In the throes of delivering her 9-pound son, Anthony, Lynda Hildred finally said it: Fahrvergnugen.
Her husband, David, immediately understood: He kept his place by her side and squeezed his wife’s hand. Meanwhile, the couple’s doula, Ana Hill, took off in search of a nurse.
Weeks earlier in the Hildreds’ home, Hill helped the couple develop a birth plan. If Lynda shouted, this code word meant it was time: She really wanted the drugs.
Along with the scented candles and overnight bags prepped for a last-minute trip to the hospital, savvy moms have added a labor doula to their birthing checklist.
Tackling the job of “mothering the mother,” doulas attend the delivery as labor support for the birthing couple.
These women assist mothers (and their partners) during the labor process, while leaving the medical care to the doctors and nurses. So instead of focusing on the baby’s monitor and the mother’s vital signs, the doula deals with the mother’s needs.
“It’s like having your best friend with you who just happens to know a lot about babies,” says Lynda Hildred.
Today, thanks to a word-of-mouth network of happy mothers, doulas are becoming more popular in the Denver area, and not just with the granola-crunching, natural-childbirth crowd.
“Some of it is fashion and some is function. It’s very ‘in’ right now,” says Regina Rodriguez, owner of Harmony’s Family, a childbirth education center and resource for birth and postpartum doulas.
The reason? Pregnant women talk.
Whether they meet at prenatal yoga class, waiting in the doctor’s office or in line at the grocery store, a not-so-secret sorority exists among these women. They’ll trust their bump-laden sisters with everything from exercise trends to sonogram technicians. Chances are even if the mom-to-be can’t tell you what a doula does, she’s heard a fabulous recommendation for one.
The doula philosophy centers on supporting a woman’s right to have whatever type of delivery she wants. That can mean natural childbirth, use of narcotics, an epidural or even a scheduled Caesarean section. The doula doesn’t judge the woman’s decision, she supports whatever option the mother chooses.
Doulas are a trusted source of labor information and an emotional pillar for the parents. That could mean walking the halls with Mom, hitting just the right spot with a back massage or simply relieving Dad.
Most doulas will meet with a couple at least twice before the birth and determine the family’s needs for the big day. Once that due date nears, the doula is on call 24/7 and will stay for the duration of labor and delivery. Generally doulas charge a flat fee ranging from $450 to $850 for their services, depending on their scope of practice. These prices usually include a few pre- and postpartum home visits. Prices and services for more extensive postpartum doula services, such as night visits and breast-feeding assistance, are separate.
Once in the delivery room, the doula is there to serve the parents. The nurses come and go, the doctor shows up at the end, but the doula stays in the room the entire time. Often she’ll help translate medical jargon or convey the patient’s wishes in hospital lingo.
For many first-time moms this is their first stay in a hospital. They find themselves intimidated by the regimented policies and procedures. As the day wears on, doulas will give opinions when asked but never medical advice.
“I was in labor for 21 hours and having Ana there the whole time really gave us peace of mind,” says Audrey Walker, who also used Hill as a doula for the birth of her son Dalton.
Hill, a mother of six who also serves as director of Rocky Mountain Doula Educators, adds that when labor exceeds 24 hours she’ll call her backup doula so she can take a catnap.
Unlike midwives, doulas don’t deliver medical care and there’s no required state licensing. However, several certification programs exist, including the international nonprofit Childbirth and Postpartum Professionals Association. In 1999, Colorado had a single CAPPA-
certified doula on record; by 2005 there were 51.
“As more people learn about having doulas attend births the interest in the profession is spreading like wildfire,” says Gina DeRosa, president of the Colorado Doulas Association. Her organization has an estimated 91 members.
Before receiving certification from any of the major organizations, doulas must undergo training, a process that sometimes can take years. Certification training generally includes childbirth education, required reading, live-birth evaluations and a written test.
