The term "doula" has become quite a buzz word these days! Dr. John Kennell, pediatrician and researcher, has said, "If a doula were a drug, it would be malpractice not to use it." That’s pretty rad statement! So what is a doula and why is everyone talking about them?

The modern definition of doula is derived from a Greek word that refers to a female servant. Today's doulas are trained to support women and their families during labor, birth and postpartum. A doula gives non-stop support and attention to the birthing woman in labor and, as Paulina Perez states, "to the childbearing family." I love that term, because often, the birthing woman will have a husband or partner, a mother or mother-in-law and others who may be present during the labor and birth. Doulas can provide information and support to all who attend the birth.

Doulas are (or should be) highly trained and educated in the normal birth process and in methods and techniques (such as relaxation, massage and acupressure points) that can help reduce labor pain "naturally" or without medication. Professional doulas are trained in maternal positions and movements that can help reposition a baby during the labor process, which can help the labor progress more steadily.

Doulas are not just helpful in unmedicated births, however. Women receiving epidurals or other birth meds have also reported more positive experiences when a doula was present. With a medicated birth, doulas provide explanations and answers to questions about the medical tests and processes involved in medicated births, and they continue to provide emotional and physical comfort to the mom in labor. Also, if the medication doesn't work as desired or expected, a doula can be very helpful to provide comfort to the laboring mom while she is confined to the bed and equipment.

It is important to know that doulas do not do any kind of medical evaluations. They do not do cervical checks, blood pressure checks or any kind of medical test or evaluation. Midwives, doctors and nurses are the experts in that area. Doulas are the experts in understanding the emotional and physical needs of a woman in labor, birth and postpartum, and how to meet those needs in a non-medical way.

Studies conducted by Drs. Kennell and Klaus show the incidence of interventions is lower when a doula attends the birth. Women who had the support of a doula during labor tended to have shorter labors, less complications during labor and birth, a reduced need for pitocin, forceps and vacuum extractors, a lowered use of pain medications and epidurals and a reduced incidence of Cesarean sections. Equally important, women who had doula support had more positive feelings about their birth experience, their newborns and even more positive feelings toward their partners. It was also noticed that the establishment of breastfeeding and a strong maternal/infant bond was notably enhanced when a doula was involved.

Thanks to the positive impact doulas are making in the birth experience, many pregnant women are seeking out doulas to support them during this life-changing time. 

How can a doula have such a significant impact? The answer to that question is both simple and complex. Birth is a normal physiological event, but it is a very dynamic event. For many women, it is the most powerful experience they will ever have.

Over the ages, women have traditionally been supported by other women during childbirth and postpartum. Their mothers, sisters, aunts, cousins and friends were often present to provide emotional encouragement and physical support during the birth process. But as families moved apart, many women found themselves virtually alone as they faced the upcoming labor and birth of their baby. This societal change occurred at the same time as the change from home births to hospital births.  The baby's father and other family members were excluded from the mysterious delivery room and whatever went on in there. Women were often scared and alone, which increased their pain during childbirth. One intervention led to another, and the face of childbirth changed in many modern societies.

Many women decided to reclaim their place--and their peace--in childbirth, both as the birthing woman and as women offering labor support. Although this idea seemed radical to some, it was actually just a resurgence...a renaissance, if you will...of age old birth practices.  Having a trained, experienced companion to provide emotional and physical support during the birth process helped the birthing women feel more at ease, less frightened and more trusting of their bodies and the natural process of birth. And while the positive results of those changes have been noted in the clinical studies conducted by Klaus and Kennell and others, more importantly, they have been noted by the birthing women and their families.

You can find doulas in your area by searching websites of certifying organizations, such as www.cappa.net (Childbirth and Postpartum Professional Association) or www.dona.org (Doulas of North America International). You can also check your region for community-based doulas, and ask your friends for personal referrals of doulas they would recommend.

Happy birthing!
Julie White
JuJuBabies LLC

categories. hospital birth, epidural, episiotomy, induced.
year story took place in. 2010.
country birth took place in. USA.

