provide psychological and emotional support to a woman during childbirth and iv) to assist the mother in understanding the medical decisions that may need to be taken during childbirth.

We note that there is significant empirical evidence that supports the case for private doulas. For instance, a review undertaken by Hodnett, E. et al (2009) of sixteen trials involving 13,391 women suggests that women who had continuous intrapartum support were likely to have slightly shorter labours, were more likely to have spontaneous vaginal birth and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth experience. Furthermore, in general continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff (emphasis added).

We understand that the concern of AKUHN management relates to potential interference by doulas in medical decisions and the potential risk this poses to AKUH, the mother and child. We understand that this may also pose a risk to AKUHN’s accreditation with the JCIA. We note that doula participation should not be relevant for AKUHN’s accreditation, doula participation is commonly accepted in the more reputable hospitals globally. Furthermore, we fully agree that intervening in medical decisions should not be the role of doulas. However, the goal of AKUHN should not only be the physical well-being of mother and child, but equally the psychological well-being. We very much believe that a private doula plays a critical role in ensuring the psychological well-being of the mother and child. A private doula is generally a trusted partner of a mother through the relationship that is built between the doula and mother during pregnancy and childbirth and further the role a doula may play in postpartum care. Having a private doula present during childbirth therefore provides significant psychological reassurance. Furthermore, a private doula may act as an advocate for the mother allowing the mother to focus on the birthing process. As noted above, the empirical evidence also suggests a doula’s role in supporting a mother’s physical well-being.

We were very surprised that no patients have been consulted with regards to the proposed ban. We note that while a decision on this issue has not yet been taken, we understand that certain hospital staff are already implementing a ban on private doulas as if it were already in effect. For mothers that have built a relationship of trust with a private doula and were planning to have their doula present during childbirth this sudden change to their birth plan is already having an immeasurable psychological impact.

We therefore request that the proposed ban on private doula attendance during child birth is immediately dropped. We note that there are also alternatives to a ban that AKUHN could consider. In order to address, AKUHN’s concern with regards to its potential liability, a liability waiver could also be signed by the doula or the patient’s liability waiver could be extended to cover the doula. We also note that in other hospitals where the potential interference of doulas has been a concern, doulas are required to sign a form that outlines their role to limit potential interference. We believe that these options would fully address AKUHN’s concerns while still enabling an active role for private doulas.

We look forward to your immediate and positive feedback. If such ban is not dropped, we will be considering alternative options for our future deliveries.

We encourage you to reach out to any of us. Our names and contact details are provided in Annex 1.

Yours Sincerely,

Concerned Women of Nairobi