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Bringing Up Baby

By Naomi Mendelsohn

"You've taken the classes, you've read the books and been with kids. But suddenly you forget everything."

The hardest part is over: the nine-month gestation period, the breathtaking contractions, the awe-inducing pain of labor. From now on in, this whole "new baby" thing is a cakewalk, right?

Not so fast. Some people might be "naturals" at reading their newborn’s expressions and interpreting his or her cries from day one. For others, bringing home a newborn from the hospital is an experience tinged with terror. How do you take care of a baby’s needs and your own all at once?

For many people, the secret to success is a five-letter word that rhymes with hula: doula.

A do-what?

A Greek word meaning women in the service of women, doulas offer emotional, physical and mental support to mothers and extended families of newborn babies.

"I come to your house every day for 10 days or so," explains Esther Gallagher, a doula who teaches childbirth preparedness class at University of California at San Francisco. "I’m there every day observing. How is this breastfeeding relationship evolving? What things can we change to make this go more smoothly? What kind of care does the mother need to heal?"

The role of the doula, however, is not limited to post-partum care. In fact, most people are familiar with doulas because of their role as birth assistants.

"I’m going to be the one consistent face, voice and set of hands," explains Gallagher who also acts as a birth assistant doula. "Nurses have to change shifts. Doctors come and go. They’re primarily there to deliver the baby. My job is to encourage you along."

This kind of constant encouragement is often needed, especially in a hectic delivery room.

"The doula’s role is to be the mother’s advocate [during labor] and act as liaison between herself and any staff," explains Kristi Ridd, administrative director for Doulas of North America(DONA). "She also supports the extended family and models for the father. Fathers tend to be a lot more involved if there’s a doula there."

But what about the father or partner? Can’t they provide the emotional support an expecting mother needs?

According to DONA, the woman’s partner plays an essential role in providing support which a doula cannot, such as intimate love for the woman and child. But, as a woman trained in the methods and procedures of childbirth, a doula can offer help and advice on comfort measures such as breathing, relaxation, movements and positioning.

"I’m there to facilitate what you want. I’m part of a team," explains Gallagher. "I don’t want to usurp the nurturing partner. I’m not there to move them out of the picture. I might even end up being the gopher. I might sit back in a chair and wink and nod and say, ‘You guys are doing great.’ I might do everything. It just depends. My role is pretty wide open."

To do or not to do

The benefits of a doula are very visceral. Just ask Lewis Buzbee and Julie Bruck who used a doula for the birth of their daughter, Madeline.

"Just having somebody there on the medical side during the birth gave us a lot of security, " explains Buzbee. "There was somebody on our side who would be with us the whole time. I wanted to be a part of the birth as much as possible and I had concerns going in: Was I going to throw up? Was I going to pass out? Esther was especially reassuring when Julie was in pain."

But the most critical part of their doula experience came immediately after they left the hospital.

"They give you this little bundle in a plastic basket and tell you to take it home," says Buzbee. "You’ve taken the classes, you’ve read the books and been with kids. But suddenly you forget everything. Esther, our doula, was there to answer questions about nursing. She would come in and cook. She would go shopping or let me go shopping, and I could leave knowing Julie was going to be okay."

Aside from that, the doula helped Lewis and Julie negotiate that special period of bonding between a family.

"Esther made sure that we had a ‘babymoon’," explains Buzbee. "She made sure that we weren’t besieged with too many relatives and friends so that Julie, Maddy and I could get to know each other and hang out with each other. She helped build a cocoon around us."

The scientific side

While the use of doulas may be seen as purely alternative, this method does have medical benefits.

"Doulas have reduced the c-section rate by 50 percent," explains Marshall Klaus, M.D., a neonatologist and groundbreaking researcher in the area of doulas in the United States. "The length of labor is decreased by 25 percent, the need for oxytocin by 30 to 40 percent and the need for epidurals by 20 to 30 percent."

Not only can the use of a doula affect your body, it can affect your mind as well.

"In one study in South Africa, women who had a doula had a higher rate of success in breastfeeding, a more positive view of delivery and a more positive view of their relationship to their spouse," explains John H. Kennell, M.D., a professor of pediatrics at Case Western School of Medicine and Dr. Klaus’ co-researcher. "Women with a doula had less anxiety and less depression. All these things are positive for the future of the mother, father and family."

Can doulas do no wrong?

With all the positive affects a doula can have on childbirth, it seems that every expecting mother should have a doula. And, in fact, according to Dr. Klaus, the Canadian Obstetrical Society recommends that every mother have a doula or some type of one-on-one support system.

Some physicians, however, do recognize several flaws in this near-perfect birthing scheme.

"Some doulas are great, but some are very interfering with the patients in the hospital process," explains Patricia Robertson, M.D., perinatologist and associate professor of obstetrics and gynecology at UCSF. "I’ve had to fight doulas to get my hands on delivering babies. Occasionally the doula feels possessive and assumes that since the mother is delivering in a high-tech place, we’re not going to be supportive of the mother’s birth plans. We have to spend energy making sure that everyone’s on the same page."

And, Gallagher agrees, this situation would be bad for everyone.

"I’m not there to be your lawyer," says Gallagher. "I don’t want to have an adversarial relationship with your medical care providers. I don’t feel that’s appropriate in the birth setting. I don’t have an agenda about where you want to have your baby. That’s your choice. "

What’s the first step?

If you are interested in finding a doula in your area, DONA will provide an updated list of members and certified doulas on request.

After tracking a doula down and setting up an appointment, clients will meet the doula prior to the birth to set up a plan.

"My role in the prenatal period is getting to know you, getting to know what you’ll need," explains Gallagher. "Also, I spend a lot of time finding out who the people are and getting to know them, building rapport."

Unfortunately, as many plans as you make for labor, there is no way to predict the outcome.

"You make your plans, and then you have the labor that you’ll actually have," explains Gallagher. "There are all these possibilities and we’re all just going to do the best we can

Naomi Mendelsohn is a content editor at savvyHEALTH.com.

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