As usual, I woke up at 2 AM to pee. I was 37 weeks pregnant, 19 days away from my due date. But this time, when I stood up to head to the bathroom, I felt a gush of fluid. Hmm, that's different, I thought. After relieving myself, changing my pants, and considering the possibility -- OK, very good chance -- that my water had just broken, I went back to bed and tried to sleep. But of course I couldn't sleep because hey, if my water just broke that means I would be having a baby today.

I got up and decided to answer some email and complete a few work tasks. Around 6 AM, my husband Chris woke up, noticed I was missing from our bed, and came looking for me. "What are you doing up?" he asked. "Oh, my water broke, so I decided to answer my email." Surprised by my answer, he did well to not freak out but thought I should at least call our doctor. Dr. L, of course, wanted us to come to the hospital right away, but knowing that once we were at the hospital we would be stuck, Chris and I decided to take our time. After all, my contractions were nearly nonexistent. We both showered; he cleaned out the litter box and vacuumed. We ran a load of laundry and did the dishes. And then we headed to the hospital.

Once there, the nurses in L & D verified that my water had broken and then admitted me. Because my water had broken six hours earlier and I'd made nearly zero progress in the effacing and dilating department, Dr. L decided to treat my labor as an inducement and put me on pitocin to get things moving. After we were settled in our room, the anesthesiologist came in to talk to me about an epidural. I had in my mind that I wanted to keep labor as natural as possible, but I also knew that pitocin has a reputation for making labor very uncomfortable. I could tell the anesthesiologist was doubtful about any woman's ability to make it through labor without an epidural -- maybe that's just his job or maybe he just sees women with the best of intentions to not have an epidural request epidurals every day. He said that most women he sees end up getting an epidural and that I would too unless I was a marathoner or a Navy Seal. I was determined to give it a try.

For the first two or three hours, I was very comfortable. Because I was on pit, the nurses made me wear a heart rate monitor for the kiddo, which means I was confined to my bed unless I had to go to the bathroom. The nurses also pumped me full of fluids in case I did want an epidural (because from what I can remember, you have to have two bags of fluid before it can be administered). The nurses thought I was too comfortable and that I wasn't progressing as quickly as they would have liked, so they increased my pit dosage every 15-30 minutes. Finally, maybe around noon, I started feeling uncomfortable contractions. I definitely did not know what to expect, but now I would best describe my contractions as the worst menstrual cramps you can imagine. At one point, the contractions became so intense that I vomited. And not knowing how much worse the pain was going to get, I asked for the epidural. If I knew then what I know now, I'm sure that I could have handled the pain. At some point in time, the nurses put me on oxygen, but I don't remember why. My heart rate and breathing rate were really low -- I attribute that to being a runner and to practicing yoga -- so maybe they thought the kiddo wasn't getting enough oxygen.

I tried groaning through the contractions like I had seen in a few birthing videos, but drawing attention to myself like that -- yes, even in the middle of the birth of my child -- is just not my style and I felt stupid. Which is dumb. But at the suggestion of the anesthesiologist (maybe he just didn't like to hear a woman groaning), I found a zone and tuned everything out. This helped me breathe through the contractions and handle the pain that remained after the epidural. Within one hour I had dilated from 4 cm to 7 cm, and within another hour I was ready to push. I pushed for 45 minutes. The epidural took the edge off my contractions, but I could still feel them, and when the time came, I definitely felt the ring of fire. I am still somewhat irritated with my nurse who gave me some very bad pushing advice. She told me to push like I was having a bowel movement and to use those muscles, but she should have told me to focus on my Kegal muscles and to squeeze them together like I'm cutting off a stream of urine. It's a subtle difference, but using the right muscles would have made the delivery go faster and caused less pain when I did have a bowel movement after delivery.

