After more than 30 hours of labour to give birth to her first child, Brooke Graham was convinced she'd never have another.
During the birth she took every medication offered and later suffered severe postpartum anxiety.
Four years after her daughter's difficult birth, Graham became pregnant again. She was terrified. A counsellor suggested she hire a doula.
She'd never heard the term. "I thought, 'Whatever, we'll give it a try. It can't hurt,' " Graham said.
Now, after the birth of her son -- the "most empowering experience" of her life -- she's training to become a registered doula.
"It's the greatest secret ever kept," Graham said.
The term doula means "caregiver" or "woman of service." The loose translation Graham is most fond of is "mother of mothers."
Doulas provide non-clinical support or care before, during and after birth for the woman and her partner.
Lisa Wass began working as a doula before she knew what they were. In 1998 Wass left teaching and began working in mental health services. Her first client was pregnant. Three weeks later, she supported the young woman in labour.
"I realized that day that . . . every birth at our hospital was very much a part of the big birth machine," said Wass. "I wanted to advocate for women so they understood that they had choices."
A few years later she was in the library doing research when she met Debbi Mbofu, the province's first registered midwife.
"She said 'Oh, you're a doula.' I said, 'a do-what?' " said Wass.
Misconceptions about doulas abound.
"When I first started meeting clients and I'd come in and have a conversation they'd say, 'This is cool. You didn't come in waving incense and crystals,' " Wass said.
Doula work is anything but hocus pocus. Wass details the different angles used in child birth, how a position change could mean the difference between delivering the baby in a yoga position or relying on vacuum suction.
Though they can provide suggestions, doulas are not midwives. They cannot prescribe medications, do medical interventions or conduct clinical examinations.
A doula responds to the wishes of the expecting mother, whether that means an all-natural, at-home water birth, or a planned caesarean section.
"We provide resources so that they can make informed decisions," said Wass.
"Somehow I would love to dispel the myth that doulas are all hippies," Graham said.
Both doulas say they support the concept of a doula for every woman who wants one. For that to happen, more women must become doulas.
"We need a lot of different women. Variety is very important," said Wass.
Though diversity is desired, it's difficult to come by. The work is demanding -- once the doula arrives, there are no shift changes. Labour lasts on average between 12 and 20 hours. The maximum caseload is one to two births per month, and that means being on call 24 hours a day. It's too much for many doulas, which means turnover is high.
From 1998 until 2007 there were about five or six doulas taking clients in Saskatoon at one time.
Wass has since trained 45 doulas from Saskatoon and area. She's worked to expand services into northern Saskatchewan, and is one of a few doulas who travel around the province. She has also spearheaded the Prairie Birth Collective, an organization of doulas, hypnotherapists, birth educators and massage therapists.
Evidence shows that doulas' efforts work. Intervention rates drop drastically and epidural requests are reduced. Caesarean sections also drop by 30 or 40 per cent when a doula is involved, says Wass. Studies show a woman's birth experience directly relates to her experience mothering, and women have fewer instances of postpartum depression and problems breast feeding.
It equates to a cost saving for the health-care system, but it's up to the mother to seek out.
Doula care can cost on average between $300 and $1,000. In British Columbia, where demand is very high, people pay thousands of dollars. Because of the demand, and the results of a task force study that show the rates of intervention drop dramatically if a doula is present, B.C. has begun incorporating doulas into public-health programming.
Right now there are no plans to incorporate doula care into the health-care system in Saskatoon, where the focus is expansion of the year-old midwifery program, says Sheila Achilles, director of primary health services for the Saskatoon Health Region.
"We don't have the capacity to pursue bringing them on as employees," Achilles said. "We certainly are supportive of any mom who chooses to have a doula with her."
After more than a decade serving mothers and their partners, Wass says the medical community is finally responding positively.
"It's a huge shift in Saskatoon," said Wass. "We used to come into the hospital and they'd say 'You're a what? Your name's Abdula?'
"For a little while there was a lot of hostility, because there was that needing to define roles. But now, there's such a great understanding of what a doula brings to the birthing woman and how we can work as a team," she said.
jstewart@sp.canwest.com
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