Hi, I’m a Doula, Birth educator and mum. I started my doula journey in Turkey and continue in London, where I have been living since 2019. I provide physical and psychological support to many pregnant women in a non-judgmental way during this special process.

I have prepared this article with the intention of collectively responding to questions from numerous pregnant women whom I have assisted during their labour or those with whom I have crossed paths. Additionally, I aim to share the successful implementation of certain practice in the UK that I hope to see embraced in Turkey.

In the light of my experiences and research during the births I supported in Turkey and England, I would like to make an analysis of the birth processes in the two countries as follows:

1. Who is Responsible for the process in the Medical Team?

In Turkey, after you learn that you are pregnant, you inform your GP (Aile Hekimi) and/or obstetrics.These two teams follow the process.

If you are following the pregnancy process with your GP, you also need to find a gynecologist when the time of labour approaches. After your first registration is made to the system, your doctor will follow your process on the side of the medical team. Your doctor will perform regular check-ups throughout your pregnancy, as well as mother and baby health checks during birth and after birth. On the other hand, in regions where the number of doctors is insufficient outside of big cities, midwives can also follow up.

In the UK, when you learn that you are pregnant, you inform a General Practitioner (GP).Afterwards, you choose the hospital where you plan to follow your birth process and give birth. Your GP directs you to the hospital you have chosen, and the midwives of this hospital contact you and begin to follow your process. If any risk is detected during the interviews, the doctor is also involved in monitoring the process.

Differences in process:

Ultrasound;

• In Turkey, the number of ultrasounds performed in public hospitals is less, but this number can increase in private hospitals.
• In the UK, the number of ultrasounds is less (mostly two) in public hospitals if no complications or risks are observed.

Episiotomy;

• Episiotomy is performed more frequently in Turkey. (This rate is very high, especially for first births)
• In England, this rate is much lower, they generally prefer natural tearing. Episiotomy should not be performed in any of the births I have supported since 2019. (regardless of first or second baby)

2. Birth Plan

The birth plan is a document in which the expectant mother communicates to the birth team any interventions she wants or does not want to be made to herself or her baby during or after birth. In this way, you can tell the people who will accompany you during birth (your partner, birth team, etc.) what kind of birth you want.

In Turkey, the issue of “preparing a birth plan” is not seen as a routine. Pregnant women can prepare and share a birth plan with their own efforts, if they wish.

In the UK, preparing a birth plan is considered a routine task. Usually between 34-36 weeks, your midwives ask you to fill out a set of questions and sometimes you go over them together and discuss and clarify important parts. For example, you can state that you don’t want to be examined from below unless there is an emergency during birth, or that you do not want people to talk loudly around you during birth. You may also want your husband to cut the cord after birth ect.

3. Birth Location

In Turkey, birth is generally done in a hospital. Home birth is not very supported. As far as I know, doctors are not legally allowed to attend births outside of hospitals. Although there is no law for midwives, they are not supported in terms of equipment and experience, and an investigation can be opened regarding the cause etc. after home birth.

In UK, you have 3 options

a. Birth Centre

• The entrance may be different from the hospital entrance or in a separate building.
• The rooms are warmer.
• Instead of a patient bed, there is usually an area with cushions and pilates balls close to the floor, which is more suitable for the pregnant woman to sit, stand, and stand in any position she wants on the floor.
• There is mostly a bathtub in the room. If you want to give birth in water or use water as a pain reliever, you can choose any time you want after entering the room.
• There are generally devices such as a plate ball, bar, birth stool, rope hanging from the ceiling, etc. that will help the woman use gravity during birth.
• The use of artificial painkillers is limited here. Epidural is not given here.
• Medicines such as morphine or Parol are available. (The medication administered by each birth center may be different, I recommend that you clarify these issues with the birth center you are examining.)

b. Labour Ward

• It’s more like a hospital room. There is a patient bed. Apart from this, in some hospitals women can also spend time on the floor.
• There is generally no bathtub, but there are showers in toilets.
• You can use painkillers (epidural ect.) here.

c. Home Birth

• Generally, two midwives are with you at home from the beginning to the end of the birth. Even if there is a shift change, they do not leave you alone.
• Midwives leave emergency response kits before labour during home visits.
• If there is an emergency during birth, the hospital to be visited is determined in advance and the pregnant woman’s last week information is shared with them.
• You can rent a pool etc. for your own home.

The features I mentioned above are general situations. I recommend that you discuss and clarify these with your midwives when deciding on the place where you will give birth.

In the UK, in public hospitals, you are giving birth in a private room, and after labour, you often transition to shared rooms with partitions. You usually have the option to have a companion with you. In some public hospitals, you can also pay extra to reserve a private room at this stage."

4. Hospital admission criteria

In the UK, in order to be able to move to a private room in public hospitals, the cervix must be dilated 4-5 cm. Otherwise, they recommend that you can wait in bed in the hospital garden, corridor, stairwell, or in the compartments where there is a bed divided by curtains, if there is space, or you can go home.

Private hospitals in Turkey accept you, but the room you will stay in may be somewhere other than the room where you plan to give birth or where they indicate you will stay after birth.