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Recently in Salon Mothers Who Think

Trapped and torn
Locked in by a chain of protesters, I wanted to kick myself. My kids were at home and I was about to be pummeled for all the wrong reasons.
By Lisa Guide
[12/03/99]

Wild in the streets
What better place to find a hottie than at a riot conveniently taking place in my neighborhood?
By Annie Culver
[12/03/99]

Taking a chance on love
Suddenly, we would be allowed to adopt a baby -- if we could accept the very real possibility that, one day, he would be mentally ill.
By Jane Smith
[12/01/99]

Giving in to Ritalin
I hate it, but my son needs it.
By Karen Shoemaker
[11/30/99]

Till death do us part
Is it a promise of love or a life sentence? Our readers weigh in with advice.
By Jennifer Foote Sweeney and Amy Benfer
[11/29/99]

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The object of her scorn was a column on the latest dust-up about drugs during childbirth. Once again, the debate was framed as a battle of ridiculous extremes: The no-drug mothers -- smug masochists who use birth as the ultimate extreme sport -- face off against narcotized moms who are weak, shallow stoners. "You either suffer or take massive loads of drugs," she said sarcastically. "No one is talking about what mothers really need -- which is support, so you may not have to do either."

Sarah is no ideologue. Two years ago, before our son Ian was born, she filled out a form in Lamaze class that asked her to rank the likelihood that she would need drugs during childbirth. She had to pick a level on a scale from 1 (roughing it) to 10 (Janis Joplin). She chose a 7. This was higher than I'd expected, but even a first-time father knows not to debate such things. When the time came, though, she needed no drugs at all -- thanks to the help of a doula, a professional labor coach.

Also Today The fainter I tried acupuncture, strumming my veins and "Shocking Brain Surgery." But nothing could prepare me for witnessing my son's birth. By Aaron Shure

If you've never heard of a doula, don't worry. Experienced birth attendants have been around since the beginning of humanity, but the term -- Greek for "trusted servant" -- dates back only to 1992, when a Seattle childbirth educator decided the position needed better branding.

Today, fathers are allowed in the delivery room and midwives sometimes elbow out doctors. Doulas fill a remaining gap: They serve as an experienced peer focused solely on the mother's physical, emotional and psychological needs. Doctors or midwives must split their time worrying about the baby's delivery; nurses typically shuttle among several births. Dads, of course, are riveted on their partners, but we're so deeply involved we can't be always be counted on for levelheaded decision making -- and besides, even we earnest Lamaze graduates have little experience in knowing what to do when dilation comes.

While doulas aren't medical professionals, their effectiveness has been documented by medical institutions. Allina Health Systems, a Minneapolis-based HMO and hospital network, did a 1996 "meta-analysis" of six clinical trials. The results showed a 50 percent reduction in Cesareans among mothers who used doulas, a 25 percent decrease in the length of labor and a 30 percent drop in the use of pain medication. When Allina did its own trial, the results were even more striking: Mothers assigned to doulas had 64 percent fewer Cesareans, 38 percent fewer epidurals and a 27 percent reduction in labor duration.

Even studies that showed no reduction in C-sections -- such as one done by California-based HMO Kaiser Permanente -- found that the use of doulas provided emotional benefits to mothers. Women accompanied by doulas are significantly more likely to cope well with labor, rate the birth experience as good and say that enduring labor improved their feeling of self-worth.

"If a doula were a drug, it would be unethical not to use it," says Dr. John H. Kennell, a pediatrician at Cleveland's Case Western Reserve and a father of the modern doula movement.

Yet despite its successes, the "doula movement" remains largely word-of-mouth -- which is how Sarah and I found out about it. A few years ago, I hosted a radio show. As the lone liberal on a conservative AM talk station, I'd use nonpolitical topics as a way to create space between caller insults. While Sarah was pregnant, my conversation naturally gravitated to the joys and fears of impending fatherhood.

Midway through the pregnancy, Doug, one of my regular callers, phoned after a show. His wife, Maureen, was a doula and wanted to offer her services. The cost was $300 for a couple of pre-delivery meetings, attendance at the birth and postpartum follow-up. (I later found out that doulas typically charge between $200 and $600, depending on region and extent of consultation.) I was suspicious, but Doug had proven himself to be one of my more thoughtful intellectual combatants, so I figured it couldn't hurt to meet Maureen. If it got weird, at least I'd have a good anecdote for a slow morning.

A suburban matron soon turned up on our doorstep, looking as proper and beatific as a door-knocking Jehovah's Witness. In truth, Maureen was an evangelical Christian -- a not-uncommon trait among doulas. The profession sports a liberal-conservative coalition rivaling WTO protesters: The God Squad is equally matched by the New Agers; both share a belief that birth is a natural and spiritual thing.

Since Sarah and I are confirmed secular humanists, my first reaction was, "Uh-oh." It would've been the same had an earth mother flounced in. But Maureen quickly won our trust. She focused on what we wanted out of the birth and asked us to be blunt about what we didn't want.

"Well, I said, "we don't want to be evangelized."

"Fine," she responded, "I won't." And she didn't.

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