One Labor-Intensive Job

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Barbara Guralnick is leaving her New York City apartment carrying a blue plastic ball that measures 75 in. around, portable CD player and shoulder bag packed to the brim with lotions, washcloths and hair scrunchies.

"Oh, going to have a baby?" her doorman asks cheerfully. Guralnick, 38, smiles and nods but has no time to chat. She's a doula, also known as a childbirth assistant or labor coach. One of her laboring clients has called and requested her presence. She will be with the parents through the labor and delivery, which could be anywhere from three hours to three days.

Doula is a Greek word that means "woman servant." Unlike midwives, who deliver babies and are licensed to perform medical tasks, labor doulas provide emotional and physical support to the laboring parents. "I do everything from getting wet cloths for a mother's forehead to relaxation exercises to massage," says Guralnick.

When the first modern doulas began practicing professionally, roughly 20 years ago, their work was seen as part of another alternative birthing method. But in the past three years, there has been a remarkable rise in the demand for their services. Doulas of North America, which trains and certifies doulas, has 3,500 members--up from 750 in 1995, according to Kristi Ridd-Young, DONA's administrative director. "Part of this increase stems from the fact that the consumer is taking birth back into her own hands and wants to be a part of the decision process," says Ridd-Young. "Also, it's a natural instinct to gather the right kind of support around you."

Across many cultures and throughout history, women have assisted births. But in the late 1970s and early '80s, when doulas were rare, obstetricians John Kennell and Marshall Klaus conducted a survey of 128 nonindustrialized, hunting-and-gathering and agricultural societies. All but one featured continuous support by other females for mothers during labor and delivery. As birthing moved to hospital settings, this element of support was lost. Kennell and Klaus found that the presence of doulas not only reinstates support but also is associated with fewer labor complications. In their book, Mothering the Mother, Kennell and Klaus compare labor in both doula-assisted and non-doula-assisted births and report that doula-assisted mothers made fewer requests for pain medication, had shorter labor and had fewer epidurals. They were also half as likely to undergo caesarean section.

A doula's presence does not guarantee a complication-free birth, but the emotional support she provides can be invaluable. Ann Grauer's doula was with her in Milwaukee, Wis., when doctors told her that the child she was about to deliver would be stillborn. Her doula consoled her throughout the painful ordeal. Says Grauer: "It was amazing the peace of mind my doula was able to give me." The same doula was there later for the birth of her son. "It was such a celebration. We are still very close."

The role of a labor doula varies depending on the needs and desires of the parents. For some people, the support of a doula is more important after the actual labor. Ruth Callahan of New York City owns Doula Care, a service that provides postpartum home services, including help with breast-feeding, new-baby and new-mother care. The doulas might even run errands or baby-sit siblings. "I was much more interested in the transition into motherhood--teaching them about breast-feeding and helping them gather their confidence," says Callahan. Doulas tend to specialize in either labor or postpartum work but rarely do both.

Training and certification for both types of doulas are available through various organizations (see box), though there is some debate among the doulas themselves over the need for certification. "Some people feel very strongly that being certified isn't what makes you a good doula," says Lijah Friedman, a DONA-certified doula based in Brooklyn, N.Y. "It's creating a political and selective situation in the doula world." Most doulas think that while training and certification don't guarantee quality services, the knowledge can't hurt. Says Guralnick: "Your heart and hands are the most important. If someone's not certified, they're not necessarily less qualified."

Debra and Ash Suri, a Manhattan couple in their early 30s, are expecting their first child at the end of this month. After reading several childbirth books and attending a Lamaze class, Debra decided she wanted to have a doula present at her baby's birth. She interviewed several women and chose Guralnick. "I really wanted to go with a doula, because Barbara has so much knowledge and experience, and I find it very comforting to have somebody there with us from the beginning to the end, to be able to answer our questions," says Debra.

Individual doulas follow their own routines, and Guralnick includes two pre-natal visits with a couple to get acquainted and go over options. In a meeting in the Suris' apartment--Ash's first with the doula --Guralnick provides the couple with documents and reviews topics like pain medication and various interventions that can be used during labor and delivery. Debra sits on the massive 75-in. ball to get accustomed to how it feels. (Women in labor often find the ball more comfortable than a chair.) She guides them through massage techniques and positions that ease labor pain, demonstrating for Ash what he might be called upon to do on the big day, and shows them a birth-and-labor video, which serves as a springboard for questions.

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