When Mandy Ackermann fell pregnant with her first child she knew she wanted all-round support for her pregnancy and birth. Support which would come in a different form to the type her husband could offer.

She first looked into hypnobirthing and when she stumbled across a doula she instantly knew it is what she was looking for.

A doula assists pregnant women and their partners during pregnancy, labour and after childbirth. They are not healthcare professionals but offer emotional support, help couples prepare in practical terms and talks through various options. Some doulas call themselves a birth coach or a birth companion.

“During pregnancy there is a lot of focus on your physical health but very little about mental health yet it plays a big role,” Ackermann said. “I had a special bond with my doula, it was as if she was a member of my family and I trusted her 100%. I spoke to her about absolutely everything.”

‘She was there for my wellbeing’

Ackermann chose to give birth in a birth centre instead of a hospital, with no available pain relief such as epidural.

“There were no doctors at the birth centre, only midwives,” she said. “I knew hospitals were too medicalised for me and I wanted flexibility in the protocol.”

Ackermann’s husband and doula was present during the birth. When they arrived at the birth centre, the doula organised the room to make it more cozy, went to get food for the couple, massaged Ackermann when the contractions were becoming more intense and helped her take a shower.

“She was there for my wellbeing,” Ackermann said. “She asked if I wanted music. She knew my birth plan so when the midwife came she knew exactly what I wanted. She managed all of that on our behalf. She only intervened when I wanted her to and she gave space to myself and my husband.”

The role of a doula has become more popular in Luxembourg in recent years. More and more women are looking into alternative labour such as giving birth in a birth centre or at home or opting for a water birth in hospital. Some couples who do not have family around look for additional support post-partum.

Rise in C-section births

Most babies born in Luxembourg come into the world via vaginal delivery but there has been a slight decrease recently, and the number of births by cesarean (C-section) are constantly increasing, data from the Health Ministry shows.

Around 30% of babies are born via cesarean in Luxembourg. In other European countries, the rate of cesarean births varies from around 17% to 54%, figures from the European Commission show. Northern European countries including Finland, Sweden and Lithuania had the lowest share of C-section births, below 20%, while Cyprus had the highest rate at 55%, followed by Romania and Bulgaria at over 40%.

Between 2020 and 2022 the number of C-section births in Luxembourg increased from 2,169 to 2,284. During the same period, the number of vaginal deliveries dropped from 5,354 to 5,284.

Water births remain rare but increased from 115 in 2020 to 130 in 2022.

Intergenerational or birth trauma

Natascha Bisbis has been working as a doula in Luxembourg for five years and is available round the clock to accompany her clients going into labour. She offers three different services – prenatal, birth and post-partum.

“Most people who use my services do so because they want another support,” she said. “They want somebody to talk to about everything, who will take care of the mother both physically and emotionally. For post-partum services, I often find women who don’t have family nearby or who have had twins.”

Doula Natascha Bisbis is available 24/7 when her clients go into labour © Photo credit: Tania Traversini

Bisbis offers massages to the mother, practical help such as looking after the baby while the mother sleeps, cooking meals for the family, and answering the long list of questions new parents have.

Doula Marise Hyman describes her role as a “helper with two hands a loving heart”. One of her focusses is tackling intergenerational trauma when couples are trying to conceive, during pregnancy and after birth. She also works with women who have experienced a traumatic delivery to eliminate the trauma before a second birth.

“Your early life imprints will determine the emotional activation and your ability to regulate those emotions,” Hyman said. “It can be anything from childhood stress or emotional neglect, for example. The earlier you start to clear that trauma the easier everything is after that,” she explained.

Doula Marise Hyman (left) works on eliminating intergenerational trauma before birth © Photo credit: Marise Hyman

“A lot of people have a negative birth experience where they felt disempowered,” Hyman added. “After birth, people come to me to clear the trauma before the next birth. It’s about limiting imprints in the body and nervous system.”

Doula is a non-regulated profession and none of the work is based on medical knowledge. A doula’s role is to provide support along various steps of the way. Some doulas offer prenatal, birth and post-partum support while others focus on one or two of these stages.

“You need to know what kind of doula you are working with and think about what you need,” Hyman said. “Women in Luxembourg can’t choose their birth midwife, it’s a lottery. There’s a stranger in the room and maybe you gel, maybe you don’t. And that is why a doula is beneficial.”

She says that since the beginning of time women have been helping women around the time they become parents, to support them in non-medical ways. “When women started having babies away from their families, the work of a doula became a real profession.”