Summary: Doulas form a bond with expectant mothers, offering aid, comfort and encouragement during childbirth.

Byline: Catherine Clabby
Source: Staff Writer



Driving through the winter dusk with her husband, Meg Shouse was glad to be on the way to the hospital, glad to finally be in labor.

Eight days late with her second child, she was tired of being pregnant. She hadn't had a good night's sleep in weeks. She couldn't take drugs for the migraine that hounded her. And she had run out of closets to reorganize at her Apex home.

Ann Tumblin was glad, too. For weeks she'd carried a beeper at home, to work, to tennis matches, waiting to be summoned to the hospital. She knew Meg was ready.

At Wake Medical Center, Ann helped Meg and her husband, David, settle into a pale pink birthing room on the fourth floor. She found blankets and towels for later. Until Meg's contractions started coming fast and strong, the three of them paced the maternity center's wide halls to bring the baby faster.

When Meg could walk no longer, Ann urged her to step into a shower back in the delivery room and sit down. Ann sprayed warm water on Meg's back and on her swelled belly to help her relax.

It wasn't enough.

By 7 p.m., Meg's initial relief had turned to alarm. She sat hunched on the edge of her bed confronting a pain bigger than anything she had imagined or remembered from the last time.

David stood inches away, praising her in a soft tone. "That's good, that's good," he said, grateful that Ann sensed when to step in. Ann stood directly in front of his wife. She wiped her face with a washcloth. She fed her ice chips.

Between contractions, Meg pressed her face against Ann's chest and held on tight, like a child seeking comfort. When the pain swelled, Meg called Ann's name and grabbed her hand. Using

finger signals, Ann set a pace for breathing through the worst of it. "He-Who, He-Who, He-Who" they chanted together, sucking in air and pushing it out.

"Oh Ann," Meg told her after a contraction passed. "I don't want any more of these."

"You can do it," Ann said, stroking Meg's dark hair with one hand and holding onto David's shoulder with another. "Your body is working hard. You are going to make it through."


Ann Tumblin says too few mothers get the support they really need to make it through labor. She wants to change that.

She is a doula, one of a small but growing number of lay labor assistants across the country. Mostly women, they give emotional support and physical comfort to women and families during childbirth.

For Ann, the job is a natural.

At 47, she has been trying for 20 years to make childbirth more humane. Ever since the day in 1975 when the staff at a Georgia hospital agreed not to give her any painkillers but insisted that her hands be tied down during the delivery. It was her first child.

"They had this thing for the sterile field," said Ann. Back then, hospitals treated childbirth like it was a surgery, insisting on a highly clinical protocol.

By the time she was ready to give birth to her second son three years later, Ann had moved to the Triangle, where hospitals were more liberal. Encouraged by a woman who taught her a refresher class on coping with labor, Ann also became a childbirth educator.

Since then she has witnessed more than 50 births, first while teaching in a private practice and now while working at Wake Med. Students sometimes ask her to be their coach. Occasionally, when she's at the hospital, she checks on women she knows and ends up staying to help.

About four years ago, she learned from an article in a childbirth magazine that there was a name for women like her: doulas, an ancient Greek word for slave, meant to conjure the image of female servants who assisted women. "We didn't know what to call ourselves,'' said Ann, who taught elementary school before becoming a mother. They weren't midwives, who have extensive medical training. "We just went in and helped.''

Ann found a nonprofit group in Seattle that certified doulas. She traveled to Atlanta for training, did the required reading and served as an apprentice. Now she is preparing to teach others. In November, she hosted a three day session at Wake Med that attracted 50 women from as far away as Florida.

In her new role, Ann attends one birth a month and usually charges a one-time fee of $250 for her services, though she didn't charge Meg, a family friend.

She asks that couples inform their doctors that she'll be

helping, and she guarantees she'll be there. She recently missed celebrating her 25th wedding anniversary for a birth. She was helping another mother on Christmas Eve.

But that's the nature of labor. It happens when it happens.

"I like to consider it work instead of pain," Ann said. "Nothing in life comes easy. "


Some two hours after arriving at Wake Med, Meg decided she needed relief from the pain. Her cervix had dilated to only 4 centimeters. She knew she wouldn't start the second phase of labor, the pushing, until she reached 10 centimeters.

Dr. Burt Harden, Meg's obstetrician, asked her to lie on her side and curl her back. He gave her a spinal injection, an epidural, to numb her body from the waist down.

In minutes, the birthing room turned calm. Lights were dimmed. Meg lay peacefully on her back.

An electronic fetal monitor attached to Meg's stomach broadcast her baby's galloping heartbeat. Laura Griggs, a labor and delivery nurse, watched a computer monitor to track the pace of Meg's contractions and the baby's heartbeat.

