What do these advocates do for parents during birth?
Friday, January 20, 2006
Sarah Rountree wasn’t sure what to expect with her first delivery. "I was a nervous mom," she says recalling the birth of her son, Brody.
Since she had few family members in town, the 35-year-old Lincoln Park mom hired a doula.
Doulas: an ancient greek word now meaning a profession of women helping women. Part midwife, part nanny, part your mother without the nagging, doulas help women through their delivery and the transition into motherhood.
While only 5 percent of women used a doula during delivery in 2002, doulas are gaining more members, more acceptance from doctors and medical proof that they are helpful during the delivery.
After an emergency Caesarean section, Rountree ended up using several rotating postpartum doulas during her six-week recovery. The postpartum doulas helped care for Brody and did some household chores, allowing Rountree and her husband to sleep.
"They just came in and whipped everything into shape, but not in an intrusive way," Rountree says. "It was kind of like the MasterCard commercial. Twenty-two dollars for doula, eight hours of sleep; priceless."
Some describe a doula as an experienced set of hands. Someone to be there when the doctors and nurses can’t be.
Karen Laing, president and founder of Birthways, which helps expectant moms find doulas, explains that doulas are professionally trained women who provide emotional support for families.
There are two types of doulas—labor and postpartum. Labor doulas assist women in planning for their delivery, help find answer to questions or talk through concerns expectant mothers may have, and then be present for the actual delivery.
Postpartum doulas help new mothers adjust to their new lifestyle. They guide them through breastfeeding, lighten the workload by running errands or doing chores and reassure the mother that everything is going to be OK.
Laing says it’s important to remember the role of the doula is support, not expert advice. Doulas aren’t there to teach parents how to be parents.
The cost of a doulas’ services depends on experience. Laing says labor doulas can charge anywhere from $350 to $1,000 while postpartum doulas are usually $23 to $30 an hour. Often, medical insurance does not cover these costs.
But that could all be money well spent. According to a study from the University of Michigan the support provided by labor doulas not only calms women, but also shortens the duration of labor. A shorter labor means less need for certain medical interventions like the use of forceps, vacuums and episiotomies. The study also showed a decrease in the use of Caesarean sections.
Dr. Xavier Pombar, director of obstetrics at Rush University Medical Center, says he works with a doula almost every other month. Pombar sees them as valuable emotional support to moms and his office even provides a list of doulas to his patients who are considering using one.
"For the most part I welcome doulas," Pombar says. "Doulas can be [in the delivery room] the entire time. It can be hard for doctors and nurses to be constantly present."
Charity Cooper, a certified nurse midwife at the University of Illinois Medical Center in Chicago, agrees. Doulas’ nonmedical support to expectant moms does not overlap with the doctors and midwives. "We’re all here for the same purpose," Cooper says. "Women in labor need people around them and I think that’s the role the doula is now filling."
Support during delivery
"[It’s] a mixed bag of when women will call seeking a doula," says Natalie Evans a Roger’s Park resident who has been a trained labor doula for three years. Most seek a doula in the final trimester.
Addison resident Rachel Dolan Wickersham has been a certified doula for 12 years, she typically meets two to three times with a mom and dad before a baby is born.
"It’s really more of a chance to get to know each other," says Natasha Gittings, of Forest Park, who has been a labor doula for eight years and a postpartum doula for seven.
Jen Small, who lives in Chicago’s Andersonville neighborhood, wanted a doula during her first pregnancy when her son, Alec, was born. The 33-year-old mom hired Gittings. "It was like having the perfect mom there. It felt like there was someone there just looking out for me," says Small.
As the due date approaches, the doula is on call around the clock until the mother goes into labor. Sometimes a doula will join the mother at her home to help her through contractions or meet her at the hospital, says Gittings.
Creating a comfortable setting is vital. "I do whatever I can do to make it not seem like a big hospital," she adds. "Getting rid of florescent lights can go a long way."
