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'Mothering the mother' during birth

Assistants called doulas offer emotional and physical support

By Peggy Peck
MedPage Today Senior Editor

Editor's note: has a business partnership with, which provides custom health content.

Angela Ferin teaches a couple a childbirth technique called the "double hip squeeze."




NEW YORK (MedPage Today) -- Before it takes a village to raise a child, Angela Ferin says it takes two women to birth that child -- the woman in labor and her doula.

When Ferin gave birth to her first child, the experience was nothing at all like she expected. She saw an opportunity to help other women. Within six years, she had become a doula -- a woman specially trained to help others give birth.

She says the word doula comes from a Greek word for servant but its meaning changed over time to mean "mothering the mother." And that's what doulas do. "We take care of the mother during childbirth," she says.

Ferin says that research by DONA International, a group that certifies doulas in all 50 states and in 20 countries, suggests that when a doula is present at birth labor is shorter, there is a 50 percent drop in the expected Caesarean section rate, reduced use of forceps, reduced use of induced labor, decreased need for pain medications and less postpartum depression.

Ferin says that women need emotional and physical support during childbirth -- assistance that is unlikely to come from their husbands, boyfriends or partners. She was 22 when her daughter, Rosella, was born.

"During the pregnancy, I did all the things that women are supposed to do -- prenatal care, read all the books, went to all the classes," she says. "The baby's father was there, but he didn't understand my need for support."

But "after she was born, it got really intense," she adds. "I had severe side effects caused by a post-epidural headache. I was overwhelmed."

Weeks later while she talked about the experience with a close friend, she says, "I told her that I wish she had been there with me to give me support. That got me thinking about the need for support during labor and right after birth."

Doula training

She heard about doulas from a friend. The more she learned about them, the more intrigued she became until she finally decided to sign up for training.

The decision was a significant change for Ferin, 28, who grew up in a small town in Iowa, the oldest of six children in a "typical Midwestern Catholic family."

After high school, she held a few jobs in Iowa until at age 19 she moved to New York, where she "worked as a waitress, just like all the other young people who come to New York."

Along the way she met and married her husband, Tim, and settled in Brooklyn. But the decision to become a doula brought a new focus to her life.

It took her a year to earn her doula certification by participating in a series of workshops, attending three births under the supervision of certified doulas and finally by passing a DONA birthing-doula certification examination.

Since then, she completed training for postpartum doulas and has DONA certification in those skills as well. This year, she attended a child care education course and became a certified child care educator. She will begin teaching infant care classes to new parents this fall.

As a birthing doula, she typically meets with expectant parents during the third trimester. "That meeting is really to determine if this will be a good relationship, if we will be able to work together," she says.

She explained that the doula does not help with the delivery of the baby, but rather focuses all her attention on the mother. "For example, I may be massaging the mother's back; I may suggest that the mother's partner massage her hips during a contraction. I will help her focus her breathing, feed her water between contractions and I'll provide emotional support. After a contraction, I'll tell her, for example, 'That's one less contraction that you have to go through to have the baby.' "

Ferin says she has excellent relations with obstetricians and midwives who deliver the babies and with the hospitals where the babies are born. "After I meet with a pregnant woman, I meet with her midwife or obstetrician to confirm that I will be attending the birth as a doula," she says.

She is present at all her clients' vaginal deliveries but does not go into the operating room for Caesarean deliveries. She's just outside the operating room and is with the mother as soon as they bring her out.

After the delivery, as a postpartum doula, she usually will spend about 12 hours a week with the mother for two weeks. She won't take care of the baby, but "I will take care of the mother. I will help her with breastfeeding by talking her through her attempts, helping her learn more comfortable positions," she says.

"We will talk about her feelings after the birth. I may help her get her life organized, show her ways to accomplish tasks but not feel overwhelmed by the need to care for the baby as well. I can run errands for the mother. There are a number of tasks, but always the focus is on the mother."

A humbling experience

Five months ago, she gave birth to her second child, Nigel, at a birth attended by a doula, and as she shifts Nigel in her arms, she says his birth has absolutely confirmed her belief in the value of a doula. "Emotional support makes all the difference," she says.

Nigel's birth did, however, cause Ferin to limit her doula practice over the past few months.

"When I'm back up to a full client load, I'll have four birth clients and two or three postpartum clients a month," she says.

In many cases the birth clients go on to become postpartum clients, "which makes it nice because we have an ongoing relationship."

Ferin says her doula work is uniquely fulfilling

"I am a nurturer, and sometimes when I'm working with a woman during birth I look at her face and I realize that I am really helping her," she says. "I'm really supporting her as her labor progresses. At that point I feel a natural high; I am euphoric, but it is also very humbling to be able to experience such an intimate part of a woman's life. I am very honored to be able to help."

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