The Doula Difference

By staff December 1, 2001

Three years ago, Coreen Wilde was enthusiastically awaiting the birth of her first child. The 34-year-old Sarasota resident, who normally has the blood pressure of a teenager, had little reason to worry. She'd begun to experience some bloating, a few headaches, even breathlessness; but with only 10 weeks left to go, she attributed all that to the pregnancy.

Then, during a regular monthly doctor's visit, a nurse instructed her to go to Sarasota Memorial Hospital "for some tests." There Dr. Washington Hill, a neonatal specialist, informed Coreen and her husband Mark that she had developed toxemia, a dangerous form of pregnancy-induced hypertension. And Wilde started to worry-a lot. "Basically he told us that people die of toxemia every day."

Everything that came next is a blur. With her blood pressure soaring, Wilde was rushed into an operating room for an emergency Caesarean section. She's been told she went into convulsions, but she doesn't remember them. What she does remember is taking magnesium sulfate to combat the seizures and then vomiting during the entire operation.

Afterwards, nurses whisked their premature son Hayden and a terrified Mark out of the room to the neonatal intensive care unit. Still hooked up to tubes and monitors, Wilde says she was left on the bed alone. "I didn't even know if he was breathing or not. I didn't see my baby for two days."

Wilde understands that because of her sudden, severe toxemia, the hospital staff had little time to prepare her for what was about to happen; even so, she was so traumatized by the experience that she almost gave up any notion of having more children.

All that changed with the birth of her second child, Samantha, in August. Although her toxemia recurred, this time, when her child was spirited away to the NICU, Wilde was not alone. She knew what was going to happen, minute by minute. She knew what medications she was being given and what they would do to her, and she knew all those things because this time, she had a doula.

A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after birth. The term comes from an ancient Greek word meaning "woman's servant," and in Wilde's case, that person was Cindy Morris, a certified doula and the Florida State representative for Doulas of North America (DONA).

Wilde hired Morris after asking her doctor John Sullivan Jr. about the possibility of having a vaginal birth instead of another C-section. He suggested she use a doula, and Wilde says it made all the difference in the world.

Doulas help patients relax and become more comfortable, offering advice on breathing, movement and position. They're familiar with medications and their likely side effects. They also ease the pressure on fathers, who often feel frustrated by their inability to stop their wives' suffering. During Wilde's second birth, Morris made a list of things for Mark to do so he wouldn't feel helpless.

A doula is also a liaison between a bustling hospital system and emotionally frayed parents. Morris didn't supplant the medical procedures necessary to ensure Wilde's health, but she made certain that after Samantha was born, she was placed on Wilde's chest so the new mother could see that her daughter was fine before she was taken to the NICU.

Because Wilde's second pregnancy was considered high-risk, Morris accompanied her to doctor appointments and took notes for her. She even kept charts on Wilde's fluctuating blood pressure. When Wilde had questions or didn't understand terminology, she always turned to Morris. "It's much easier at midnight, if the baby isn't kicking as much as you think it should, if you can call a doula," says Wilde. "It might seem like a stupid question to ask your doctor, but you can always call your doula." Wilde compares it to having a dictionary-"a dictionary that hugs and holds your hand."

Morris, who says most women hire a doula because their first experience was traumatic, says her job is to protect the memory of birth. "You basically 'mother' the mother." That means napping alongside them during labor, if necessary. She attends between three and four births a month on average, but has handled as many as eight in one busy month.

An average birth demands 30 hours of a doula's time. Morris meets with the parents at least twice before the birth and stays available by phone, 24 hours a day, for questions. At the earliest sign of labor, she will meet the patient at home or at the hospital. She will stay until after the baby is born and nursing well.

Doulas charge between $300 to $1,000 per birth, but Morris says that in affluent urban areas, like New York, the figure can go higher. She says major insurers are starting to cover the service if it is pre-approved by an obstetrician. Studies have documented a 50-percent reduction in C-sections among women who use doulas. They also report a 60-percent reduction in epidural use and a 30-40-percent reduction in pain and narcotic medication. First-time labor is cut by up to 25 percent.

Unlike midwives, doulas provide no clinical support. They do not dispense medications or perform medical exams. Doulas do not diagnose, offer second opinions or give medical advice, and they clear all actions with medical staff.

Doulas have been practicing at the Florida West Coast Birthing Center, Doctor's Hospital and Sarasota Memorial Hospital for at least five years. Carole Eldridge, coordinator for the Babies Program at Sarasota Memorial, says that for the past four years, the hospital has been offering space for certified doulas to train new doulas.

Kristi Ridd, administrative director of DONA, says that with the current nursing shortages, "it's almost impossible to have one-on-one contact with patients." Doulas take up that slack. They can grab a blanket or run for ice. If the patient needs to walk around, a doula can run to the nurses' station and ask if that's OK.

Christina Lavender-Holmes, a doula who is also studying to be a midwife, agrees. "When a woman goes into a hospital, she's no longer in a familiar environment. She asks permission for everything. Can she get up? Does she have to lie down, or could she sit instead? She's compliant with hospital policy."

"You can really become an advocate for the mother in that type of setting," agrees Morris, who says she's forged friendly, working relationships with maternity nurses at the hospital.

According to Hill, the neonatal specialist who performed Wilde's emergency C-section, doulas make his job easier by preparing the mother for all aspects of birth. "Patients who are more prepared for labor are more willing to accept [the pain] and see how things progress," he says. Patients who are afraid do worse. "They are not relaxed enough to allow the cervical dilation and descent" necessary for a vaginal birth.

Hill, who sees patients only after they're referred to him by other obstetricians, says the only problem with doulas is that more women don't know they are available.

A woman can contact a doula any time during her pregnancy, even if it's a first-time call during labor. Some doulas also provide postpartum support, performing light housework and cooking so the new mother can rest.

Lavender-Holmes believes that the support of a doula during and after pregnancy reduces postpartum depression. "[Mothers] feel better about themselves, their babies and their mothering ability. What can all this lead to? Maybe less child abuse, and hopefully, happier lives."

Although no studies are available to confirm her hypothesis, she adds, "It's kind of amazing that we've already had to do so much research to show that just being nice to a woman has such a positive impact on childbirth."

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