During 42 hours of painful labor, Julie McNitt of Amherst, New York, had two constant companions: Her husband and a professional labor assistant called a "doula." And if she ever has another child, both of them will be invited back.
Her husband earned points by sticking around despite a bad case of "deer in the headlights" syndrome. Her doula, Cindy Whittaker, simply helped her survive. "Because she was so experienced, she was able to calm me through the contractions," McNitt says. "She knew exactly what to say to me. She threw me a life preserver."
In delivery rooms across the country, doulas are no longer a rarity. Unlike certified nurse-midwives, they have no medical training. But they aren't there to insert IVs or recommend treatments. Their only goal is to support women during labor and delivery, says Susan Martensen, then a doula in Ottawa, Canada, and the president-elect of DONA International. "The doula works for the parents, not the hospital or the doctor," she says.
The name doula really says it all. Translated from Greek, it means "a woman's servant."
Whittaker has attended around 50 births in the last three years. In that time, she has fine-tuned her techniques to help women stay calm and comfortable. She'll massage a woman's head, feet, and back. She'll suggest different positions. She'll rearrange pillows. Most of all, she'll give the mother constant reassurance. "I tell her where she's at and what she needs to be doing," she says. Most doulas have had babies of their own. "We know what we would want and how we would want to be treated," she says.
If you have a baby in your future, you might consider adding a doula to your team. Depending on where you live, you can expect to pay between $300 and about $1,000, which generally covers one visit before and after the delivery as well as the delivery itself. And if you find a good doula, the payoff can be huge. A recent study found that women needed less pain medication and were less likely to have cesarean sections when they had constant support from an experienced caregiver.
If you decide to hire a doula, ask your midwife, doctor, or obstetrician for a recommendation. You can also check http://www.dona.org for a DONA-certified doula in your area.
Finding the right person
But before you let a doula into your delivery room, the two of you should have a long talk. Ask about her training and credentials. Anyone can call herself a doula. And even if she's a certified member of DONA or another doula organization, her training might be limited to a weekend course. Ideally, she should have plenty of experience with labor and delivery and a good working relationship with local doctors and midwives.
You should also ask about her philosophy of childbirth. If she has rigid ideas about how a delivery "ought" to go, it's time to find someone else. She needs to be completely committed to your birth plan, yet also willing to accept the medical advice of doctors or midwives.
If you decide to hire a doula, it might be a good idea for her to accompany you to a doctor's visit, especially one in which you're going to discuss your birth plan. And make sure the baby's father is comfortable with the person you choose. A good doula should make everyone in the room, including the medical staff, feel at ease.
Unfortunately, some doulas have been known to put their own feelings about childbirth ahead of the needs of the mother and her baby. A Wall Street Journal article caused some introspection within the profession, detailing cases where doulas fought against medical intervention even when the mother or her baby was in danger. In one instance, a doula reportedly urged a mother not to accept IV fluids even though doctors believed she was severely dehydrated. Doctors at one San Francisco clinic reported that several babies needed to be revived after doulas encouraged mothers to avoid cesarean sections until the last possible moment.
But such cases are very rare and are in direct conflict with the Code of Ethics for DONA members. Doulas who belong to the organization view their role as supporting the laboring woman, not making medical decisions.
What does a doula know?
Doulas still face plenty of skepticism in the medical community. Elayna Hollifield, a surgical nurse living in Spruce Pine, North Carolina, certainly didn't rush to find a doula when she became pregnant. "My feeling was, what is a doula going to know that I don't know?"
Her husband, Jason, had no such reservations. He wanted extra help in the delivery room, and he eventually convinced his wife to hire a doula. "I knew that there would be a lot of things that we weren't prepared for," Jason says. Even after attending birth classes, he wasn't sure he was ready to comfort her through the contractions. "We had a midwife, but she was busy doing all of the things that she had to do. Our doula was with us the whole time, and she gave us a lot of personal attention."
The Hollifields expected to have a natural childbirth, but the baby had other ideas. When it became clear that the baby was stuck in the birth canal, the doctor and midwife both urged a cesarean section. Their doula encouraged the Hollifields to listen to the medical professionals. Elayna underwent a cesarean section and delivered a healthy boy. "As soon as he was born, we both said we couldn't have done it without (our doula)," Jason says.
Julie McNitt, the mother from New York, didn't see the need for a doula either, but her husband insisted. "I figured I could always send her out to the hallway if it wasn't working out," she says. It never came to that. Cindy Whittaker was by her side for 42 hours, from the first induced contraction to the eventual cesarean section. "I wouldn't have been able to get through that without Cindy," McNitt says.
And if McNitt has another child, Whittaker will be in the room, ready to throw out another life preserver.
Interview with Susan Martensen, doula and president-elect of DONA at the time of the interview.
Interview with Julie McNitt
Interview with Jason and Elayna Hollifield
Interview with Cindy Whittaker
Hwang, Suein. As doulas enter deliver rooms, conflicts arise. The Wall Street Journal. January 19, 2004.
DONA International. Position paper: The doula's contribution to modern maternity care. http://www.dona.org/PDF/BDPositionPaper.pdf
Taylor, JS. Caregiver support for women during childbirth: Does the presence of a labor-support person affect maternal-child outcome? American Family Physician. October 1, 2002. http://www.aafp.org/afp/20021001/cochrane.html
American Academy of Family Physicians. Midwives. http://www.aafp.org/online/en/home/policy/policies/n/nursemidwivescertified.html
DONA International. Finding A Doula. http://www.dona.org/FindingADoula.html