Women Helping Women

Miriam had her fingers intertwined with mine. With each contraction that rushed through her body, she squeezed tighter. “Please G‑d help me, please G‑d help me, bring my baby to me,” she whispered in between the rushes. I adjusted the cool washcloth across her forehead and I prayed with her.

As her grip began to further tighten I said softly in her ear, “You’re doing it, Miriam, you’re birthing your baby.” In a moment of pure intensity and release, a sweet little black-haired head emerged – “now pant gently,” the midwife said. “Phhh, phhh, phhh,” we panted together. “When you feel like you need to push, give a little push,” the midwife I’ve prayed, sang, danced, even read E.E. Cummings said. With a deep breath and a renewed grasp of my hands, she pushed the rest of her baby boy into the world. “Thank you G‑d, thank you G‑d, thank you G‑d!” was all she could say as she laid her head on my shoulder. It was beautiful. It was Miriam’s 2nd birth and I was her doula.

A doula (pronounced doo-lah) is a woman, usually a mother herself, who helps birthing women. It is a Greek word, which literally means “woman who serves.” I have been blessed to serve many women throughout their births. Some women I’ve helped by offering encouraging words, a hand to hold, and a solid place to lean on. Others I massage with scented oils or lead through guided visualizations.

I’ve prayed, sang, danced, even read E.E. Cummings out loud. But the one consistent thing that every doula brings to a birth is a willingness to offer the birthing mother whatever support she needs to help her get through this powerful experience with confidence, strength, dignity and love.

I first met Miriam when she was in her fourth month of her second pregnancy. Miriam had a rather traumatic first birth, which ended in a Cesarean Section. She didn’t take a doula with her to her first birth - she didn’t think she needed one. She figured she would go in to the hospital, have an epidural if the pain became too much for her and push her baby out.

She didn’t come into birth with any alternative pain coping techniques, and wasn’t aware that an epidural doesn’t always provide 100% pain relief and can often lead to a series of other interventions and complications. She spent the vast majority of her birth in pain and frightened. After the birth, she was plagued by feelings of failure and fear about how she would ever be able to birth another child. By the time I started working with Miriam, she was desperate to do something different to ensure that her second birth not in any way resemble the first.

From the beginning, Miriam had a deep desire to replace her feelings of regret and fear with feelings of strength and confidence. In our first phone conversation she said “I’m willing to do the work, I just need someone to help me figure out what the work is.” We met every month and discussed her fears. We talked in depth about her previous labor and birth, and dissected every aspect of the experience, so that we could work through what could be done different starting with the pregnancy to labor through birth itself. Often when women are not given proper guidance and education during the pregnancy, they are that much more unprepared and unaware of choices that may need to be made during labor itself.

We experimented with some new, positive birthing imagery, and worked on exercises designed to help her “let go” emotionally and physically. I had Miriam practice holding a piece of ice to simulate a one minute “contraction.” We explored different coping techniques to get through each “contraction,” movement, breath awareness, non-focused awareness. We also worked on loosening up her lower body by working on some specific movements designed to relax the pelvic muscles.

I referred her to a specialist at one point to work on some specific gynecological issues. And we spoke at length about introducing a new baby to her first child, Tali, In fact, Tali attended most of our meetings, and along with her mother, gradually became thrilled with the prospect of a having a new baby.

Miriam’s second birth was long, but she was a trooper. Throughout the labor, I encouraged her to get in a hot shower as water drastically reduces the intensity of the contractions, rest in between contractions and to let go of tension in her body. If I noticed that she was beginning to slip into a fearful or stressful place, I massaged her shoulders, with a focus on specific shiatsu points to help her regain a sense of calm. “I’m right here beside you, we’re just going to take this one contraction at a time,” I repeated.

In between contractions we spoke about the beauty of birthing a new soul, how every neshama that comes into this world, brings the world one more step closer to redemption. When labor picked up a bit, we focused more on breath awareness, shifting positions, and I applied counter pressure on her low back.

As her baby began his descent into this world, we hummed a beautiful song together. “Pitchu li sharei tzedek” – “Open for me the Gates of Righteousness.” There is a beautiful Jewish tradition that says that at the time of birth the gates of Heaven are completely open to the birthing mother and it is an exceptionally auspicious time to speak to G‑d. Traditionally, this is when women pray for the health of others, especially for women who have not yet been blessed with the ability to bear or birth a child. Between pushes, Miriam prayed in her own way, and it helped keep her focused and strong.

Then after about 20 minutes of pushing (a relatively short period of time), she pushed her baby out, all on her own. She found had found her strength, and she was glowing. “We did it,” she chanted over and over, “we did it.” It was a beautiful experience to share.

In just about every culture worldwide, women have supported women in childbirth. Our Torah speaks about the courageous Jewish midwives in Egypt, Shifra and P’uah, who tended to all the births in their community. It is only in the last century, with the improvements of medical education and the conception of an organized medical profession, that birth began to move from midwife to doctor, from home to hospital, and from female care to primarily male care providers.

The advent of the doula aims to fill many of the gaps that are created by a typical 21st century medically managed birth. The Cesarean section rate in the United States and beyond is sadly soaring. By 2004, the number of C-sections had reached an all-time high, accounting for 29% of all births according to the latest data from the National Center for Health Statistics. With almost 1/3 of US babies born by major surgery, many women are seeking alternatives. A doula can provide some significant advantages.

The evidence in favor of doulas comes from a number of carefully designed studies (Kennel, et al, 1991 also see JAMA. May 1, 265 (17):2197-2001.) Simply put, hiring a doula cuts the chances of having an unnecessary C-section by half. It also halves the chances of other assisted deliveries like forceps and vacuums, in addition to reducing the frequency of medical intervention, pain medication and shorting the length of labor.

While the hospital staff is available to tend to the medical aspects of birth, the doula, a non-medical professional, is available to tend to the many emotional, physical and spiritual needs of the birthing mother. Far too many women find themselves in the throes of labor in a sterile hospital birthing room, scared and alone, both emotions, which work against a woman’s innate ability to birth normally. But, a doula provides a constant presence, even as hospital shifts change, and new staff enters the scene.

The doula stays with the birthing woman throughout her entire labor, maintaining a calm, positive, supportive and stable environment. She also serves as a much needed bridge between the birthing family and the hospital staff. A doula will help provide balanced, evidence-based information, which can allow the mother to make informed choices about hers and her baby’s health.

Imagine being in labor for twelve, eighteen or even twenty four hours. These long labors can get exhausting for everyone, especially to a husband expecting his first child. It is important to remember that many fathers have a significant amount of fear and anxiety surrounding birthing. Birth, being a uniquely female experience, and traditionally attended by women only, can leave a father at a loss for what to do.

A doula helps take the pressure off of the father and frees him up to help his wife in the ways that he is comfortable. She can also make sure that the father understands what is happening, and is aware of his wife’s condition and status. For the man, knowing his wife is in pain can be very overwhelming. A doula can provide him with the reassurance that his wife’s needs are well taken care of and that what she is experiencing is perfectly normal.

Typically, a doula will stay after birth until breastfeeding is established and the mother is stable. However, there are a growing number of postpartum doulas who have additional training in the afterbirth This is your birth experience, she is there to support you experience. The postpartum doula offers companionship, wisdom, and experience as a mother. Additionally, she will help with light cooking and housework, she can help care for the newborn while mom takes a nap and offer breastfeeding support, and help to identify any signs of postpartum depression.

Here are a few things to keep in mind when interviewing a doula.