By Imaan Moosa
Edited by Yumna Bodiat
We spoke to Lisa van Niekerk about the empowering journey of birth, and her role as a doula.
Activism translates to more than mobilizing and attending protests, signing petitions, or donating to noble causes. Activism is assumed in daily life and for some, activism is the profession they choose to dedicate their lives to.
Cape Town local Lisa van Niekerk may be defined as an activist on the frontlines of bringing life into the world. She is a ‘woman who serves women’, translated from the Greek word ‘doula.
She told To EmpowHER a doula is a person, typically trained, who supports a person during a life-changing event, such as birth, post-partum and bereavement. Lisa is trained as a birth doula, who currently completed her certification with MamaBamba in February 2020.
As a recently trained birth doula, the 23-year-old provides physical and emotional guidance to pregnant women during pregnancy, labor and delivery. However, van Niekerk says that doulas are not medical practitioners.
"We typically only work from the waist up, meaning that while your doctor or midwife attends to the physiology of birth, doulas are there to empower mothers to trust their bodies and contribute to a positive and healthy birth experience. It is not within our scope of practice or ethical code to interfere with the role of any medical practitioner."
Van Niekerk’s journey to empowering women began during her LLM degree. She holds a Bachelor of Laws Degree and a Master of Laws Degree in Private Law and Human Rights from the University of Cape Town.
Although she says she has always been fascinated by birth and the journey she took to be on this earth, it was when she was researching the topic of obstetrics abuse that she imagined
becoming a birth-worker.
Obstetric abuse in the public space usually encompasses physical and verbal abuse of labouring mothers. In the private space, the abuse is insidious and often takes the form of a lack of birth options. In both spaces, it embraces the power and knowledge imbalance with a devastating impact on the dignity, autonomy and bodily integrity of labouring mothers.
Van Niekerk says through her research and peer engagement she identified obstetrics abuse as “a major, yet underrepresented human rights issue as it constitutes an abhorrent subset of violence against women”.
As a lawyer who is fervently committed to the promotion of human rights, she embarked upon the process of certifying as a doula; now committed to advocating for the right to birth with dignity.
I aim to serve women by advocating for women’s rights in the birthing space and contributing to a shift in ideology one birth at a time.
Striving to uphold justice in the legal and health fields was not easy. Van Niekerk says working a full-time corporate job that she is not quitting any time soon has been challenging.
"It has been empowering to realize that I am capable of pursuing both my passion and my career simultaneously. That being said, I won’t undermine the discipline required by this balancing act.
"Pursuing my passion project means reading up and educating myself on birth and pregnancy in my spare time, and on many weekends, attending various training courses and volunteering."
When asked about her experience being a doula, van Niekerk notes that her experience as a trainee doula does not reflect the average experience of other doulas in South Africa. When she completed her training, she volunteered in public midwife and obstetrics units (MOU) to offer physical and emotional support to women who ordinarily would not have access to a doula.
"This approach differs, to some degree, from the standard practice of being a doula which entails building a relationship with clients throughout the course of their pregnancy and empowering expectant mothers with information related to pregnancy during the antenatal phase.
“By volunteering, I meet mothers on the day of their delivery and my role is typically limited to holding space for birthing mothers and offering as much comfort and reassurance as they require. My role is limited as there is not much time to establish a relationship of trust and it is too late to start teaching breathing techniques while the woman is already in the active stage of labor.”
However, most doula-client relationships are developed during pregnancy, months prior to birth. The doula creates a safe space for expectant mothers to ask questions, share their fears and discuss birthing options. Doulas share their knowledge on the physiology of birth to inform their understanding of birth and what to expect on the day. Thereafter, the parents will devise their birth plan.
“In the month the client is due to birth, the doula will go ‘on-call’. This means that the doula will make herself available to the mother by phone, will often have her doula bag packed, and for many doulas who are also mothers, have childcare on-call in case her client goes into labor.”
Each birth is different. Van Niekerk gives the example of mothers who appreciate a hands-on approach during labor, such as breathing exercises, verbal reassurance, advice on labor positions, head and back massages, and other comfort and pain-relief techniques. This differs from mothers who prefer doulas to “hold space” by maintaining a positive birthing environment by encouraging participation from the birthing partner.
She says the primary role of a doula is “to serve as the mother’s advocate in order to achieve a healthy and positive birthing experience for the mother that is in line, as much as possible, with the mother’s expectations.”
