Making childbirth easier with doulas

More mothers-to-be hiring companions for delivery room to help with physical, emotional comfort measures

'It made such a difference'

March 01, 2004|By Margo Stack | Margo Stack,Special to

Anxious husbands and a small army of attending medical professionals aren't the only ones joining laboring women in hospital delivery rooms in the Baltimore region.

A growing number of expectant mothers are hiring female birth companions -- doulas -- to provide round-the-clock physical, emotional and informational support during labor and delivery. This has led to a ten-fold increase in their ranks statewide in the past decade.

A doula, which means "woman's servant" in Greek, is different from a midwife, who is a trained medical professional who performs clinical tasks or diagnoses medical conditions. A doula helps with physical and emotional comfort measures. She also works to ensure that the nonmedical needs of laboring women are met in what otherwise is an essentially clinical environment.

"Having a doula present creates a balance," said Brenda Lane, a self-employed doula and the Maryland representative for Doulas of North America (DONA), an international organization established in 1992 and based in Jasper, Ind. "Doulas can't possibly do what doctors and nurses do -- and in most situations, doctors and nurses aren't able to do the work of a doula. Everyone has their own part."

Less need for pain medication

There are two kinds of doulas: birth doulas, who assist with labor and delivery, and postpartum doulas, who help with care afterward. While Lane is a private doula, hired by individual clients, doulas also may work for specific hospitals.

The Greater Baltimore Medical Center operates one of the more established programs in the region, and Johns Hopkins University Hospital operates and trains doulas through its School of Nursing. Costs for such private services could range from as little as $21 an hour to as much as $275 an hour.

According to DONA, some women feel less need for pain medication when a doula is present during childbirth. That was the case for Kim Rawlings, a Pasadena mother of three who hired Lane for the birth of her third child last spring.

"With my first two, I was begging for an epidural early on, but with my third, I was in labor for 11 hours with no medication -- and I honestly don't even remember the pain," Rawlings said. "It made such a difference having someone there to remind me of my options, and just help me get through the process."

Extensive training required

Doula training programs generally require prior experience with childbirth and include a two- or three-day course during which students are instructed in labor-relaxation measures, breathing, positioning and massage.

Becoming certified as a doula, however, usually warrants a broader background in maternity education and childbirth, more extensive training and written exams that assess a solid understanding of key labor-support concepts. The doula certification process can take six months to a year, according to DONA.

Over the past decade, the number of certified doulas in Maryland has jumped from about 10 to more than 100, Lane said, keeping pace with a nationwide spike in the demand for female birth companions.

"Many of the state's doulas work independently and are employed directly by the parents, but a handful of hospital-administered doula programs have also cropped up in the last eight years," she said.

Some doctors resist

Even as doulas are more widely viewed as making a positive contribution to modern maternity care, Lane noted that some doctors fear that having one present could be disruptive.

"For some obstetricians, [doulas] are still viewed as a potential pain in the neck," she said. "But the fact is, we are not there to take over the doctor's job. And a good doula knows that."

Dr. Susie Noel Chung, who practices at Harbor Hospital Center in Baltimore, has worked with doulas three times at GBMC. Each experience has been positive, she said.

"I thought it was nice for my patients to have that extra support and encouragement in the delivery room," she said.

Continuous support

The Doula Touch Program at GBMC is five years old. For $275, patients at the private hospital can hire a staff doula to provide continuous support during the labor-and-delivery process. Doulas offering Cesarean section and postpartum support also are available.

Lanny Dowell, the program's coordinator, said GBMC's doulas must participate in three births and are required to finish a training program before joining the hospital. They also must be working toward certification.

GBMC has 12 birth doulas on staff, half of whom are certified as pregnancy massage therapists -- specializing in the particular needs of expectant mothers.

The hospital is instituting a certification program this year, through the Childbirth and Postpartum Professional Association in Lawrenceville, Ga. The move most likely will increase the number of doulas on staff, Dowell said.

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