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December, 2008, Vol. 08, Issue 12 >> Practice Management

In Honor of a Doula

By Elaine Stillerman, LMT

Doula (doo-lah) is a Greek word that means "servant" or "handmaiden." Doula also refers to the compassionate labor coach who supports, advocates, nurtures, massages and protects a laboring woman from her first contraction until after her baby is born.

In childbirth, the presence of this highly skilled, nurturing professional can completely change the labor experience for the better.

When we were still living in close-knit communities, it was common practice for the friends and family of a laboring woman to assist the midwife or doctor (when they still made house calls) during birth. But as we moved into urban and suburban areas, away from rural traditions, we moved away from this intimate circle. Women found themselves giving birth in hospitals without the support and assistance of anyone other than their partners - that is if the hospital permitted her to have that essential companionship. Fortunately, a labor doula and (for postnatal care) a postpartum doula fill the role of the community of women and provide the emotional and physical support that a laboring woman needs.

The labor doula is not part of the medical team. She doesn't deal with medical issues and unlike the obstetrician or midwife, she doesn't catch the baby. She is there for the duration to keep mother calm, relaxed, comfortable and focused on the task at hand.

In a controlled study conducted at a public hospital affiliated with the Baylor College of Medicine, women who labored with doulas had C-section rates of 8 percent as compared with 18 percent for women without doulas. The need for pain medicine dropped from 55 percent to 8 percent and labor was shortened by two hours when a doula was present. In addition, neonatal hospitalization dropped by half. These doulas recorded that on average, they touched the woman 95 percent of the time, as compared with less than 20 percent by male partners.1

Five studies conducted in Guatemala, Canada, the United States and South Africa confirmed that the presence of a labor doula reduced the need for surgical deliveries, shortened labor time and reduced prenatal and postnatal complications.2

At Jefferson Davis Hospital in Houston in 1993, 600 women who had never carried a pregnancy to term were divided into three groups: a control group, an observed group to measure the effects of a passive observer, and a group actively supported by a labor doula. The doula group had the following results as compared to the control group:

  • 56 percent reduction in Cesarean sections;
  • 85 percent reduction in the use of epidural anesthesia and other pain medicines;
  • 70 percent reduction in deliveries requiring the use of an instrument (either forceps or vacuum extraction);
  • 61 percent reduction in the use of the drug Pitocin to speed up labor;
  • 25 percent shorter labor; and
  • 58 percent reduction in neonatal hospitalization.3

So, what exactly does a doula do? To give you an idea, let me tell you about my doula, Ilana. I knew Ilana professionally for years before I worked with her as a laboring mother. She was among the better known and most sought-after labor coaches in New York City. She founded the Metropolitan Doula Group (MDG), which is an organization that provides skilled doulas in the New York area. The MDG also conducts classes for its members and brings doulas into hospitals for women who can't afford them. They believe that no woman should labor without the support of a doula, and money shouldn't be the determining factor. During the 9/11 crisis, the MDG sprang into action by providing doulas for any laboring woman in a hospital, birthing center or at home who wanted one free of charge.

I called Ilana when I became pregnant. She came to my home to interview me and my husband about our hopes for the big day. Ilana took copious notes in the attempt to get to learn my likes, dislikes and what would be most helpful during labor. She gave us a realistic list of items I would need to make my labor more comfortable. Since then, I have provided my clients with that invaluable list and offer it in my textbook.

When the day came, Ilana had just returned from another birth she had stayed at for 13 hours. She had been home for two hours when I called. "Don't worry," she said, "I'm on mommy time." My water broke and I went into active labor within minutes. The contractions were coming one after the other. She asked to hear a contraction. Did this mean put the phone on my abdomen? Or did she want to hear the sounds I was making? By this time, all rational thought was out the window. "What?" I asked. "Let me hear a contraction," she repeated. Mine were silent. "I'll meet you at the hospital."

Once there, she directed my husband to get a different nurse and a private room for me. She disappeared for a few minutes and came back with a pile of waterproof pads and clean gowns. She opened her bag of goodies and asked if I was hungry or thirsty. And she held me. She massaged me. She danced with me. When the pains got intense, she took my face in her hands and said, "Give me the pain. Give it to me." And the pains lessened.

When I felt I was losing strength, she told me to relax my feet and let Mother Earth's power help me. She stayed by my side for 19 hours, encouraging me, honoring my efforts and nurturing me. And when my son was born, she told me how magnificent I had been. A week later, Ilana came to my home for a visit, bringing lunch, gifts, pictures and my birth story. We shared a life-affirming experience and I wasn't going to let her out of my life since she had been such an important part of it.

But life sometimes has other plans. In a cruel twist of fate, Ilana got ovarian cancer and lost her four-year battle last month. Her family and friends showered her with the same unconditional support she provided to the hundreds of new mothers she cared for and the countless doulas she taught. Ilana was all about giving, respecting and honoring a woman's efforts. That's a doula.


  1. Sobel DS, Ornstein R, eds. "Emotional Support Eases Labor." The Mind/Body Health Newsletter 1992;1(1). In: Stillerman E. Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum BodyWork. St. Louis: Mosby, 2008.
  2. Klaus MK. Maternal assistance and support in labor: father, nurse, midwife or doula? Clin Consult Obstet Gynecol 1992;4(4):211-7.
  3. Sobel DS, Ed. The Mind/Body Health Special Report, 2004.

Click here for previous articles by Elaine Stillerman, LMT.


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