“Stay with me, look into my eyes, Sarah. You’re stronger than this contraction, you can do it.” Sarah clutches my hand tightly and breathes rhythmically. Her eyes are very wide, and in them I see a familiar mixture of fear, trust, vulnerability and determination. “It’s almost over, you’re coming down the back of it, almost done now… “ I guide her through the end of a powerful contraction as I wipe the sweat from her forehead, helping to keep her focused and not get lost in the pain.

Sarah’s husband John sits next to her, stroking her face and arms and softly whispering to her his awe of her strength and determination, his belief that she can do it. I massage her feet, neck and shoulders quietly between contractions, holding the intimate space between husband and wife, and not interfering. It is a fine line between supporting and interfering, and I have to use my knowledge as a labor doula, wife and mother to navigate it.

A labor doula is a person (usually a woman) who has been trained in normal birth, interventions, and comfort measures for laboring women. We are not medical professionals; we are emotional, physical and informational support people for the laboring woman and her partner. Labor doulas are not trained for clinical aspects of care like dilation checks, blood pressure monitoring or determining test results. Our place comes in knowing that when a mother stays in bed, it can lengthen her labor, or that upright positions are best for pushing, or that the mother prefers a certain type of touch when she is in pain.

Many couples believe that they will receive the bulk of their labor support from their doctor and the attending nurses. Unfortunately, the patient load of labor and delivery nursing staff can become quite heavy, precluding skilled nurses from labor support roles. Additionally, a laboring couple will usually see their physician only when the mother is in the pushing stage, assuming their doctor is on call when she delivers.

All of these variables can make couples very uncomfortable as they enter into one of the most transformative, intimate and vulnerable times of their lives. A labor doula is an answer to the concern of, “Who will help us?” Once the doula is called to attend the client in labor, she does not leave until the birth is over and the new family is settled in. A culmination of studies show that having a knowledgeable person in the room during labor reduces the need for several interventions, including cesarean by 50 percent, requests for pain medication by 60 percent, and the length of labor by 25 percent (Klaus, Kennell, Klaus, The Doula Book, pg. 97-98). They also found that mothers breastfeed longer, have less postpartum depression and more overall satisfaction with their birth experience.

Birth is a taxing process that requires levels of energy from the birthing mother as well as her attendants that are not usually needed in every day life. While the father is the perfect emotional support for his wife, a doula can be a physical and informational support to the couple as a whole. Knowing that if he leaves to eat or use the bathroom that his wife will not be alone is a comfort to many fathers, as well as knowing that there is someone always present of whom he can ask questions, get ideas, and get a good back rub.

Several organizations train and provide referrals to doulas in Washington State. Pacific Association for Labor Support (PALS) (www.pals-doulas.org), Childbirth and Postpartum Professional Association (CAPPA) (www.cappa.net), DONA International (www.dona.org), and Association of Labor Assistants and Childbirth Educators (ALACE) (www.alace.org) hold several trainings per year, internationally. There are also advanced doula trainings offered for doulas who are already practicing. Visit their websites to find out more information on becoming a doula or hiring one for your birth, or check the telephone directory to find doulas in your area.

Sarah begins to push her baby out and John holds one leg while I hold the other. He chants, “You’re doing great, honey! 10… 9… 8… 7.” Sarah follows the numbers in her mind while her knuckles grow white from the power of her pushing. Her baby’s head begins to emerge and she melts like butter into the bed to rest in between contractions. “Almost done, Sarah,” I say, quietly next to her ear, “You are about to be a mom, your baby is almost here!” She rises again to push, and the room goes quiet as we witness the birth of another human being into the world. We all weep as John announces, “It’s a boy! It’s a boy!”

(Editor’s Note: Kristina Kruzan is a labor doula in Kitsap County, and co-creator of Birth Connections, a publication for families and childbirth professionals. To find out more about Kristina or her services, visit her website at www.dynamicdoula.com or email doula@dynamicdoula.com.).