Doulas can help ease anxieties of giving birth

• Questions to ask a prospective doula

By Zenaida Serrano Espanol
Advertiser Staff Writer

Doula Tenaya Jackman massages Stephanie Derauf, whose baby is due in May. Doulas are trained, professional birth helpers. Deborah Booker • The Honolulu Advertiser Get information about doula care For information about becoming a doula or finding doula care: • Doula Network of Hawai'i, 373-9436, e-mail doulahawaii@aol.com For more information about doulas: • Association of Labor Assistants and Childbirth Educators, alace.org • Birthing From Within, birthpower.com • Doulas of North America, dona.org, (888) 788-DONA (3662) • Hawaii Births, hawaiibirths.com • International Childbirth Education Association, icea.org

They had hired Cathy Eyre, a doula or birth helper, who stayed with the couple throughout the entire process, which lasted more than 10 hours.

Eyre did everything she could to make the experience positive for them — giving advice on how Stephanie Derauf could position her body to ease the pain, offering emotional support through encouragement, holding the first-time mother's hand and stroking her head.

"She told me what was going on and she made me feel comfortable about how I was handling (everything), verbally assuring me," said 34-year-old Stephanie Derauf, who gave birth to a daughter two years ago at Kapi'olani Medical Center for Women and Children.

The Deraufs, like a growing number of soon-to-be parents, chose to use the services of a doula, a Greek word that originally meant female servant, now a term used for a professional birth helper.

The number of doulas statewide has increased from about 35 two years ago to about 50 today. Typically, one doula may assist with anywhere from three deliveries a year to as many as 50, said Elizabeth Lee, a member of the Doula Network of Hawai'i. The organization is the local affiliate of Doulas of North America, or DONA, which is based in Jasper, Ind., and is one of about six certifying organizations in the nation.

Nationally, doulas number in the thousands and are increasing. Membership in Doulas of North America alone includes more than 4,000 doulas compared to just 1,800 in 1997, said the organization's president, Jennifer Nun, in a telephone interview.

Though doulas have been around for generations, experts say there is a resurgence of interest in doula care. "It's definitely available as a service now, whereas six years ago it wasn't as available," said Lee, who attributes this to a greater awareness among parents of how clinical care and emotional support complement each other during the birth experience.

Another reason is referrals and word of mouth, Lee said. "Women are always talking about the birthing experience, especially if it's a great experience," she said.

Doulas work in birth centers, homes and hospitals, but unlike certified midwives, who can deliver babies, doulas do not do any clinical or medical tasks.

Rather, Eyre said, they are "the epitome of a support person," providing "emotional and physical support to pregnant women and their partners and family members throughout the process of pregnancy, birth and the early postpartum period."

Doulas typically help the mother by giving massages and coaching in breathing, positioning and relaxation techniques; providing constant reassurance; and guiding partners who want to take an active role in the birth experience. Some may also coach parents in breast-feeding and infant care.

Emotional support and more

Couples who have worked with doulas, Eyre said, have found that it "makes a tremendous difference in terms of the amount of anxiety that is relieved (and) fears that are relieved, having someone with them that they can trust to help them through the whole process."

Some say the benefits go beyond the emotional.

Research done by Drs. Marshall H. Klaus and John H. Kennell have suggested that having a doula may decrease epidural anesthesia use by 60 percent, Caesarean birth by 50 percent and length of labor by 25 percent.

The studies, which were published in a book called "Mothering the Mother: How A Doula Can Help You Have a Shorter, Easier, and Healthier Birth" (Perseus Press), were done in the 1980s and involved more than 2,000 women from several countries.

"What we try to do as doulas during pregnancy is try to help women plan and figure out what their goals are, what they're looking for and how we can be the most optimal support for them," said Eyre, of Kailua, who says she has assisted with hundreds of births during the nine years she has been practicing.

For Jaydene Sniffen Hong, a 36-year-old resident of Kaimuki, her goal was to give birth naturally, without the use of drugs.

"Being able to go through the birth moment by moment and being present with the experience so that I could actually feel and sense what was going on — that was important to me," Hong said. Thanks to Eyre, Hong was able to achieve this with the birth of her two sons, now 2ý years and about 3 months old.

