I met Mary Riley on a snowy morning in Kingston, during a quiet break in her round-the-clock profession of helping women and their families through the hoops of childbearing. Over a span of two decades she has assisted over a thousand births; even as we talked, the invisible helplines of cell phone and beeper linked her to two mothers in early labor. Parents, midwives, nurses, and doctors describe Riley as remarkably gifted, an angel, a great teacher. Her calling is to restore childbirth to an empowering rite-of-passage for the mother, and to deeply weave the new family's bond by modeling nurturance, patience, and respect.

Riley is a doula, a term borrowed from Greek meaning "female servant." If you've never heard of a doula, you're not alone. A doula is not a midwife, though their roles overlap somewhat. Both monitor a mother's and baby's well-being during pregnancy, birth, and postpartum. But midwives are trained medically to do clinical tests and interventions, and vary in the time they spend with a laboring mother. Doulas give continual one-on-one attention and don't intervene medically; in fact, they reduce the need for doing so. Randomized clinical studies have documented that a doula's help lowered the C-section rate by 50 percent, forceps deliveries by 40 percent, and requests for epidurals by 60 percent. Significant postpartum benefits included lower rates of maternal anxiety and depression and greater breastfeeding success.

Some of the Hudson Valley's certified doulas (CD) recently spoke with me about their profession (apologies to those who aren't quoted here!). Read on even if you aren't planning a baby anytime soon, because a doula's services make a fantastic gift.

A doula builds a relationship with her client (and partner or other relevant family members) as pregnancy progresses to understand the particular wishes of the woman and family for the birthing experience. Once labor begins, the doula stays with the mother at home, a birthing center, or a hospital (and helps her move among these as needed), offering physical and emotional support both to the mother and also as needed among other family or friends in attendance. A doula also visits the family after the birth to ease the transition to life with a newborn ("postpartum doulas" specialize in this).

When Deborah and John Schachter of Woodstock were expecting their first child, says Deborah, "almost everyone in this area said I must use a doula. I was a little skeptical. I thought, is this a Woodstock thing? I hadn't heard of a doula, and I didn't want to fall for the hype." But they took a childbirth class taught by Mary Riley, and John was impressed that "a friend who had used Mary said she couldn't imagine having a baby without her." So they hired her.

Deborah's uneventful pregnancy evolved into a five-day labor with complications (low amniotic fluid volume), which headed her down the path toward a C-section. "Mary explained the problems," John says, "and helped us understand what our options were. I could ask her opinion because of her experience." Deborah says "Mary helped me be confident that I could have a baby—me, not the doctor—and helped us discern what the doctors were saying, and have the confidence to wait a little on a decision and work with the natural process. I really think we might have had a C-section if she wasn't there." Not only did they avoid that, John says, "Mary made the experience the closest thing you're going to get to magic"—even with five days of labor.

A doula's forte during labor is drug-free and intervention-free support, using a host of strategies, to ease a laboring woman's pain and anxiety (but she also remains a faithful ally for a woman who needs or elects for medical assistance, acting as liaison to doctors and nurses). Riley especially encourages women to trust their animal instincts to discover how and when to move or to rest; to make sounds or be silent; to be open to others' attention or turn deeply inward. She has used animal imagery to help a woman work with her energy to keep the labor progressing, and encourages going outdoors to be in a natural setting during labor if possible, "to bring out that basic earth connection and the space to find out what she needs to do to have that baby." Or she might lie beside the woman for hours. "My job is to help create a safe environment so the laboring mother can go into deeper and deeper levels inside herself in order to do this," explains Riley. "It's very powerful stuff, and it's an individual journey for each mom and her partner."

Doula Liz Pickett joins a woman in labor at home to help her stay out of the hospital (if she wants the birth there) for as long as possible. "If you've never had a baby before, you may not understand that 'uncomfortable contractions' doesn't mean you're in active labor. But I'll know when it's time to head for the hospital." By contrast, "doctors often encourage a woman to come in right away. But once she's there, the medical management impedes the progress of labor. Then a doctor might make a diagnosis of 'failure to progress' [which can prompt C-section] based on the woman's perception of when she thinks her labor started."

At the hospital, a woman's doula is most attuned to her specific needs and can advocate for her in ways that might seem minor but can be a godsend to a woman in labor. Pickett describes a case when "a nurse wanted to get a 20-minute recording from a fetal monitor [which goes around the mother's belly with an elastic belt]. I was able to at least get the nurse to wait until a contraction was over." Another client was made to sit in a wheelchair when she arrived at the hospital. "She couldn't talk, but I could tell she really didn't want the chair moving during contractions. So I whispered into the orderly's ear, 'Can you please just stop until the contraction is over?' And he did." Pickett also devises a code word for "pain medication" with each client, because "it's a release and a coping mechanism for her to say she's in pain. We want her to be able to do that without the anesthesiologist coming down the hallway waving the epidural. I can help her change positions, get into the shower, or do other things until she says that code word and really means it."

