By Judy O’Gorman Alvarez
When Melissa Ghaffari and her husband were expecting their first child last year they didn’t know what they would encounter in the delivery room.
“We knew we wanted an unmedicated birth, but you really never know what could happen,” Melissa said.
Obstetrician visits, prenatal yoga classes and reading material were all helpful, but when the couple met their doula, her calming personality convinced them she would be a comforting presence in the labor and delivery room.
Although Ghaffari and her husband Rahmin took a few childbirth classes, they opted to rely on their doula to provide instructions when delivery day came.
“No matter how many classes we’d take, we thought that with having her there, we’d have peace of mind,” she said. “And have the birth I hoped to have.”
When contractions started, her doula had Ghaffari climbing stairs, practicing meditation and spending time on a birth ball at home. At the hospital, doula coaching was in full swing: encouragement, reassurance and helping the birthing mother through breathing and laboring techniques are all ways a doula can assist during a delivery. “If I didn’t have her, I would’ve gotten more nervous,” Ghaffari said.
Sixteen hours after contractions started, 6 pound 10 ounce Brayden was born. “Having that extra support was important to us,” Ghaffari said.
Some may call them labor coaches, birth companions or post-birth supporters, but certified doulas, non-medical, trained professionals who provide physical, emotional and informational support to a mother before, during and after childbirth, are becoming more common.
“It’s a very popular means of support right now,” said Suzanne Spernal, vice president of women’s services at RWJ Barnabas Health, “so more people are reaching out to get doulas.”
Community doula programs create a relationship between the patient and doula and their services vary. “The doula may accompany a patient to prenatal visits, come to the hospital, stay during the whole labor experience. She’ll come to see mom for mom-and-baby postpartum home visits,” said Spernal. The doula can answer questions and lend support for moms in areas such as breastfeeding, diapering and what to expect when caring for a newborn.
“It takes a village,” said Spernal and compares a postpartum doula to the help that a new mother’s own mother, sister or friend may offer. “It’s what doulas provide to women who may not have that support,” she said, “to make sure that the patient’s physical and emotional needs are met.”
Whether to employ a doula is a personal choice and, as Spernal points out, the biggest drawback may be the cost. Doulas are not usually covered by most insurance companies. And although there’s talk of a proposed bill for New Jersey Medicaid patients, there is not one at this time.
The cost of a labor doula varies by region, but it can range from $800 to $2,500. Some doulas charge by the hour, while others have a flat fee. Their services usually include a prenatal visit, labor and delivery, and a post-delivery follow-up.
“It’s out-of-pocket cash that’s not reimbursable,” Spernal said and points out that although it may be an expense for couples who have the means, it’s a barrier for someone who wants a doula and cannot afford one.
For some women, perhaps a single woman without a partner, she said, “a doula would be great support.”
The concept of doulas is more broadly accepted today than it was in earlier years. “The more experienced a doula is, the more respected they are in the community and within the hospital by the nurses and physicians,” Spernal said. “When doulas participate in the birth experience as a team player with the medical staff, that makes a huge difference.”
Nancy Freeman, founder and director of Ready for Birth in the Red Bank area agrees. “Some hospitals are more supportive than others,” said Freeman, who has served as a doula for babies born at Monmouth Medical Center and Riverview Medical Center among others.
“Years ago they thought we were country hippie granola-eating people,” she laughs.
She says that at one time many nurses felt the doula would just get in the way during what can already be an intense labor and delivery room. “They didn’t understand what a doula does. Now they realize they don’t have to run for the call bell to get ice chips.” The doula is here.
“Nurses are extremely busy and doctors show up at the end,” said Freeman, who says over the years she has been bitten, has fed chocolate-chip cookies to a mom between contractions, and once arrived at the home of a laboring mom whose husband just delivered the baby before they could reach the hospital.
Some moms- and dads-to-be are not sure of what to expect in the labor and delivery room. “A lot of times women will go for intervention, not knowing what can happen once they start that ball rolling.”
(Intervention, Freeman explains, can be anything from medication to induce labor, relieve pain or start an IV.)
Freeman says sometimes a little reassurance that they can get through it is needed and a doula can do that. A doula can remind them that the pain or pressure is normal and help the woman in labor to try different positions for relief.
“I support women every way they give birth,” Freeman said. “Through epidurals, in the tub, I can support them through anything.” Gabrielle Souza of Howell hired Freeman as a doula for her two pregnancies and deliveries. “I always say that she was my angel. She taught me how to be brave, confident and showed me peace all the time,” she said. “A perfect person to have by our side during this special and unique moment.”
“The support is key,” said Freeman. “Most of my clients feel like they couldn’t have done it without a doula, but we all know they could have,” she said. “We’re just holding their strength.”
This article was first published in the May 2 – 8, 2019 print edition of The Two River Times.
