Pregnant women, take heart. This is a great time to give birth.
Today's labor and delivery choices include a combination of advanced medical science and the fruits of a growing realization that a good birth requires attention to the social, emotional, and educational needs of the mother and her partner, if she has one. Obstetricians in the tens of thousands help with the former. Birth assistants, or doulas, as-yet unreliably numbered, help with the latter—while also providing crucial physical and comfort support during the birth itself.
Who is the doula? The word itself can be traced back to the Greek, in which it means "women's servant," according to the American Pregnancy Association. Doulas meet with expecting moms and their partners long before the pangs of labor begin. They help moms and partners get ready for the big event, providing education, training, and social support. They help to craft smart, meaningful birth plans. And when the birth begins, the doula does a little bit of everything—they assist with breathing techniques, position the mother's body, and encourage the mother and partner alike.
This last point is an important one, says Becks Armstrong, London-based CEO and founder of pregnancy-mindfulness app Curious Fu—and a doula with 16 years' experience.
"The role of the doula isn't to replace the partner," she says. "A good doula, in my opinion, should allow the two people to go through [the birthing] process without fear, making sure that they're comfortable and that they know they're doing things that are allowing the baby to come out."
She wraps up her point nicely.
"A good doula should support the space, not own the space," she tells HealthyWay. "A partner should always be No. 2."
As it happens, Armstrong has a story that illustrates this point. In fact, she has lots of stories. So do the other birth assistants we asked about helping women with maybe the most profound event in all human experience: giving birth. Here's what we learned.
1. Some births are almost romantic.
Armstrong began her career in support of pregnant women in Sydney, Australia, where she had a turn-of-the-millennium acupuncture clinic that specialized in expectant moms. By 2002, she had begun to work as a doula as well.
One of the things that keeps her coming back is the interaction between moms and their partners as they bring their new child into the world, she tells HealthyWay.
"I love to watch the interaction with the partner, if they've got one," Armstrong says. "For me, what a doula does is kind of like … a stage hand. So I try not to get in the way."
One of her most touching experiences as a doula came when she assisted a woman who had a hip injury that made the birth difficult. The mom refused the touch of doula and partner alike.
"She sat in a chair for the whole of the labor," Armstrong recalls. "She sat in the chair, leaning on the back of the rail."
But she wasn't sitting alone.
"Her partner just sat on the other side and he looked at her," she says.
"And it was just lovely. It was a really nice birth. She couldn't get up and move, so she had no options other than just getting through it and breathing through it, and she took a lot of strength from him just sitting there with her. It was just lovely."
Remember this story, all you partners of pregnant women. You won't be able to do anything about the contractions or the possibility of pain. But sometimes the loving gaze, simple and unbroken, can work wonders.
"She came off the chair and leaned on a beanbag to deliver," Armstrong says. "He just owned that space with her."
2. Some births are really, really fast.
Katie Mack has been a doula in St. Louis, Missouri, since 2002, and she has assisted in more than 300 births. You never know how long labor will last, she says, and sometimes it isn't easy to reach the contracting mom before the baby decides to emerge.
"I had [this one] client who I really liked," she says. "She was a Pilates instructor and she had one of those labors that went from nothing to done in no appreciable time."
Mack knew things were moving quickly when she got a phone call from her client's husband.
"Usually the mom wants to be the one talking as long as possible, because she feels more control over the situation," Mack says. "As soon as she can't [talk], then you hear from the partner."
The man described the situation; his wife was in the bathroom and she was too deep into labor to move. Mack had a tough call to make.
"I knew just what he was describing to me," she says. "I could either tell them to call emergency services right now, I can tell them to get on the highway and get to a hospital right now, or I could get to them."
She was only 10 minutes away; she decided the safest course was to zip over there to assess.
By the time she arrived, "there was really nothing for anybody to do," she says. This baby was ready. Mack called 911, a standard practice for unplanned home births. By the time a team of fire fighters showed up, the baby was in the mother's arms, healthy.
"It was pretty sweet, actually," Mack says, describing the scene that ensued. "All these fire fighters show up, and they're these giant men in all their gear, and they have to be the ones to transport the baby [to the hospital]."
Mack won't soon forget the sight of big men in rough uniforms cradling a newborn infant.
"They were so kind," she said of the attending fire fighters. "They couldn't have been any more kind. They were just super-tender, these giant men holding this little baby and taking care of this mom and getting her off to the hospital."
3. Some births are not so fast.
Kristy Zadrozny is supervisor at ExpectingNYC, an evidence-based support practice for childbirth and parenting preparation, rooted in the mindfulness tradition. She's been a doula for more than a decade and has assisted in more than 200 births.
Zadrozny remembers a comment a mom made to her after what she describes as "an especially long, challenging, and anxiety-ridden birth." After the ordeal, the grateful mom turned to Zadrozny and said, "It was as if you were a statue. No matter how hard I leaned into you, how hard I pushed, or how ferocious I sounded, I knew you could hold me up," the doula recalls.
Zadrozny normally wouldn't be thrilled to be compared to a statue, an image that "invokes thoughts of cold stone and stiffness," she says via email.
In this case, though, Zadrozny was responding to the needs of the moment. It's what doulas do.
