When people used to ask Darcy Stanley what she did for a living, her first response was to ask if the person knew about doulas. Many said no. That was three years ago.
Now, the 32-year-old recent nursing graduate doesn’t even ask because most people, she finds, are familiar with the term. Even men Stanley goes on dates with have heard of doulas. They have a friend who is one or, perhaps, their mom.
For those who aren’t familiar with the term, doulas support pregnant women through the birthing process. They may do one or two prenatal or postpartum consultations, but their main job is staying by the side of the new mother throughout her entire labor, start to finish. Doulas don’t have medical training. She – there are some men out there doing this work but it’s rare – is there to provide emotional and physical support. Sometimes that means reminding the woman she can get through it, for others it’s coaching her on how to position her hips.
Stanley is part of a growing cohort of young women who are either becoming or hiring doulas in California. The trend seems to be gaining traction in some East Coast states as well, but not with the same momentum as here. Monnie Efross worked as a nurse for 34 years at San Francisco General Hospital before recently retiring. About 10 years ago, she started a volunteer doula program, which she continues to run. For the first several years, she had maybe 10 volunteers at any given time. Today she has more than 100 and is constantly turning away applicants. And she needs that many because they’re in demand.
A confluence of forces has led to this point. With the current medical system, delivery floors can sometimes feel more like assembly lines. Nurses monitor contractions until labor is induced. At that point, the gynecologist on shift – who you may or may not have a relationship with – comes in, delivers the baby, and like that is on to the next one. It’s impersonal, despite this being the most sentimental moment of some women’s lives.
A doula, on the other hand, administers compassion. “Having one person who stays in the room and is only supportive is a special thing,” says Stanley, who also works with women in rehab and prison. “It’s a very intimate environment, and powerful relationships form from it.”
As more women have the experience of having a doula during their own birth, they want to pass that on. “It’s about a person being by a woman’s side the entire time during a difficult and meaningful situation,” Efross says. “Women are seeing the need to support each other and be there for each other.”
Kristen Dodge is a postdoctoral research fellow in epidemiology, but even she had never heard of the phenomenon until moving from the East Coast to Oakland several years ago. At first she and her husband, Garrett Dodge, were skeptical, but a trusted friend boasted about the experience.
“We started out thinking it was some weird hippie thing,” 35-year-old Dodge says. “The more we learned about it though, the more it really made sense. It seemed like everyone should have a doula.”
Dodge sought out a doula when she was about six months pregnant. She started by searching online and then going to a mixer. The couple met several candidates before Sarah Hamilton. They just “clicked.” Hamilton had decades of experience, two children of her own, but most importantly she had chemistry with the mother-to-be.
DONA International is the most recognized certification program, though there are countless others. Since essentially anyone can call herself a doula, it’s usually prudent to go through some sort of reputable organization. Stanley’s training was a four-day intensive workshop that covered the gamut of topics: anatomy and physiology; business practices; birth psychology; pelvis positioning; what to pack in your doula bag; and, most importantly, how to provide support.
Jo Kilburn, program coordinator at Simkin Center for Allied Birth Vocations at Bastyr University in Southern California, says she’s seeing certification programs popping up everywhere. Where she works in San Diego, doulas are particularly popular with military wives and multicultural families.
While immigrants have embraced the concept – in many other areas of the world it’s common for midwives to be present at births – it’s still primarily a middle- to upper class trend. Doula services aren’t covered by insurance and can cost anywhere from $500 to $2,000, depending on whether they include prenatal or postpartum visits as well.
Some hospitals have started volunteer programs, such as the one at San Francisco General Hospital, which provide laboring women of all socioeconomic backgrounds a doula at no cost.
Dodge had two prenatal meetings with Hamilton. During the first, they talked about the birth plan. Then she gave instruction on massage techniques and ways to stay comfortable. She also gave Garrett Dodge some tips.
“We took a class, but they give you so much information it’s impossible to remember it all,” Garrett Dodge says. “Having a doula takes off some of the pressure.”
When the water breaks, oftentimes a doula will come to the house to help determine whether it’s necessary to go to the hospital right away. In Dodge’s case, she stayed home for most of the following day, where she was able to eat and move around.
Once at the birthing center, Dodge says her doula’s support helped her get through without having to take an epidural. “There was a point when I wasn’t sure if I could keep going,” says Dodge, whose baby just turned two weeks old. “She just knew what to say and how to make things feel better. Her skill was recognizing what I needed to hear.”
Doulas also help women communicate with their doctors, who may offer medical advice that’s not in line with the birth plan. Efross says it’s not uncommon for women to feel disempowered in hospitals. A doula acts as an advocate. “It makes the mother feel like she got to participate in the decision-making,” Efross says. “She feels in control of her birth.”
That can also lead to tension between the doctor and doula, though. When Efross first started the volunteer program at the hospital, obstetricians were wary they would get in the way. A doula has to be careful not to give medical advice, and that she’s always communicating the parents’ wishes – not her own. Now, Efross says, the doulas are popular with everyone, including the doctors.
“It’s about empowering women to make their own choices and feel proud,” Stanley says.