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THERE
was a time, not too long ago, when the childbirth experience was a time for a woman to be surrounded by loved
ones, especially those female family members whose previous birth experiences combined to form a protective
net of wisdom and love around the laboring mother.
But with time, as work and schooling caused families to move farther and farther apart from each other, geographically speaking, that sense of feminine camaraderie during labor and recovery has been lost. Pregnant women, both pre- and postpartum, often face the sometimes frightening realities of birth and the first few months with their infants alone, or, at best, with only a few days of such support before mother, sister or friend has to return home, or go back to work. The new mother is left to deal with things alone, as best she can, along with the new father, someone who may well be even more intimidated and nervous than she.
In this secular age of e-mail communication and long-distance families, many women feel a lack of emotional support during the birth process. Partners and fathers are also aware of this, perhaps more keenly than many people would realize, as they are overwhelmed by everything going on around them, not the lest of which being the physical and emotional difficulties they see happening in the mother, the woman they love. What is a couple to do; where is there to turn? Enter the Doula.
A doula, a word meaning "woman’s servant" in Greek, is a professionally trained birth and labor companion, and also a professionally trained postpartum assistant and helper. Not to be confused with midwives, nurses and obstetricians, all of whom have medical training of varying degrees and who are qualified to make clinical decisions and offer medical advice, birth doulas are there to provide emotional support to laboring mothers and nervous fathers, while postpartum doulas often serve in the role of a mother’s helper, though they can and so offer some non-medical advice on things such as breast-feeding and postpartum depression (postpartum doulas are trained to notice warning signs of PPD, and to recommend appropriate steps).
Amy Warren is a birth doula in the Lambertville area who has served many families in Mercer County; Ms. Warren is also training to become a postpartum doula. She was originally attracted to the idea of becoming a doula as a result of pregnancies among friends while she was living in Seattle.
"My friends were starting to give birth and I found that I wanted to be with them and help them through birth and through having a new baby," she explains, "I hadn’t had any children myself, and I wondered how does one do this alone? It’s such a huge thing in your life."
Many of her friends lived far from their mothers or had lost them in recent years, leaving them without strong, experienced emotional support during the important and emotionally rough event; Ms. Warren says, "I can’t imagine going through birth or postpartum without my mother being there. Then I read an article in an alternative medical journal about doulas; it was about what they did and the results they tend to get, the benefits of having a doula. And I thought, wow!, that’s fantastic! I could do that, and it would be wonderful."
Ms. Warren began her certification training through a program sponsored by DONA, the Doulas of North America, an Indiana-based organization founded in 1992, an "international association of doulas who are trained to provide the highest quality emotional, physical and educational support to women and their families during childbirth and postpartum., and boasts more than 4,000 birth and postpartum certified doulas.
Her training, which took a total of about two years, included a three-day doula training course, the reading of a series of books, attendance at a childbirth education series, as well as documentation, essays, evaluations, and observations of births. You must also provide evaluations of your own abilities from at least three clients people to whom you have offered labor support, and three primary care providers, whether from midwives or doctors (doctor evaluations must also include evaluations from the nurses present at the birth).
It’s not an easy course to take, but most trainees come to it with enthusiasm and get through it relatively quickly. Doula training and certification is a lot of work, according to Ms. Warren, the amount of essays and evaluations alone is intimidating. But, if statistics are any indication, the effort is well rewarded. Doulas are said to decrease cesarean rates by 50 percent, length of labor by 25 percent, and requests for main medication by as much as 30 percent, according to studies published over the years in British Journal of Obstetrics and Gynecology, American Journal of Obstetrics and Gynecology, New England Journal of Medicine and the American Journal of Nursing.
A prestigious Oxford scientific and medical group, the Cochrane Collaboration, reported in 1998, "Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all laboring women receive support, not only from those close to them but also from specially trained caregivers."
According to Ms. Warren, doula support comes in many forms, though she is quick to mention that none of it is medical. "We just provide physical comfort and emotional support," she states, "We don’t do any internal checks; we don’t make any medical recommendations."
What they do offer is a variety of ways to make labor easier, both physically and emotionally. Ms. Warren, who is also a certified massage therapist, utilizes massage in her technique, including showing fathers and partners how to assist. She also offers advice and help on positioning, or position changes, to facilitate labor or reduce pain. Many of her comfort measures are initially explained during a series of pre-birth meetings, where the couple can get a better of idea of what having a doula will mean, and whether or not they really want to do it.
"We do a meeting where I go over the comfort measures I might use. I bring the birth ball (a physical therapy tool that can ease labor and offer physical comfort during labor) and I show them the acupressure points I might use." She describes further techniques as well, including aromatherapy, prenatal massage, how to make the birthing room comfortable by bringing pillows and blankets from home, even how to use the birthing room floor rather than the bed if necessary.
And how do fathers and partners feel about her presence during what can be a very personal time? "I’ve found that they love to have me in the birthing room," Ms. Warren smiles, "because I can help them help the mother. That’s really why I am there. At several of the births, the father has been the primary caretaker during the birth, and I am just sort of on the sidelines in case he needs a rest or some suggestions. In some cases, I’ve been the primary caretaker during the birth and [the father] prefers to just sit back and hold her hand."
Fathers and partners are often exhausted by the birth process, especially on an emotional level, as they watch the person they love suffering great pain. "It’s unfair to expect them to remember everything they’ve learned in childbirth education courses that’s all they’ve had [by way of preparation]," she explains, "So to expect them to come in and know exactly what to do every time, through every contraction, and be creative about it is really unfair." It’s exhausting too, for everyone involved, as labors can greatly vary in time, some needing only a couple of hours while others can take a full day or more. So the doula’s presence offers another benefit someone to "tag in" while the other person attempts to grab a nap, however short it may be.
Doula support is a valuable tool for modern couples, offering support that might not be available otherwise. Doctors and midwives are important components of any safe birth, but they are not always the founts of emotional aid that many women wish they had. Family members cannot always be around, especially if they have to travel great distances. Doulas offer a substitute, an extra friend whose only concern is your comfort.
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