What is a Doula?

Over the last few weeks I have received so many inquiries about doulas. What is a doula? What does a doula do? How much do they cost? How do you interview a doula? So, I thought I would try to answer these questions to the best of my ability.

The word ‘doula’ is derived from Greek and means ‘woman of service’. (In my opinion this sounds a little negative - I prefer ‘labor assistant’!) There are two different types of doulas: labor support and postpartum care. Postpartum doulas are also considered ‘mother’s helpers’. They help mother the mother after her birth, perhaps showing her some newborn procedures, helping establish a schedule for mom and baby, and doing basic chores like cleaning the house, food shopping, and laundry. (I chose to be a labor support doula. I figure I am not that good at cleaning my own house or doing laundry, and to be honest taking a trip to Fairway is a low point in my weekly routine - so my skills are best used to help mom during labor.)

Labor support doulas are usually hired by the couple, although some hospitals provide them free of charge to offer nonjudgmental emotional and physical support. They are also equipped to help answer many questions about the labor and birth process and medical interventions. While most doulas are not trained medical assistants and do not perform medical procedures, they have quite a bit of knowledge that may assist the couple when making decisions about the path of their labor and birth. Personally, I never make a decision for the couple, but rather provide answers to their questions and both pros and cons of any options that are presented. This way, when the couple has to make a decision, they are doing it from a place of knowledge, not fear.

Another reason a doula may be a good person to bring along is that several studies have shown that the presence of a doula can reduce the rate of routine interventions and cesareans. Her assistance tends to result in shorter labors with fewer complications, reduces negative feelings about one’s childbirth experience, reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction,and reduces the mother’s request for pain medication and/or epidurals.

There are currently two principle groups that certify doulas: ALACE (Assocation of Labor Assistants and Childbirth Educators) and DONA (Doula Organization of North America). I was certified through DONA. Both groups firmly believe in the importance of consistent, continuous support throughout labor and in respecting the couple no matter how they choose to birth.

I am often asked by concerned mothers who want to have an epidural if that is likely to be ok with a doula. The answer may vary from person to person, but most doulas believe that they are there to assist in the best birth experience a mother can have through her own vision and wishes. I firmly believe that each woman needs to birth how she feels is best for her and her family. The experience of birth has a lasting and profound effect on a woman, and the doula is there to help ensure that it is empowering and satisfying.

Once you have found a doula who you think you would like to work with, what is the next step? I would suggest a ‘meet and greet’. This is an opportunity for the mother and her partner to sit and chat with the doula and inquire about her style, beliefs, price, availability, back-up support, etc.

Here are a few questions that may be useful:

1. What is your philosophy on childbirth? Do you only attend and support women that are intending to do a natural birth? Are you open to the use of pain medication?

2. What are some of the non-pharmaceuticals pain methods that you use?

3. How do we determine when you join us? Do you come to our house at the beginning of labor? Or do you meet us at the hospital or birthing center?

4. Have you worked with my doctor, practice, midwife or at the birthing center or hospital where I will be giving birth?

5. How many births have you attended?

6. What kind of training do you have?

7. Do you have a back-up doula in case you are not available when we need you?

8. What is your cost?

9. Do you have references we can check?

10. How many times before the labor do we meet? Do you help us with our birth plan?

One of the most common questions I encounter is the cost of doulas. There is a range based on several factors - where you live, for instance. A doula in NYC will probably cost more than outside the metro area. Experience is another determining factor. At this time the average range for a doula with a fair amount of experience, which I would say is at least 25 births under her belt, is $1500-$2500. I have heard of very seasoned doulas who have attended hundreds of births charging upwards of $4000. If these numbers sound outrageous, you could also consider finding a doula who is in training and would probably only ask you to cover her expenses - taxi fare and food. Some doulas even work on a sliding scale. But keep in mind when digesting this figure that the doula is making a commitment to you to be on call and available for three weeks prior to your due date up until you have your baby. It is possible that your doula will be on call for you for a whole month!

I hope this helps explain the role of the doula and the benefits of having one as a member of your support team, and that you now have some insight as to how to find the doula who is right for you.

June 27th, 2008

Home Birth: Is This the Next ‘Right to Choose’?!

On June 18th the American Medical Association (AMA) issued a resolution in support of the ACOG statement that “the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.” as well as a resolution “to develop model legislation in support of the concept…“.

The statement from ACOG and the subsequent resolutions from the AMA are very likely due at least in part to the increased attention from the media on home birth, brought to the forefront by the film “The Business of Being Born” and its producer Ricki Lake. I have seen the film multiple times and think it is a very responsible, well-done documentary on the subject of home birth. The overall message is that home birth is a safe option for a low-risk woman who has a trained, certified midwife in attendance for medical assistance.

The midwifery model of care is based on the concept that pregnancy and birth are normal life processes - not pathological medical conditions. However midwives are trained medical experts. They monitor the mother and the baby throughout labor with a dopplerscope, come equipped with oxygen and resuscitation skills, and bring Pitocin in the event that it is necessary. They are also at the ready to make a call to transport the woman to a medical facility should she need more advanced medical attention. But unlike many medical professionals within hospital walls, they allow the birthing mother a great deal more choice - for instance the position she wishes to take to birth her baby - with fewer restrictions.

There have been numerous studies demonstrating that a home birth with a trained midwife can be a good choice for low-risk women who want to avoid unnecessary routine interventions. The largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, “low-risk” women, babies were born just as safely at home under a midwife’s care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy (taking scissors to the vagina, a practice that according to the research should be obsolete but is still performed on one-third of women who give birth vaginally).

Other eye-opening statistics indicate that though the US has the most expensive births, the maternal and infant mortality rates are on the rise. According to Mother Magazine, US infant mortality rates continue to rank it below 30 other countries. Twenty-two percent of all pregnancies are induced, and most worrisome of all, in the last four years the maternal mortality rate has risen above 10 per 100,000 for the first time since 1977. These statistics can not be blamed on home birth since only 1% of US women are birthing in their homes.

If you look outside the US, many other countries are strong proponents of allowing women the choice to birth at home. The Netherlands with over a third of all births being planned homebirths. The Perinatal Study Group came to this conclusion about the Dutch system of maternity care: “This is an important exception: this country also has one of the lowest mortality rates in the world for both mother and baby. This maternity system is worthy of close evaluation and emulation.” Across the pond, the British OB/GYNS respond with “There is no reason why home birth should not be offered to women at low risk of complications… it may confer considerable benefits for them and their families. There is ample evidence showing that laboring at home increases a woman’s likelihood of a birth that is both satisfying and safe…”

Home birth is not a choice for everyone. Several states in the US have made a home birth attended by a direct-entry midwife illegal. These states include Alabama, North Carolina, Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maryland, Missouri, South Dakota and Wyoming. One of the concerns of home birth advocates is that the AMA is trying to persuade individual state legislators to see home birth as harmful to the baby, equating it as child abuse, for which the woman may be criminally prosecuted.

How a woman chooses to birth should be based on her needs and what feels right for her and her family. She should be educated about her options and empowered by her choices. Wherever a woman is most comfortable, supported and heard is the best place for her to birth her baby, whether that be at home, a birthing center or a hospital. Throughout history women have fought long and hard for the right to make decisions about their own bodies. Birthing is a natural ability with which women come naturally equipped. Shouldn’t we be able to choose how and where?

June 20th, 2008