This means that the doula should help where necessary while remembering not to encroach on the role of the father or birthing partner.
Doulas are there to support both parents and even facilitate the role of the father or partner.
The coronavirus (Covid-19) pandemic has resulted in limitations to women’s birthing options. In levels 4 and 5 of the lockdown, she says both public and private hospitals disallowed more than one person from supporting mothers during labor.
This means that mothers who choose to have their husband or partner at their birth are not allowed to have a birth photographer, doula or second person of support present. The effect of this protocol means they cannot have the birth they envisioned when they found out they were pregnant.
Van Niekerk laments the rise of new anxieties for pregnant women, who she says have had to change the way they experience and celebrate their pregnancies. For example, during lockdown, it is prohibited to hold an in-person baby shower, attend in-person antenatal classes and groups, and receive hospital visitors.
“Pregnancy check-ups and scans have become impersonal, in-and-out consultations, leaving expectant mothers with limited time to discuss their birth options or concerns. The father’s role during pregnancy is also limited as a result of measures to curb the spread of coronavirus. For example, women are not allowed to bring a companion to ultrasound scans and check-ups.
“Essentially, I think that the pandemic is an incredibly isolating time for pregnant women. Further, I believe there is more anxiety surrounding bringing a child into this world in the midst of a global pandemic. In addition to the ordinary anxieties surrounding pregnancy and birth, fears of being isolated from your baby shortly after giving birth because you might test positive for a highly infectious virus are real and unprecedented.”
Van Niekerk has had to adapt her vision of support to be able to provide support to expectant mothers remotely. By way of solution, she says it is important to shape a positive birth narrative the promotes stories of positivity and joy instead of focussing on worst-case scenarios.
A strong support system is key to a positive birth, but the strength of our support is potentially limited by social distancing measures. However, I believe that, just as we have adapted our social lives, trade and industry to meet the novel challenges posed by the pandemic, so too can we adapt the way we support mothers during pregnancy and birth.
She has prepared and compiled free, positive and constructive information about pregnancy and birth which is distributed publicly via Instagram and mailing lists. She calls herself a “free virtual doula”.
“If anything, during this pandemic, we have learned that human beings are resilient, adaptable, and dynamic. It has been inspiring to see so many professionals, doulas included, change the way they think about their work and it hasn’t been all for the worse.
“By making doula services remotely accessible by way of social media, zoom, email and skype, access to doula services has opened up to those who ordinarily would not have benefitted from doula support.”
Changing the narrative of birth has been at the core of van Niekerk’s activism. The common story of birth, she says, focuses on pain and worst-case scenarios. This story is told since childhood, scripted into movies, and iterated by doctors, friends and family that we must fear for our lives and the lives of our babies.
“In guarding against the worst-case scenario, we hand over our bodies and our births to hospitals and obstetricians to be treated as routine medical procedures,”
“When a woman experiences her labor and delivery feeling like the least important person in the room, it is clear that change is overdue.”
Wanting to shift the narrative about birth from one premised on trauma to one that is empowering, Lisa created Birth Consciousness.
Birth is beautiful and it should be viewed and treated as such. We hope that by sharing diverse stories of birth which address fist-bumping moments of triumph, victory, joy and pride with our Instagram community, we will be able to craft a more positive narrative surrounding birth.
Birth Consciousness addresses themes of love, strength, wisdom and feminine power and seeks to grow a safe space where followers can share their own birth stories.
“I created Birth Consciousness as a mechanism to tackle the knowledge and power imbalance between birthing women and their health care providers. By providing information about birth and pregnancy to anyone who follows my Instagram page, @birthconciousness, or joins my mailing list, I am able to reach and empower more women without any geographical and time limitations.
"The free visual birth plan is a generic birth plan that consists of non-interventionist birth options. The idea was to draw women’s attention to multiple birth options less commonly known so that: “you don’t have to birth on your back if you don’t want to; your informed consent should be ascertained before any procedure is performed, and your choices matter!”
She says the Birth Plan symbolises and celebrates women’s choice and autonomy in birth.
“It is a visual representation that women can and should have a say in how they birth and that their needs and vision of birth should be respected.
Van Niekerk and her team are currently in the process of preparing visual birth plans to accommodate the individual needs and circumstances of all women, such as caesarean sections, medicated vaginal births and home births.
