Families: One Labor-Intensive Job

Barbara Guralnick is leaving her New York City apartment carrying a blue plastic ball that measures 75 in. around, portable CD player and shoulder bag packed to the brim with lotions, washcloths and hair scrunchies.

"Oh, going to have a baby?" her doorman asks cheerfully. Guralnick, 38, smiles and nods but has no time to chat. She's a doula, also known as a childbirth assistant or labor coach. One of her laboring clients has called and requested her presence. She will be with the parents through the labor and delivery, which could be anywhere from three hours to three days.

Doula is a Greek word that means "woman servant." Unlike midwives, who deliver babies and are licensed to perform medical tasks, labor doulas provide emotional and physical support to the laboring parents. "I do everything from getting wet cloths for a mother's forehead to relaxation exercises to massage," says Guralnick.

When the first modern doulas began practicing professionally, roughly 20 years ago, their work was seen as part of another alternative birthing method. But in the past three years, there has been a remarkable rise in the demand for their services. Doulas of North America, which trains and certifies doulas, has 3,500 members--up from 750 in 1995, according to Kristi Ridd-Young, DONA's administrative director. "Part of this increase stems from the fact that the consumer is taking birth back into her own hands and wants to be a part of the decision process," says Ridd-Young. "Also, it's a natural instinct to gather the right kind of support around you."

Across many cultures and throughout history, women have assisted births. But in the late 1970s and early '80s, when doulas were rare, obstetricians John Kennell and Marshall Klaus conducted a survey of 128 nonindustrialized, hunting-and-gathering and agricultural societies. All but one featured continuous support by other females for mothers during labor and delivery. As birthing moved to hospital settings, this element of support was lost. Kennell and Klaus found that the presence of doulas not only reinstates support but also is associated with fewer labor complications. In their book, Mothering the Mother, Kennell and Klaus compare labor in both doula-assisted and non-doula-assisted births and report that doula-assisted mothers made fewer requests for pain medication, had shorter labor and had fewer epidurals. They were also half as likely to undergo caesarean section.

A doula's presence does not guarantee a complication-free birth, but the emotional support she provides can be invaluable. Ann Grauer's doula was with her in Milwaukee, Wis., when doctors told her that the child she was about to deliver would be stillborn. Her doula consoled her throughout the painful ordeal. Says Grauer: "It was amazing the peace of mind my doula was able to give me." The same doula was there later for the birth of her son. "It was such a celebration. We are still very close."