Wednesday, June 23, 1999
Help for a calm delivery
With understanding, support and information, doulas can soothe women through birth
BY SUE MacDONALD
The Cincinnati Enquirer
With video-toting dads, nervous in-laws and awestruck siblings gathered 'round for a contemporary childbirth, maybe there isn't enough room in a well-appointed birthing center for one more person.
That didn't stop Lisa Thomas or Mary Rake from insisting that one more person be on hand.
That person was a doula.
A what?
Susan Weickgenant and Carol Hapanowicz have been answering that question since 1990. That's when they took doula training together from the National Association of Childbirth Assistants and began accompanying friends and couples from their childbirth classes into the delivery room for moral support and advice — coaching, back rubs, explanations, hands to hold, breathing tips, among other things.
Strictly translated, doula is a Greek word meaning “female slave,” adapted in modern times to mean “mother's helper.” Doulas are trained to help women through every phase of childbirth — physical, emotional, spiritual, informational.
They explain what doctors and nurses are doing, walk up and down hallways with laboring women, work through each contraction together, offer options such as Jacuzzi baths and birthing balls to reduce pain, coach with breathing techniques, talk and help a laboring woman through delivery.
Lisa Thomas wanted a doula nearby when she gave birth to her second daughter in March, and Mary Rake wanted doula Karen Crick at her bedside when she gave birth to her third child five months ago.
“The pain was really bad,” says Ms. Rake, 37, of Pleasant Ridge. “But the fact that I didn't have an epidural, and that Karen was able to help me through it naturally, that's what I wanted. It was the best.”
As Tristate women continue to look for ways to make childbirth as natural and unscary as possible, some are turning to doulas.
A volunteer doula program is available to all women who give birth at the MOM Center at Franciscan Hospital-Mount Airy. Private doulas also can be hired to accompany women to other hospitals in the Tristate.
At the MOM Center, women who choose one of 16 volunteer doulas pay $25 for the service; as soon as they go into labor, they are linked at the hospital with an on-call doula who stays through the delivery. Women who hire private doulas pay about $300-$400 for the help, which comes at time of birth and during the prenatal period..
“It's worth it because they devote their time to you,” says Ms. Thomas, a 24-year-old single, stay-at-home mother in Springfield Township who didn't want to go through labor alone at the MOM Center. “From that first contraction until the baby pops out, they're with you. They're dedicated to you.”
Women who've used doulas say that although it's nice to have dads or labor coaches along for the labor-delivery ride, it's even better to have a woman around who knows firsthand the experience of childbirth and is trained to help women through the challenging ordeal.
“It doesn't matter how sophisticated we get with our care. It's still that woman-to-woman support that women crave when they have a baby,” says Ms. Hapanowicz, co-owner of Doulas on Call, a referral program for TriHealth. “The doula is really the only person in the room with the freedom and experience to focus solely on the mother's emotional needs, which directly affects her physical labor and directly affects the baby.”
At Franciscan's MOM Center, the statistics speak for themselves. Of the 400 women who've given birth since January, 22 used doulas:
• The Cesarean section rate was 6.3 percent among doula-assisted births, compared with 14 percent for the MOM Center in general.
• Pain medicine use was 40-45 percent among doula births, compared with a Cincinnati average of 90-95 percent.
• 90 percent of the doula-assisted moms breast-fed their babies, compared with about a 60 percent average among all women.
“Most of the obstetric providers appreciate the fact that there's somebody else there helping the patient in labor,” says Dr. Roosevelt Walker III, medical director of the MOM Center. “If patients understand what's going to happen, they're certainly going to cope better. I think there's empathy that a doula can give as a woman that a husband can't give.”
Having doulas on the childbirth team, he says, fits with the MOM Center's philosophy of offering women a variety of options to help them plan their births.
But allowing doulas into hospitals isn't always easy. Midwives struggled for years to regain a place at the side of laboring women in hospitals.
Some doctors and nurses remain skeptical or territorial over who does what in the birthing room until they experience a doula-assisted birth, says Ms. Crick, who became a doula after the birth of her second child four years ago.
“If everyone understands our role, they're very receptive,” she explains. “The biggest misconception is that we are making decisions for our clients, and that is one thing we never do. We are there only to support the decisions our clients are making and to help them reach the goals they've already set.”
Part of that process, she says, is describing to women what's happening, explaining what doctors and nurses are doing (or suggesting), and letting women know their options for the rest of the labor and delivery.
Maybe they don't know they have access to birthing balls, whirlpool baths, warm showers, a walk down the hall, a rocking chair, or non-medicinal methods to induce or speed up contractions (e.g., hooking a breast milk pump to a woman's nipples to stimulate the hormones that trigger contractions).
“So many times in our culture, women go along with whatever the obstetrician suggests, often out of fear,” Ms. Crick says. “My bottom-line belief is that women are much more satisfied with whatever outcome as long as they feel they're making choices and have some power over how the birth goes.”
Ruby Crawford-Hemphill, nursing director at the MOM Center, says most doctors and nurses now accept them because “everyone's very clear about what the roles are for the doulas and the members of the clinical team.”
Ms. Weickgenant says women in labor most often appreciate the extra voice of encouragement and support.
“Doulas, by and large, are quiet and calm,” she says. “Women have said to me over the years, "I looked up at you and you were calm, and that said to me that everything was OK.' I think we bring a calming presence that the family is not always able to.”
Ms. Thomas wishes she'd had a doula for the birth of her first child, and both she and Ms. Rake now recommend doulas to anyone they know who's pregnant.
“It's a phenomenon that's growing,” says Dr. Walker. “Patients read more. They are much more enlightened about alternatives and choices they have.”
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