Doulas also support fathers during delivery. Her job is to make sure the partner gets a chance to take a break, rest or get something to eat. "We’re working as a team so mom is never by herself," Evans says.
Laura Stukel, a 36-year-old Oak Park mom hired Gittings for the birth of her daughter, 2-year-old Kate.
"It was reassuring knowing she was there for us," Stukel says. "She knew when it was our family time and to step to the side."
Postpartum doulas, Gittings says, offer day or night help for new parents. About half of her clients are first-time parents.
Typically, doulas handle light chores such as cooking or laundry and take care of the newborn while mom and dad rest. When there are older kids, a doula can help maintain that child’s schedule.
Stukel hired a postpartum doula but was primarily looking for someone to help at night. "In our case with an easy delivery with one child, it was helpful but expensive," she says. For parents dealing with twins, more complicated births or who have younger children, postpartum doulas can be invaluable.
"She knew how to do everything and wasn’t pushy," Rountree says.
With overnight stays, her husband managed to get 10 hours of sleep twice a week leaving him with more energy to help, Rountree adds.
Finding the right one
Certification isn’t necessary to become a doula and there are no governing bodies or licensing standards.
"It’s a buyer be aware situation," says Laing. "That being said, in my experience these are very committed women who are dedicated to and fascinated by birth."
But doulas can get formal training. The most common is certification through DONA International. Other organizations, such as the Association of Labor Assistants & Childbirth Educators and the Childbirth and Postpartum Professional Association also offer certification.
Ask your doctor or your hospital for a list of doulas. DONA’s Web site lists a checklist of questions to ask. But in general, parents should interview several doulas, ask how many births they’ve attended, what is their birthing philosophy and how long they stay after the birth. For more guidance, there are agencies such as Birthways, says Laing, which interviews moms and matches them with one of their trained doulas.
Pombar stresses expectant moms should make sure their potential doula is sensitive to their wishes. "I think the one thing [doctors] look for is that patients understand they make the decisions," he says.
Wickersham shares Pombar’s concerns.
"Ten to 20 years ago [doctors] had no idea what I was doing," Wickersham says. "Now most have a pretty good understanding that a doula is there to support the family and not to step into the caregiver’s role. A good doula learns how to do her work without interfering."
When 17-year-old Frances Payne found out she was pregnant, the health center at her high school suggested Christopher House. The community outreach center provides free doulas for teenage moms through the Ounce of Prevention’s Parents Too Soon program.
"I didn’t think I needed a doula," says Payne. "I had my mom and grandmother." Payne changed her mind when she realized she needed help learning to care for her baby.
Last year, Ounce of Prevention, a nonprofit organization for Illinois families, was instrumental in hooking up 546 mothers-to-be with doula support services through the Parents Too Soon program.
But it’s not just about the baby’s birth.
"We really try to empower parents to understand the power they have in their child’s positive development," says Sara Manewith, of teen parent and infant development services at Christopher House. Manewith says the center has two doulas who make home visits to teach about prenatal health, the physical changes in the body, how to remain comfortable and how to bond with the baby in utero.
"[You] can see the attachment grow from the mom not being able to conceptualize the baby to being able to relate by talking to and reading to the baby in the womb," says Annie Levin, Payne’s doula who has worked at Christopher House since October 2004.
When Payne’s son, Giovanni, was born she was surrounded by her husband whom she had married in January, her family, friends and Levin.
"Annie would rub my hand and ask me questions," says Payne. Later, Levin taught Payne how to breastfeed, burp the baby and interact with Giovanni.
"I think it was a good idea," Payne says. "I recommend it even if you have support. It eases the stress a little bit so you’re not so scared." Meg Shreve
Meg Shreve is a graduate student at Northwestern University’s Medill School of Journalism and a former Chicago Parent intern. Chicago Parent intern Dani Litt and managing intern Graham Johnston contributed to this story.