One Labor-Intensive Job

"I thought you were here to do my job," says Ash with a laugh. His comment raises a pressing issue: If a doula is providing all this physical and emotional support for the woman, what's Dad supposed to do? While Ash is relieved that Guralnick will be there, many birth fathers feel a bit wary and even threatened by the news that their wives want special help from another nonmedical person. Good doulas make fathers feel more involved and more useful at a stressful time.

At a time when the average prenatal visit with an obstetrician lasts six minutes, Guralnick's 1 1/2-hr. visit with the Suris feels like good value for the money. Doula fees vary greatly by geographic area. The range is approximately $300 to $1,000 for a labor doula, and postpartum specialists charge hourly rates of $15 to $35, though often with a 15-hr. minimum. As doula services are not yet covered by medical insurance, most doulas say their clientele tends to be affluent.

That is changing, however, as word of their benefits spreads--and as doulas come up with creative ways of expanding their services. Stephanie Soderblom of Mesa, Ariz., has a nontraditional and nondiscriminatory fee system. She asks $450 for a birth but will do payment plans, sliding scale and even barter for services. Says Soderblom: "I'll never do a birth for free, but I've done births for a quilt, a picture frame and even homemade cookies." Her payment philosophy comes from her experiences working with young, single mothers. "I didn't want these girls to feel as if they were charity cases," Soderblom says. "Everybody has something of value to give, and I asked them to think about what they could offer."

Despite the growth in demand for doulas, skepticism in the medical community is long-standing. Judith Halek began working as a doula more than 13 years ago, at a time when doulas were unfamiliar to most obstetrics professionals. "A ward nurse once asked me if I was part of a cult," recalls Halek. "I explained that I was there to provide support. We've come a long way, but we still have a long way to go."

Opinions vary greatly, according to experience. Dr. David Axelrod, an ob-gyn in Alexandria, Va., recalls one doula who invited a father in just as Axelrod announced he needed to do a C-section. "That caused a little bit of a fuss," says Axelrod. "But basically a lot of my patients like their doulas, and they're becoming more popular."

Sometime around March 25, Guralnick's phone will ring, and she will pack up her things and dash off to be with the Suris. She will stay with them through every push, grunt and moan. And when their baby is born, she will pack up her big rubber ball and move on.