Sunday, February 11, 2001 Mothering the motherLocal doula calms fears, assists in birthBy Tamara Hill
First came the excitement as McCook started planning a nursery and decided to stop working to raise her baby. But she soon felt an overwhelming fear when she contemplated the reality of how the baby would arrive - without a stork delivering it to her doorstep. "I'm excited about the baby, but I'm not excited about having it," said McCook, 28. "I'm really scared." When McCook shared her fears with her obstetrician, the doctor recommended that she hire a doula, or a non-medical birthing assistant, to give her emotional and physical support throughout the pregnancy and delivery in the hospital. She was referred to Darla Cassel, the only registered and practicing doula in Corpus Christi. Doulas are professionally trained and certified companions that support laboring mothers by explaining complicated medical terminology and aiding them through labor.
A doula is usually there from the first contraction and then accompanies the mother to the hospital, helping to ease her into comfortable position and staying with the mother until the baby is resting in the nursery. "I'm mothering the mother," said Cassel, who has assisted 19 local mothers with their labor over the past two years. "I'm in the role to be nurturing to her but not smothering." Doula duties The term doula (pronounced doo-luh) refers to a Greek word meaning female slave. The services that doulas provide during childbirth - such as applying warm towels to the mother's forehead, holding her hand during contractions, massaging her back or cooling her with a hand-held fan - have been available for centuries. But the idea of having a birthing assistant by a mother's side, rather than the occasional visit from incoming doctor's and nurses, is a re-emerging concept in the United States, Cassel said.
"This had been going forever but when Lamaze (classes) came into the picture, it was decided that it was the father's role to take care of the mother's needs," said Cassel, who is certified by the Doulas of North America. "But men don't understand labor like women do. They don't understand the changes that your body goes through." Because a laboring woman is likely to feel some discomfort, Cassel specializes in giving relaxation treatments to help ease pain and the need for medication. She often massages each client's back, scalp, shoulders, legs and feet while playing soft, soothing music on a small portable stereo. Specialized techniques
Cassel also uses a physical therapy ball to help laboring mothers find a more comfortable position than lying on their backs. And like most doulas, she uses her voice as a way to soothe nerves. "The best tools I have are my hands and my voice to talk and help them relax. I talk in a low, calming voice," Cassel said. "I look out for the mom's dignity by pulling the curtain around them during examination and asking family members to wait outside if that's what the mom wants." Linda Hamilton said Cassel's support during the birth of her second child helped her have a more relaxed labor without using pain medications. Hamilton and her husband, Bronson, hired Cassel to help ease Linda's fears. "With the second baby, I had more anxiety than I had with the first. I had a good delivery the first time but you know what to expect as far as pain," Linda said. "I took no medicine throughout the (second delivery) and I really do think it was because she kept me focused so that it progressed along, and I was able to stay relaxed." Cassel charges $500 for her services. Cassel makes an initial home visit to meet the expectant mother and provides monthly, extended telephone consultations to provide prenatal education and answer any questions. During the last two weeks before the baby is due, Cassel stays on call 24-hours a day and will meet the expectant mother at her home for the first contraction and go to the hospital for the labor. Then she makes a final home visit a few weeks after the baby is born. Different than a midwife A doula's role may sound similar to that of a midwife but the primary difference is that doulas aren't certified to give medical advice or care, said Beth Overton, a local midwife and owner of Gentle Beginnings Midwifery. Midwives provide prenatal care and deliver babies in the home, and they usually have assistants on hand to fill the doula's role. But doulas, like midwives, are able to stay with the mother during the entire labor unlike most hospital staff who must attend to several patients at one time. "Most midwives are doulas by nature. Most midwives will rub the woman's back and stay by her side," said Overton, who uses two female assistants for each delivery she attends. "I wouldn't recommend a hospital birth (without) a doula. You cannot replace woman-to-woman care." Dr. Terry Groff, chief of the department of gynecology and obstetrics for the Christus Spohn Health System, said doulas can be very helpful for expectant mothers."Patients who have never had a baby can learn a lot from a doula and can go into the process much less afraid," he said. "This also reduces the chances of having a Cesarean birth, possibly because of the extra relaxation techniques and emotional support they provide." Groff said that one out of every four women are at risk for having a Cesarean birth, particularly first-time mothers. A variety of factors contribute to the need for a Cesarean section, including a large baby or the baby being in an awkward position, but fear and stress play a major part. Groff said. "If the baby's in a wrong position and we need the mom to relax, a doula can certainly be helpful in that situation," Groff said. I recommend them to all my patients who are having their first baby because that's where (doulas) are most helpful." Calming the fears Since their first meeting last month, Cassel has taken time to get acquainted with McCook and discuss her pregnancy fears. Cassel said building a trusting relationship is critical to recognizing a client's emotional trigger points and to addressing those needs during the birth. Cassel also explains key medical procedures to McCook and will continue the discussions through labor. "Some women have fear about their inability to birth a baby, like they won't be able to do it. A big factor is that women may be intimidated by all the technology in a hospital room because if they do early labor at home, once they get to the hospital, they lose partial control of what's going on with them and that affects them," Cassel said. McCook hired a doula because she and her husband recently moved to Corpus Christi without any family. She said that Cassel's personal experiences with labor and other clients gave her peace of mind for her own delivery. "It is important for me to have someone there. You want to know that someone will be with you the whole time and you lean on them for information," McCook said. "My husband has never had a baby or a cramp in his life so at least there's someone there to say 'OK, I have an idea. Let's do this'." Although Bronson Hamilton had already assisted his wife during birth, he said having a doula severely reduced his stress levels. "It took some pressure off me. It's just a lot easier with two people in the (delivery) room. There were times when Linda didn't want anyone to leave her but she also wanted ice or warm towels," he said. "Going into it, I had reservations about having one more person in the room, but it just made the whole process easier."
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