"She listened to the type of birth experience I was looking to have, and so understanding what I was looking to achieve ... she was then able to provide information that helped me to be mentally and emotionally prepared for the birthing experience."

However, doulas don't necessarily advocate medication-free births, as they aim to help women through whatever kind of birth experience — with or without the use of medication — that women desire to have, Eyre said.

Stephanie Derauf said that having the support of a doula gave her a lot of self-confidence and self-esteem, making the birth experience a positive one.

"If you talk to people who have doulas, they don't really talk about the pain," she said. "They talk more about the experience of birth and how beautiful it was. I think that's pretty amazing."

The benefits may extend beyond the mother.

"(Doulas) allow the father to just focus on the emotional support that they would normally provide and not have to worry about what's going on in terms of the birth," said Tenaya Jackman, of Ka'a'awa, a doula who has been practicing for five years.

That was the case with Chris Derauf, 43, who said that because Eyre is so familiar with birth, her presence at his daughter's birth made him feel very comfortable. This allowed him to focus on his wife and his daughter being born "in a very complete sort of sense," said Derauf, who is also a pediatrician at Kapi'olani.

Privacy concerns

Doulas may not be for everyone.

One reason couples opt to not work with doulas, Jackman said, may be the cost for doula care, which can range between $250 and $800.

Privacy and intimacy may be other issues for parents. Some couples, she said, may prefer to go through the birthing experience alone or with as few outsiders present as possible, and may worry about a loss of intimacy by having a doula present.

"But a good doula knows when to actively get involved and when to step back," Hong said about the intimacy concern. "So, you and your partner still have the kind of experience you're looking for."

Dr. Eesha Bhattacharyya, an obstetrician who works with Castle, Kapi'olani and Queen's hospitals, said that doulas are an important part of a team and they complement the roles of all others involved during the labor and delivery process.

"The obstetrician is not usually there for the whole labor; the father, who maybe has gone through a six-week (birth education) course, probably feels a little intimidated about trying to take care of all the different issues; and the nurses, if they have a lot of patients, sometimes they can't be there the whole time," said Bhattacharyya, who has worked with doulas for nearly 10 years. "But the doula is generally there pretty much the whole time."

Trained professionals

Before becoming a certified doula, women are required to undergo training, which is usually sponsored by one of the Mainland-based certifying organizations such as DONA or the Association of Labor Assistants and Childbirth Educators. Trainers from these organizations, Lee said, usually come to Hawai'i for training sessions about one or two times a year.

Upon completion of all the training requirements, women may then apply for certification, which is generally with the organization from which they have received training, Lee said.

According to information from the DONA Web site, services of a doula typically involve two prenatal visits, presence at labor and delivery, and at least one postpartum visit.

Heather Winfield-Smith of Kapolei, 26, said that in addition to the in-person meetings, her doula was always just a telephone call away. "There are some questions that you forget to ask your doctor, so it's nice to have someone to call," said Winfield-Smith, who gave birth to her son on March 18.

As a doula "you have to be able to have this time span where you can drop everything that you're doing in life and be there for somebody, no matter how long it takes," Eyre said. "We also like to be able to work with other doulas so that if we have a 'marathon' birth, they can have a fresh doula that comes in and takes over."

The clients vary, Eyre added.

"There's no profile, honestly," Eyre said. "I've worked with teenagers, I've worked with women in their 40s having their first baby, I've worked with women who have had a baby and had an experience that was not positive and then sought out this kind of support for their second birth."

Stephanie Derauf is eight months pregnant with her second child, and she and her husband plan to work with Eyre again. "I would never give birth without a doula," she said. "You can't predict what your birth is going to be like."

Questions to ask a prospective doula

• What training have you had?
• What is your experience with birth, personally and as a doula?
• What is your philosophy about childbirth and supporting women and their partners through labor?
• May we meet with you to discuss our birth plans and the role you will play in supporting us through childbirth?
• May we call you with questions or concerns before and after the birth?
• What care providers have you worked with? In what hospitals have you attended births?
• When do you try to join women in labor? Do you come to our home or meet us at the hospital?
• Do you meet with us after the birth to review the labor and answer questions?
• Do you work with one or more backup doulas (for times when you are not available)? May we meet them?
• What is your fee? Is any part of your fee refundable if you do not attend the birth?
• Can you provide references? (Be sure to check them.)