The doulas also are required to sign a code of conduct, a scope-of-practice statement, a philosophy statement and a grievance policy. The philosophies and requirements vary with the objectives of the certification organizations, says DeRosa, who is certified through DONA International. DONA, which has 78 members in Colorado, will hold its annual convention in Denver this summer.
Not all doulas choose the certification route, preferring not to have their practice determined by an outside organization. Regardless of qualifications it’s a patient’s right to choose her birth team, and no hospital in the metro area will deny a doula entrance to a delivery room. The only exception would be an anesthesiologist conducting a Caesarean section who may limit the number of people in the operating room because of space constraints.
Ancient and modern
Like prenatal Pilates and $200 maternity jeans, hiring a doula seems like the latest thing for hip Denver moms. Yet these services are born of age-old traditions. “It’s an ancient concept that’s been modernized,” says CDA’s DeRosa.
Throughout history it’s not the child’s father who served as emotional birth support, but experienced women such as the mother’s older female relatives. Even the term doula is derived from a Greek word for a woman servant. DeRosa sees the modern resurgence of doulas as a reaction to a splintered society where women live far away from much of their family.
“We recommend doulas, says Dr. Valerie Imperial, an OB/GYN with Denver’s Partners in Women’s Heath. “They fulfill a role for the mother that husbands and doctors can’t.”
Imperial’s practice employs two medical assistants who are trained doulas. These women see the patients throughout the pregnancy and already have established working relationships with their physicians.
Modern medicine is finding the presence of doulas can improve delivery outcomes and even help reduce the number of Caesarean sections. Sources including the Journal of American Medicine, the New England Journal of Medicine and the British Journal of Obstetrics and Gynecology support the positive results stemming from continual emotional support of a labor assistant.
The reason for the success likely has to do with the mother’s brain chemistry. Doulas are trained to keep the mother in a relaxed frame of mind so that her most powerful endorphins are released.
When women are stressed and afraid, they are more likely to feel pain, says Laurel Wilson, a certified labor doula, mother of two and owner of Mother Journey Childbirth services, based in Centennial.
“The goal is for the woman to turn herself over to her instincts,” says Wilson. “When she’s allowed to be instinctual she’ll find the safest path to birth. The key is giving her a safe environment where she can express her needs.”
Wilson stresses that the safest path of birth may ultimately include drugs or surgery and that no doula should turn her back on a patient for her delivery choice.
Parents come first
Nor should a doula usurp the bond between the baby’s parents during delivery.
“There’s no greater tool than the father or partner,” says Rodriguez of Harmony’s Family. “Their participation outweighs anything we do.”
Rodriguez’s business has a following among same-sex clients who choose doulas. She says many of her doulas are addicted to the miracle of birth and thrive on watching the energy and connection between two parents as their child enters the world.
“There’s nothing else like it,” says Rodriguez, herself a postpartum doula and prenatal massage therapist.
While it may be new moms who are gushing about their doulas, it seems most doula-initiated men quietly appreciate the added support as well.
Audrey and Joel Walker found themselves raving about Hill to a neighbor. Once the ladies got the conversation rolling, Joel Walker took the expectant father aside and gave him the guy’s take on their doula experience.
“I don’t think the guys would start the conversation, but my husband appreciated Ana as much as I did,” says Audrey Walker. “The two guys talked about it themselves for a bit and eventually Ana was their doula too.”
How to choose a doula
Colorado Doula Association president Gina DeRosa offers her advice for hiring a labor doula:
Interview at least three doulas. Make sure you have a clear understanding of their personal labor philosophy and that it meshes with yours. If you are open-minded to an epidural make sure your doula concurs.
Outline what services the will provide. Does the rate include massage therapy, pre-and post-natal visits? Does she offer an emergency back-up service? Some doulas will even record the events of the day and produce a birth book.
Confirm certification online and read the philosophy of the certification organization. Their mission statement will help define expectations of your doula’s capabilities.
Online resources:
coloradodoulas.com
dona.org
cappa.net
harmonysfamily.info
rockymountaindoula.com
