Doulas support, aid mothers during the birth process

CEDAR RAPIDS — Not that long ago, a woman giving birth was surrounded by support — from her mother, grandmother and other women who had given birth. They would help and encourage her throughout labor.

But that tradition of support has dwindled over the years.

'You go into a birth — especially a hospital birth — thinking everyone will care for you,' said Kristen Mead, a Cedar Rapids-based doula who has been practicing since 2007. 'That's not always the case.'

That's because the doctors and nurses are busy, juggling multiple patients, she said, or there will be a shift change and the nurse a mother has grown comfortable with has gone home.

'With a doula, there's someone with you all of the time,' said Mead, a DONA International-certified doula.

A doula — a Greek word that means female servant — is a birth companion, who supports both partners throughout the birth process. They can answer questions, advocate for the mother in the delivery room and provide emotional and physical support throughout the pregnancy and delivery.

Unlike midwives, doulas do not provide medical care and do not deliver babies. But they do help the mother and her partner in other ways — by providing information, helping develop a birth plan and offering comfort options during labor such as back rubs and labor positions.

This can be beneficial to both the mother and her partner, especially during long or complicated labors.

The doula can provide the partner a break — to take a shower or grab something to eat — and be there to help the mother work through sometimes scary situations.

That was the case for Kristi Johnson.

Johnson, who lives in Iowa City, gave birth to her son, Torben, four months ago. She wanted to have a natural, at-home birth and enlisted Mead's help. But her labor was long, and complications meant she had to be transferred to the hospital.

'I ended up really needing the extra (physical) support,' Johnson said. 'It helped with the amount of pain.'

She also said Mead's help was crucial to her having a vaginal birth rather than a cesarean section.

'Women deserve to be supported,' Johnson said. 'Culture used to be very much about supporting moms and births, but we've stopped doing that.'

Johnson added that mothers and fathers are now expected to do it alone.

'It's helpful to have someone there,' she said. 'It can really make a difference, whatever your birth situation.'

Changing perceptions

The use of a doula during birth can help reduce labor complications and the need for cesarean sections, according to research. This can result in a more positive birth experience, which also lowers mother's risk factors in developing postpartum depression.

But doulas are unregulated, and no training is required. The price tag for hiring a doula can range greatly, and some honor payment plans.

There are various certifying bodies all with different requirements — from reading assignments and essays to shadowing another certified doula.

All of this may contribute to some physicians and soon-to-be parents shying away from hiring a doula. But area doulas say they've seen a shift in perspective in recent years.

'Most nurses are excited to see me,' Mead said. 'They know the patient will have more help.'

Andrea Shandri, a Des Moines-based, DONA-certified doula, said she's had a wide range of experiences with health care providers — from pleasant to tension-filled.

But 'times are changing,' she said. In the past she worked more with pregnant women opting to deliver with a midwife, but these days she's also assisting women who want to have a more traditional hospital birth.

'Moms realize (doulas are) a safe, positive part of the birth team and medical care providers have a different scope of doulas,' Shandri said.

There are also far more practicing, certified doulas these days. Chicago-based DONA — the largest international doula organization — has certified more than 10,000 doulas since its founding in 1992, according to the organization's annual report.

The not-for-profit has trained doulas in more than 50 countries and has grown from 750 members in 1994 to more than 6,500 in 2013.

Iowa Doula Agency

Shandri also hopes a new business venture of hers — the Iowa Doula Agency — will further spread the knowledge and acceptance of doulas.

The goal of the agency, made up of doulas who Shandri said share a similar mission and vision, is to help more families access doulas while also helping doulas grow their client base.

She wants the agency, which she started in January, to bring 'validity, credibility and more accessibility to hospital system patients,' she said.

'I want all pregnant women who see an OB-GYN for care to know about doulas,' she said.

Shandri has recruited doulas with varying experience in the Des Moines area and is now working to find doulas in Cedar Rapids interested in joining her. The doulas who join the agency work as independent contractors, meeting with and working with clients, while Shandri would deal with the business side, helping with things such as marketing.

She wants doulas of varying experience levels to create a three-tiered pricing system, with three to five doulas in each tier.

'Not everyone can afford a $900 doula,' she said. 'But maybe they can afford a student-doula.'

She plans eventually to expand to three markets — Eastern Iowa, including Cedar Rapids, Iowa City and Waterloo — Central Iowa, and the Council Bluffs area. The agency is modeled after similar groups in other parts of the country, including Las Vegas and upstate New York, she said.

'It's really important that mom and dad feel like they are respected during the birth of the baby,' Shandri said.