Labor and delivery can be like a labyrinth, says doula DawnStar Sarahs-Borchelt.
There are no wrong turns, but some inevitable twists and curves.
“I teach people to think about the curves, as those could be big things like, ‘My doctor’s on vacation and I’m going to have a different doctor,’ or little things like the room got too hot and I’m going to have to change the thermostat,” Sarahs-Borchelt said.
Couples hire her to help them navigate labor and delivery. A doula, or childbirth companion, provides hands-on emotional support, but no medical care.
In a Cochrane analysis of more than 20 studies and 15,000 patients, women who received continuous support were less likely to require surgery to deliver their babies. The women also reported greater satisfaction with their birth experience.
In 2014, the American College of Obstetricians and Gynecologists explored ways to prevent cesarean births.
“The theme of the ACOG white paper was we should be looking to do everything we can to either reduce the C-section rate or at least keep it in check, and this is a valuable opportunity to use support persons or doulas — that, compared to other things, is a rather simple intervention, and probably only upside,” said Nathaniel DeNicola, a clinical associate in the department of obstetrics and gynecology at the University of Pennsylvania.
Across the Philadelphia region, a doula’s help can cost $800 to $1,200.
The Cochrane review did not address the economics of hiring a doula or its impact on health care costs.
“It’s not hard to imagine you could make a cost-effective argument,” to counter the cost of a first surgery and subsequent C-sections, DeNicola said.
Teamwork in delivery room
A doula is an extra person in the delivery room that can be crowded with doctors, nurses, partners and family — but Sarahs-Borchelt says she fits in fine. She feels generally accepted by the medical staff when she’s attending a hospital birth, except for the rare exception when some feel “protective of their turf.”
DeNicola says doulas become part of the team that helps a woman make informed decisions.
“The ultimate goal is a healthy baby and a healthy mom,” he said.
“Oftentimes there’s a reason why the medical care provider is suggesting something that might not be what the mom and dad wanted ahead of time,” Sarahs-Borchelt said. “I don’t think it’s my job to say ‘No, you shouldn’t do that.’ I do think it’s my job — if there’s time, if it’s not an emergency — to say, ‘Hey, everybody, let’s take a step back and think about it,’ so mom and dad are really comfortable with the plan and know why it’s happening.”
Sarahs-Borchelt, who was trained and certified by the group Birthing from Within, has attended 32 births and has four children. In March, she was at the bedside when Colleen Frens delivered her son. Frens’ husband, Basel, was on the other side of the bed.
“When you are at that part of labor, there’s not a whole lot anybody else can do for you, you just have to do it yourself,” Sarahs-Borchelt said. She said she tries to be compassionate and attentive while mothers do the work.
‘There for just one mom for that birth’
“Unfortunately, even if medical care providers have the very best intentions, they have a job to do. Their job is providing medical care to keep the mom safe, and they might really want to do support.”
“But if your nurse has three or four people in labor who she’s supposed to be taking care of — and you have a question — she’s very likely to answer it really quickly because she has to get in the other room and do the charting for the six other people who she’s supposed to be providing support for,” said Sarahs-Borchelt. “A doula is there for just one mom for that birth.”
Frens, a West Chester, Pennsylvania, resident, said she hired Sarahs-Borchelt to be an advocate for her desire to have a natural birth in a hospital.
“And also, if there were complications during labor, to have someone there who would help me evaluate how to move through those, if labor stalled. ‘OK, what do we do?’ If the C-section became necessary, and kind of to help me go through those steps and also to not feel guilty about it afterwards,” Frens said.
Frens, who was a collegiate athlete, said she’s subjected her body to pain before, but she knew birth was going to be the hardest thing she’s ever done. “I’m also pretty stubborn, and I just thought I could do it, so I wanted to do it,” she said.
And supporting the partner
The plan was to lean primarily on her husband, and hire a doula as backup.
“Once we talked about and it became something we both wanted to do, you just fit into the budget,” Frens said.
When Sarahs-Borchelt showed up at the Frens home about 2 a.m., Frens was crouched on the couch, and her husband was rubbing her back. When the doula arrived, Basel was able to step away for a moment to get an overdue break.
“I see a really important part of my job as the doula, as supporting the partner in being able to be the main support,” Sarahs-Borchelt said.
Frens remembers with a laugh that after hours of increasingly intense contractions, she said to her husband, “This is so hard, I want that epidural.” He said “OK.”
When the doula arrived, Frens says she got a boost of confidence to stick to her natural birth plan.
“OK, I can do this. The thought went out of my head of getting an epidural,” she said.
Frens hired her birth companion through Main Line Doulas. The agency opened in 2011 and now has 25 affiliated doulas.
Founder Aliza Bancoff says she gets steady business from women who want a birth doula, but another service is in higher demand: providing post-partum doula care.
That side of the business has “quadrupled,” she said.