By Phoebe Nobles
Tuesday, October 30, 2001
In ancient Greece, doulas were women, often slaves, who helped at childbirth, and today the multiskilled doula is increasingly in demand. While midwives focus on delivery, doulas are coaches, listeners, hand-holders, teachers about motherhood.
NEW YORK (WOMENSENEWS)--For pregnant women who lost their partners in the World Trade Center attack, the prospect of childbirth in these harrowing times can be unsettling, and a time that is ordinarily stressful can be even more fraught with anxiety and psychological pain.
But the New York Metropolitan Doula Group--a professional association of some 65 childbirth assistants--has offered its life-affirming services to these women at no cost through June. They also have volunteered to help women who will be giving birth past that date while their partners in the military are serving away from home.
"It's hard to give birth anyway, but especially hard to bring a baby into a world that feels really unsafe," says Bonnie Hannibal, a professional doula who is volunteering to help pregnant women to give birth without their intended partners.
In the next few days, one woman who lost her partner on Sept. 11 will give birth for the first time and confront the unexpected absence of the father. Hannibal, the first to volunteer, will be at her side.
Doulas give physical and emotional support, as well as critical information, to the mother before, during and after childbirth.
Doulas differ from midwives in that midwives have medical training and focus on the delivery, while most doulas do not have medical training and focus on easing labor and providing psychological support. Doulas do receive certification that includes taking courses and attending deliveries, but they are not licensed--and many doulas want to keep it that way.
After the attack, Hannibal says, the New York doulas realized, "This is not going to be over next week. There are going to be babies born for the next eight and a half months that are not going to have fathers."
Hannibal's first client, a consultant whose husband worked in the World Trade Center, is due to give birth in mid-November. She had never considered using a doula, but after her husband's death, the woman called the director of childbirth education at Beth Israel Hospital, who suggested childbirth support, recommending the Metropolitan Doula Group. The group turned to Hannibal because of her training in grief counseling. She also holds a master's degree in developmental psychology and is working toward a doctoral degree at New York University.
"She's an amazing woman. She's so in tune with herself," Hannibal says of her client. "At our very first meeting, she said, 'I'd rather laugh than cry, and if you can help me do that, that's what I want.'"
The client also hopes that by having a doula at her side in the delivery room, she will not need any pain medication.
"Part of her feels that she's still frozen. She wants to be able to feel," says Hannibal. This desire for emotional healing through pain runs counter to an instinct in the medical profession to medicate in the face of the first ache.
Doulas say that women with partners can use additional support, too. The volunteers don't intend to replace those who have died. But Hannibal believes her services could help a woman facing birth alone "even more dramatically."
"There's going to be a moment, I'm sure, in her labor when it's going to hit her that he's not there with her," Hannibal says. She meets with her expectant client once a week in order to catch up on bonding and advice that would usually be spread over a few months.
"I'm helping her create this mental image of what her early labor is going to be like ... a mental picture that is very different from what it was a few weeks ago. She's probably had a mental image since she was a teen-ager, and it probably always had a partner in it."
Every birth is different, and Hannibal says, "You come with your pockets full of a hundred different ideas and techniques, and you pull them out one at a time."
Doulas do not mean to replace or undermine husbands and partners, but their philosophy is that people with close emotional bonds to the pregnant woman and very little experience with birth may be overwhelmed. The doula should be able provide enough mental distance and experience to stay calm.
Traditions of woman-assisted birth from myriad cultures have been lost to modern medical practice, which often isolates the mother-to-be in the delivery room with her partner and hospital staff.
But doulas have assisted in their own rebirth since they began making their way into delivery rooms in the late 1970s. The membership of the prominent national organization Doulas of North America, or DONA, has increased from 750 in 1995 to 3,350 at the beginning of 2001.
In 1992, Drs. Marshall Klaus, John Kennell and Phyllis Klaus founded Doulas of North America, and in 1993 they published "Mothering the Mother," now an essential textbook for practicing doulas. The authors present evidence, collected from six scientific studies in different countries, that having a doula present often facilitates natural birth.
In addition, these physicians say, the attendance of a doula reduces the rate of Caesarian sections by 50 percent, decreases the length of labor by 25 percent, decreases requests for epidurals by 60 percent and decreases the use of other drugs or forceps by 40 percent.
Most doulas have given birth themselves, but being female is the only basic requirement. Those without children of their own relate to the woman through their psychological and biological kinship as women.
"I find immense trust in someone who's done it before," says first-time mother Pascale Roger-McKeever, whose doula had given birth to three healthy infants and assisted at 17 births by the time of Roger-McKeever's delivery in February 2000. With little knowledge about the process before taking childbirth classes with her husband, Roger-McKeever was reassured that "quadruple-millions of women did this before me." She sought to reap some of that experience by hiring a doula.
Professional doulas receive extensive training, and certification is available from the Association of Labor Assistants and Childbirth Educators, and the International Childbirth Association, as well as from Doulas of North America. A trained doula will have attended from three to six births, completed a three-day workshop, a childbirth class, a relevant reading list and a written exam. In addition, certified doulas must know adult and infant cardiopulmonary resuscitation.
They are not medically trained or licensed.
"We hope to keep it that way," says Ilana Stein, director of the Metropolitan Doula Group and manager of BirthFocus, a service providing labor support professionals to women who want them.
The professional doula charges a flat fee for each birth, from $200 to $1,500, says Stein, depending on the level of the doula's experience. Many doulas also base their rates on the client's ability to pay. The fee generally covers one or two prenatal visits, the birth and a postpartum visit.
She typically meets her client during the last three months of pregnancy, when the two women gauge their personal compatibility. However, some hospitals and community maternity centers provide doulas, and a woman using those services will probably not meet her doula until she is in labor. For now, though, most doulas are hired privately through preliminary meetings.
Armed with a pager or a cell phone, the doula is on call during the week of a woman's due date. The hours of labor require her presence, and the doula coaches the mother through the demanding process.
A doula might advise her client on different positions and activities to try--walking, for example, instead of lying down. She might give a massage or provide physical support while the woman pushes in the last stage of labor. And, though the doula focuses on her communication with the mother and generally avoids conflict with hospital staff, she may also act as an advocate. In addition, some doulas are specialists in post-partum work, advising on breastfeeding and other adjustments to motherhood.
"I had an instinct that Jonathan, as great as he is, would not know what to do when I would be in a lot of pain," says Pascale Roger-McKeever. Her husband, Jonathan McKeever, does not argue otherwise. She felt confident Stein would know how to help. "I just wanted her to look me in the eyes and just completely be there."
Stein decided to use doulas for her second and third births, and eventually to make childbirth assistance her own profession. "What it came down to," she says, "was being listened to," something that she insists doctors, nurses and even husbands--"they're sweet, but they don't listen"--are not equipped to do.
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Phoebe Nobles is a free-lance writer in New York.