Ann rubbed an acupressure point on Meg's foot, telling her it was normal for the baby's heart beat to change slightly after an epidural. Everything looked fine.

Meg teased David about his hunch that the baby was a girl. She was sure it would be a brother to Parker, their 7-year-old son. David leaned over the hospital bed and kissed her.

Ann gently touched Meg's bent legs and told her to relax and try to sleep.

Meg thanked her. "I'm glad you're here," she said.


Whether the presence of doulas in maternity wards is a fad or an enduring trend is not yet clear.

If they survive, the credit will go to Penny Simkin.

Like Ann Tumblin, Simkin is a veteran childbirth educator who for years volunteered at her students' labors in Seattle, where she lives. She is mother to this movement.

During the 1980s, she paid close attention to a series of studies by pediatricians Marshall Klaus and John Kennel. While studying breast- feeding, they learned that women in labor appreciated having a sympathetic female observer with them in delivery rooms.

In subsequent studies involving hundreds of women in Houston and Cleveland, they found that trained labor assistants gave more than comfort. Mothers with trained assistants needed less pain medication, had fewer cesarean sections and had fewer forceps-assisted births than women who didn't. The Houston study looked at 600 women. It showed that 8 percent of mothers with doulas needed caesareans, compared to 18 percent for women who labored alone. Also, 8 percent of women with doulas needed epidurals, compared to 55 percent among women who didn't use


It was Klaus and Kennel who came up with the term doulas. They, along with Klaus' psychotherapist wife, Phyllis, in a recent book titled "Bonding," recommend that all women in labor have them.

The physicians' findings reinforced Simkin's belief that what she and other volunteers were doing was important enough to expand.

"It was then that a lot of us got busy," Simkin said.

In 1992 she founded the nonprofit Doulas of North America and developed a training program.

The group now numbers 1,300 members with 100 certified doulas, including four in North Carolina. About 500 women have written for applications. The group has scheduled more than two dozen training sessions across the country this year.

Training takes as long as two years, and involves reading a series of recommended books, training in childbirth education or midwifery, a 14- hour labor support training course and favorable reviews from laboring women and their nurses, physicians or midwives.

These newcomers to maternity wards are gaining acceptance but are not yet as common as fathers or other family members. Four county health departments in Washington state will provide doulas to poor women who receive prenatal care at their clinics, Simkin said. But insurors don't automatically subsidize their services and not all hospitals or midwives welcome them.

Several things could change that, Simkin said.

Women today often can't turn to their own mothers for the support doulas can offer. As late as the 1970s, some American women were highly medicated during their deliveries and many don't remember much of childbirth.

These mothers can offer tremendous emotional support, Simkin said, but can only offer so much practical advice.

Also, working couples don't have the time to take lengthy childbirth education classes, so they often aren't as prepared as they could be, Simkin said. Sometimes too much is expected from husbands during labor as a result.

"Not every partner is equally committed," Simkin said.


By 9 p.m., Meg was fully dilated. Suddenly, she felt an immense pressure on her back, despite the painkiller. Her baby was moving, edging its way down the birth canal. The feeling frightened her.

Meg cried out, reaching for both Ann and David, who stood on either side of her bed. They squeezed her hands.

"You want to go with that pressure,'' Ann said. "Breathe, don't push, just blow it out." They breathed loudly together.

The baby was moving fast, too fast. Griggs, the nurse, rushed to a phone to summon Harden, who was out of the room. She told Meg to close her legs until the doctor arrived. Ann breathed

with her.

"Is the baby breathing?," Meg demanded. "Is it all right? Is the baby all right?"

Once the doctor walked in, Ann and David held Meg's back as she sat, ready to push. Ann told Meg to put her chin to her chest.

But the baby was coming without the mother's help. She wasn't pushing.

In minutes, a dark scalp was visible between Meg's legs. Then a head. In no time, a 7-pound, 2-ounce boy slipped out, a little bit gray and a lot wet.

Harden placed the wiggling baby on Meg's chest.

Smiling, David carefully cut Forrest McDaniel Shouse's umbilical cord. Meg cried, her bocly rocking with sobs, happy and sad. Ann reached for a camera.

"It's a boy. I told you it was a boy," Meg said, suddenly laughing. "He's so cute. Oh. He's so cute." End Text ****************************************

Art: 3 c; photos; 3 photos
Cutline: Tumblin gives a foot massage. Ann Tumblin and David Shouse help
Meg Shouse focus during a painful labor contraction. At right,
doulas Ann Tumblin comforts Meg Shouse moments before her son is
Credit: Staff Photos By Gary Allen
Date: 19960202
Yearmonth: 9602
Length: 55
Slug: doulas202
Access: 1996032063