Elijah was born around 3:30 at 6 lbs. 5 oz. and was 21 inches long. Completely healthy. Post delivery, once we were in our hospital room and had seen some family, we tried to relax as a family. Our overnight nurse made it her personal mission to get E to breastfeed, but he just wasn't interested. After talking with a lactation consultant in the hospital, we learned that 37-weekers fly under the radar as being full-term babies. More or less, they are ready to come into the world, but she said they notoriously have trouble breastfeeding because they want to sleep all the time. So I pumped in the hospital, and we fed him with a cup in order to avoid nipple confusion. After we got home, we continued to try breastfeeding, which E wasn't interested in, so I would pump and Chris would feed him with the cup. He wasn't interested in eating at all, and my milk really didn't come in very well, so we made a trip to the LC. She gave us some tips and tricks for improving my milk, but E was losing weight, so she told us to supplement with formula and to give him a bottle. Any nipple confusion could be remedied later. I still pumped, but I was never able to produce a full meal for E, so we continued to supplement with formula. At another LC appointment, we worked to switch E back to my breast by introducing a nipple shield. He ate well from that, but he never really learned how to latch properly. As much as I wanted breastfeeding to work because it was best for E, Chris and I decided we had to do what was best for the whole family. We were all exhausted and frustrated, and after working at it for 3-and-a-half months, we went to formula only and never looked back.

Now E is 16 months old, and he's one happy little dude. We haven't decided whether or not we'll have another, but if we do, we're on the five year plan and will -- God willing -- wait until E is four or five to have another.

categories. hospital birth, epidural, induced, preeclampsia, postpartum hemorrhage.
year story took place in. 2007.
country birth took place in. USA.

During my pregnancy, I did everything right. I ate well, got enough sleep and exercised everyday.

At 34 weeks, my husband and I drove 3 hours for a weekend visit with friends. I, being el preggo perfecto, brought a gallon jug of filtered water to keep hydrated during our drive. I sipped, then chugged, and finally gully washed myself with my gallon of goodness. So, down the open road we crept. One hour, then two hours passed, and finally, three long hours had brought us to our destination. We arrived at our hotel and I was incredibly relieved to stretch my pregnant legs. I sprawled on the perfectly fluffy hotel bed and took my boots and tights off and sighed with relief to finally be comfortable…until I caught a glimpse of my feet.

I yelped to my husband, who was in the bathroom, "You've got to take a look at this!"
His face turned white as he gasped, "You've got Shrek feet!" My feet were a pitiful shade of chartreuse and my calves and ankles resembled halved watermelons. My legs were still in the shape of the boot that had been taken off minutes before. I then realized that during our three-hour car ride that I NEVER had to urinate.

The next day we met friends for lunch and I felt great but still had alarmingly swollen feet. Later that evening my abdomen became painful and I wrote it off as indigestion. I swallowed Tums and tried not to think about it. A couple hours later, I told my husband to pull into any hospital parking lot and wait out my pain. I knew if I walked into the ER of a hospital 200 miles away from our home, that I might be kept overnight, and of course we couldn't do that, we had dinner plans that night! I endured the indigestion type pain for the rest of the night and was relieved to be headed home in the morning.

While driving back home, we made a bathroom pit stop. I was excited that I needed to pee (a weird, but comforting healthy pregnant feeling!) As I did the "big belly hover" over a well worn public potty, I glanced at my urine stream and noticed that it was the color of coffee (not a latte, but a straight up, late-night 24hr diner coffee.) "Uh oh, this doesn't look healthy", I silently exclaimed.

The next morning, I woke up in my own bed. I could barely move and I was seeing small black dots. My husband had already left for work and I became a little worried at this sudden, heavy paralyzed feeling. I called maternal triage at my delivering hospital. The nurse spoke with a frightened tone and sternly suggested that I get to the hospital immediately. Her instructions, of course, scared me so badly that I leisurely dragged myself out of my bed, laid in a hot bath and attempted to shave areas that I could still reach. I loathe dramatics so much, that I got quite a bit of shaving done. I finally called my husband and relayed the nurse's message. He picked me up brought me to triage, where I was diagnosed with preeclampsia.