"As doulas, we strive to put our needs aside, to blend into the walls, to remain unbiased and solid," she says. "[The mom's comment] was the most on-point description of my support style."
4. Some births include elements of comedy.
When pressed for stories, Armstrong immediately launches into a particularly funny—and simultaneously joyful—experience of assisting a young mom.
"She was so trusting in the moment, and she had not done a lot of reading about birth, and had not got the fear that a lot of women have going into birth," Armstrong says.
In Australia, the UK, and other countries, a treatment called "gas and air" sometimes helps laboring moms cope with their contractions. There was a tank on hand for this particular birth. Gas and air, by the way, goes by a more common name in the U.S., where it's seldom employed to help women give birth. It's nitrous oxide, or laughing gas.
"You can pull on this nitrous oxide and all it does is it makes you a bit light-headed and makes you not feel the pain of the contraction as much," Armstrong explains.
"[The mom] took a really good couple of pulls on it and thought she was in a disco," she says. "She was flailing her body back and forth and rolling from side to side, and just because she relaxed so beautifully, she actually delivered the baby really quite quickly."
While it doesn't sound easy to assist a woman who's dancing her way into motherhood, it's all part of a day's work for a doula. Armstrong's just happy that the birth was meaningful and happy for the new mom.
"She was explaining how she was in this disco, and there was fog, and she was wrapped in a flag, and it was a really lovely experience to go through," the doula says. "She had the best feeling out of it because it really was relaxing."
5. Actually, a lot of births include elements of comedy.
If you want to make your living as a doula, you need backup, says Mack. Unfortunately, being the backup sometimes leaves you with a surprise visit in order.
"I was called in as backup for one of my good friends, who's now a midwife," Mack says. "She had a client that seemed like they were probably going to be in labor, but it was three weeks early."
Early enough, that is, for the original doula to take a trip out of town. Really, Mack was on standby. No one expected the woman to actually go into labor so soon. One day, Mack was going about her normal—albeit aromatic—routine.
"I was making kimchi and I was drinking fire cider, which is a special tonic that includes like horseradish, ginger, garlic, citrus, apple cider vinegar. It's not the kind of thing I'd ever drink if I knew one of my clients was going to need me that day. I think there were onions in there."
Of course, just when Mack's breath reached peak-ripeness thanks to her beverage of choice, the phone rang.
"I hear from the partner," she recalls. "I'm close to their house so I run over there because I can tell things are going fast."
Keep in mind that Mack hadn't yet met this couple—she was just covering for a friend.
"They are out of gas in their car," she says.
"I show up and [the partner] is figuring that out, and they don't have their stuff packed, and I go upstairs and I've never met this person before. I have to go up in her bathroom and there she is on the toilet, in the full, biggest throes of labor. I've seen enough births to know it when I see it."
Mack introduced herself politely. Unfortunately, she didn't make the best first impression.
"[The mom] was like, 'You really smell like a cheeseburger,'" Mack says. Not in a good way, is the implication.
Despite the hiccup, Mack got the woman to the hospital and supported her throughout her healthy, successful birth.
Birth Assistants Then and Now
In a very real way, the doulas of today are just picking up where generations of women who've helped other women through pregnancy and birth left off.
Two hundred years ago, the American birth tradition was big on community, big on the support of women for women, big on heart—and big on danger. Take the account of Abraham Lincoln's rural Kentucky birth, circa 1809, as described by Carl Sandburg in the first volume of his presidential biography:
"One morning in February 1809, Tom Lincoln came out of his cabin to the road, stopped a neighbor and asked him to tell 'the granny woman,' Aunt Peggy Walters, that Nancy would need help soon. On the morning of February 12, a Sunday, the granny woman was at the cabin. And she and Tom Lincoln and the moaning Nancy Hanks welcomed into a world of battle and blood, of whispering dreams and wistful dust, a new child, a boy."
Unfortunately, the birthing practices of the 19th century were also big on illness, injury, and mortality. There was not enough food for many mothers, or enough knowledge to address the exposure to germs we know how to manage today. Around the turn of the century, medical science came marching to the rescue, led by a vanguard of men with advanced degrees.
As men, though, they had no lived experience of giving birth, and they decided that the greatest service they could offer was to make birth painless. They succeeded, at a terrible cost.
One hundred years ago, American birth was big on medication, big on patriarchy, and big on forgetfulness and haze. There was a name for the painkiller-and-amnesiac-fueled delirium that took over the early-20th-century mother's experience of giving birth: the twilight sleep. Generations of women woke up in hospitals to find they had become mothers almost without knowing it.
The figure of the birth assistant—a woman or women who supported the mother before and during the birth, physically, emotionally, and socially—was stripped away from the birthing process as cultural attitudes shifted in favor of this sterile medical approach. But by the 1970s, women began to seize control over their birthing experiences, perhaps most visibly in the work of medical anthropologist Dana Raphael.
The return of the birth assistant, the home birth, the doula, and the midwife had begun.
Today, American birth—for the privileged, at least—is big on choice, big on women's support for women, and big on doulas. The organization once called Doulas of North America (renamed DONA to reflect its international reach) boasts of having certified 12,000 practitioners. The doula philosophy of care has expanded as well; many doulas now provide postpartum care, too.
Others work in hospice, gently helping lives slip away—just as birth doulas help others enter the world, collecting priceless stories along the way.