“We want every woman to feel that her birth choices are valued, respected, and celebrated."
By advocating for women’s rights within the birthing space as a lawyer, van Niekerk is able to educate her clients on their rights, choices and medical procedures to empower them to make informed decisions.
I want every woman to know that, no matter where you birth or how you birth, it is your birth and your body. As such, you always have a say in how you birth.
More on Lisa van Niekerk:
What do you believe is the most important part about being a doula?
For too long, pregnancy and birth have served as a source of women’s disempowerment. It is the ground upon which women have historically been discriminated against in our employment and with regards to our care responsibilities and family roles. Yet, birth is a defining moment in a woman’s life. Ina May Gaskin, an American midwife and author of Spiritual midwifery, described birth as the “event that shakes and shapes [a woman] to her innermost core.”
If birth is a defining moment in a woman’s life, then doulas have the potential to play a significant role in contributing positivity, strength, resilience and peace to each mother’s redefinition of herself. Thus, for me, the most important part about being a doula is to focus on birth as empowering. I want every mother to feel like a warrior or a goddess both during and after the birth of her child.
What has been a highlight of your experience being a doula?
The highlight of my journey towards certifying as a doula has been being embraced by a community of strong, passionate and motivated women. I have met so many wonderful women who have taught me to embrace my own feminine power. During my training, I felt nurtured and empowered by my trainers and fellow trainee doulas. It is this sense of nurture, safety and empowerment that I hope to create for each woman that I work with.
Through my platform, Birth Consciousness, I have been contacted by a number of South African women who had queries about their own pregnancies and birth. It has been extremely fulfilling to establish a sense of community among my followers and to be able to offer information, guidance, support and reassurance to mothers who expressed anxieties or fears about their upcoming births.
What does feminine power mean to you?
I acknowledge that there are many births which are experienced with elements of fear, anxiety and trauma and I don’t want to discount the experiences of many women who have not experienced their own births as beautiful. When I say that birth is beautiful, I refer to the potential for healing, growth and empowerment that can be drawn from the birthing experience. To me, there is nothing more beautiful than witnessing a woman step into her primal state and draw upon her body’s inherent wisdom to do what may feel impossible at the moment. Birth is not easy, it is not glamorous and it is not always a serene or spiritual experience. But those are exactly the qualities that make birth so beautiful.
Women are told consistently that we are not as strong as men, that we are weak or powerless, yet the act of bringing another person into this world is powerful beyond measure. It is an act of overcoming which is achieved solely by the trust a woman places in her body. Birth may not be easy, but that is a testament to the unquantifiable strength, power and resilience that resides in every woman.
Each day, approximately 353,000 women give birth and not one of those births will be the same as another. Varying cultures, religions, socio-economic factors and circumstances, birth ideologies, gender norms, medical histories and degrees of health care quality are just some of the factors that play a role in shaping a unique experience for each and every mother who gives birth. There is no single adjective capable of encompassing the diversity in birth, but beauty, a concept capable of encompassing an indeterminable combination of qualities, comes pretty close.
Why do you believe birth is beautiful?
Power, as a societal construct, refers to a capacity to effect change or influence within society. Historically, masculinity has been associated with power while femininity has remained associated with adjectives of ‘soft’ and ‘gentle’ which are really just euphemisms for ‘weak’.
The irony is, however, that women have demonstrated our power since the beginning of time, but that power is consistently undermined and disregarded.
Feminine power is unquantifiable and its definition is elusive because it means something different to every woman. However, regardless of the varying forms that feminine power may take on, one fact remains constant. Our societies, workforces, economies, and the human race itself rest upon the resilience, strength, and power of every woman. In defining birth as beautiful, I describe the act of bringing another person into this world as powerful beyond measure. I believe that potential and power reside in every woman, regardless of whether she chooses to give birth or not.
That being said, I believe that the source of our feminine power does not reside in our ability to give birth or to become mothers. Rather, birth is an exemplification of feminine power in play. When pushed to our very limits, when the only way out is through, women have tapped into that inherent feminine power to perform the ultimate act of love and selflessness.
In order to harness feminine power, we need to redefine conceptions of power entirely. Women do not need to be the same as men to be equal to men. Women do not need to be more masculine in order be just as good leaders as men are considered to be. Our feminine power, which resides inwardly qualifies us to be just as good leaders, if not better.