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Over the course of our pre-delivery sessions, we built up trust in Maureen, leading us to ask the sorts of questions we might not have been comfortable throwing out in a group class. It became easier to talk about fears -- including mine. I could admit my absolute lack of confidence, talking through each of my panic scenarios like a paranoid to a shrink.

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

Some couples worry that Dad will be upstaged by the doula on delivery day -- a reasonable fear. I tell prospective Dads that a few hundred bucks is a small price to pay for Knucklehead Insurance. Allowing fathers in the delivery room is a wonderful and well-intentioned gesture, but most of us are rookies as labor coaches, and it's ridiculous to have a rookie in charge of anything, much less his gravid wife's comfort.

"It's almost unreasonable the pressure we put on fathers," says Kennell. "I work with med students who have been training for a year, and when they go into hospital divisions for the first time, it's very common for them to feel faint. [Doulas] are a great psychological benefit to mothers, but also to fathers."

When Sarah went into labor, we found ourselves in a situation Maureen had warned us might occur: She was tied up at another, very difficult birth. She would have to send her backup.

Soon after we made it to the hospital, Allison, a severe Australian, arrived. The three of us had no bond outside of the fact that we all knew Maureen. The first hour didn't go well for me. Fortunately, it went well for Sarah. Allison locked on to Sarah like a lamprey to a rock. She was so competent and assured that I became nothing more than a marveling spectator. Sure, I'd learned about the birthing ball, breathing exercises and the soothing effects of the seated shower, but who knew when the time was right for each? Allison did.

While I wasn't interested in wresting command of the pain-relief detail, I also wasn't doing the most that I could do. I vividly remember standing behind Sarah, watching Allison work, and realizing that I'd drifted out of my wife's sight because of some imaginary inadequacy I felt in comparison to the doula, rather than concentrating on what the hell was happening with my wife.

But no one was telling me to be passive. I gathered my wits and decided to assert myself ever so gently. I moved back in front of Sarah, essentially sharing space with Allison. I started to ask Sarah my own questions when my instinct moved me, cracked a pallid joke or two and basically resumed being myself. This was met with no resistance; Allison was fierce but not a control freak.

With us, at least. There was one charged moment. A nurse had left Sarah hooked to a baby heart monitor. After several minutes, Sarah whimpered, "My belly's cold." I probably would have waited until the nurse returned, assuming that such discomfort was the price of vital information.

Allison snorted. "I'm going to get someone," she said, and stomped out of the birthing room.

Soon an apologetic nurse appeared; she explained that she'd been busy and had forgotten to unhook the monitor.

Some medical professionals resent having to deal with another party in the delivery room, though our OB and nurses apparently did not. Even the nurse who made the error sought us out after the birth to tell us how neat it was to work with the doula. I'm sure it's a relief for professionals working with us amateurs to have a seasoned intermediary to go through. Doulas themselves insist that they defer to the clinicians.

"Doulas say that their place is at the patient's head, not in the physician's way," explains Bonnie Blake, vice president of operations for two Allina hospitals.

That's how it was during the late stages of Ian's birth. Sarah experienced excruciating back labor, but she didn't ask for an epidural. Allison stood behind her head, offering steady suggestions: how to turn, how to breathe -- simple suggestions that I would have been grasping to recall, had a doula not been there. I sat next to Sarah, held her hands, gazed into her eyes and offered reassurance. Meanwhile, the OB and the nurses worked undisturbed. After six and a half hours of labor, Sarah delivered our perfect baby son.

Our doula did not prove herself to be some sort of human ibuprofen, able to miraculously mask the pain. "Childbirth didn't feel like people said it would feel -- it hurt a lot more," Sarah recalls. "But fear makes pain worse. Maybe my pain wasn't any less, but I wasn't afraid. I would have been terrified if Allison hadn't been there to tell me this was normal."

Now that we've become doula acolytes, I'd like to know why health plans are so timid about promoting them. Forget, for a moment, about the emotional advantages. Even in the bloodless financial world of the modern HMO, doulas make sense. Each bypassed epidural saves about $150; a forgone C-section saves around $3,900. If one woman in 10 avoids a Cesarean, the money saved could pay for doulas for all. This, folks, is health maintenance.

Yet even Allina, which documented the benefits of doulas in its own studies, offers a mere $150 toward the expense of hiring a doula, and this incentive is available at only two of its 15 hospitals.

Allina, says Blake, wants to slowly increase the use of doulas, gradually making sure the benefits shown in the 1996 study hold. Still, it's no accident that its hospitals with doula programs also lack nurses' unions. Two Allina officials told me that the nurses' union fears that the doula program is a backdoor attempt to reduce the number of nurses on duty.

Blake insists Allina isn't looking to replace nurses with doulas. She predicts that resistance will drop as more nurses work with patient-provided doulas -- and don't lose their positions because of it. Physicians don't see doulas as a direct threat to their profession, but some still need to see the advantages of doulas for themselves.

Union nurses aren't the only one who distrust Big Medicine. Doulas are thought of as cool and sort of alternative when patients seek them out, as we did, but Blake suggests that mothers might find it more difficult to bond with a labor coach if institutions are the promoters. "We prefer to be a less paternal organization," she says.

I don't know. It is possible that health-care costs might rise in covering the heart attacks people would experience when offered cheap, innovative, human support -- but I say let's take that risk.

Two months ago, Sarah discovered she was pregnant again. Our baby is due in June. Of course, we're going the doula route again, reimbursement or not. This time, Maureen promises us she'll be there.
salon.com | Dec. 7, 1999

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