A doula boosts a mother's—and everyone else's—confidence, faith, and patience with the natural process of childbirth. Often she advocates for a mother's wishes to hold off on medical interventions. "You don't just hand yourself over and become a victim [of medical interventions]," says Riley. "In any situation, as long as the baby and the mom are okay, you really have the right to take all the time in the world. There are some really good medical practitioners in this area, but certain things have to be offered because of insurance protocol or hospital protocol. So it's up to us as consumers to know how to navigate that."

It may sound like a doula and medical staff are at odds, but they often work extremely well together. Pam Rhoades, a labor and delivery nurse for 25 years and Director of Women's Services at Northern Dutchess Hospital in Rhinebeck (home of the Neugarten Family Birth Center), says a doula "takes a tremendous amount of stress off the nurses. When we have three or four labor patients, we don't have as much time to sit with each one like a doula can. And if there are medical issues and the clinical aspects kick in, a doula can say to the mother that we need to rearrange the priorities."

Dr. Dean Bloch, an OB/GYN at the Women's Care Center in Rhinebeck and Kingston, appreciates a doula's presence as a go-between who has the "trust of the patient and an existing relationship, so she can talk with the woman and her partner about clinical situations. If labor slows down, for example, the doula can help the patient understand the medical aspects without being threatening." If pushing the baby out has been going on more than two hours, "legal and medical standards require the doctor to discuss the risks and benefits [of continued pushing or C-section] at that point. I may not be able to connect to where the parents are at that moment, and it can take time for them to digest the situation." The doula helps them do that.

While many mothers have midwife-assisted births, Suzanne Berger (a midwife at the Women's Care Center) says "everyone deserves a midwife and a doula. There are many ways we act as a team for the birthing mother. I have found that women who had a lot of fear about birth, or had a previous birth that was far from their expectations, really needed the one-on-one attention that I could not always provide. And when a mother's mind goes into a place of fear, or they have a history of abuse, the doula can really help." Berger and Riley have worked together in VBAC (vaginal birth after Caesarian) deliveries, combining extra medical observation and deep personal support. "We had a woman who previously had two C-sections, but really felt she could push her next baby out. We allowed her to be up and moving around, and she pushed out a baby that was a pound bigger than  her others."

A doula does not supplant the birthing mother's partner or family members invited to participate, but actually helps them stay in the process. "Some first-time parents don't recognize the need for a doula because they expect others like doctors and nurses to step in," says doula Nancy McDaid, "or they expect the husband is really going to help. But many of them are shell-shocked." 

John Schachter, like many first-time fathers, says, "I was so naïve about what to expect. I thought we would take classes, I would be able to help her breathe, say 'push' at the right time—but I had no idea what an amazing, intense experience this would be. In reality, I didn't know how to help my wife facilitate the process of birth. I wouldn't have known how to propose positions, use massage, ask for different pillows, get in the shower—all the things the doula did were invaluable for Deborah in dealing with pain."

"A lot of pressure is put on a woman's partner," Riley concurs. "They go to a few weeks of childbirth class and now they're supposed to go into the most amazing and biggest event of their entire life and know how to care for her, say the right thing, advocate for her? They don't know what to do."

Doulas strive to create a positive, memorable connection among mother and partner (or friends or family) during the birth. She perceives how everyone is doing and will rescue a stymied relative by suggesting specific ways to help—where to touch, massage, hold. Riley very much encourages partners to be present. "The dads or partners gain a respect for what the mother can do, and it creates a tremendous bond that helps in the parenting role later. Often I'll have the partner catch the baby. I had a dad who just fell on his knees weeping with the power of that life force coming into his hands."

These efforts to facilitate a phenomenal shared event is another aspect of doulas that make them unique. Susanrachel Condon of River and Mountain Women's Health (with Susan Rannestad and Cari Naftali) enjoys that aspect immensely. "When you've done hundreds of births as we have, you're more invested in being there for the family than just being at the birth." She notes that "a lot of families in the area are staying home to have their kids." The trio provides midwife and/or doula services for completely at-home births or hospital births.

Postpartum doulas work their magic with the new families. Mavis Gewant typically visits a family for a few hours each day during the first few weeks after birth. "We find that many new mothers are nervous, so we give a lot of support. We listen nonjudgmentally and compassionately because, even with an ideal birth, women need to process the experience and talk about it." Gewant also offers lactation education, cares for the baby, does laundry, prepares meals, runs errands (or stays in so the partner can), plays with older children, and boosts confidence within the family.

The Hudson Valley has many doulas at your service. Several are listed below; and birthing centers, midwives, and doctors can help with referrals. Note that a doula might also call herself a birthing assistant or birthing guide; conversely, some women call themselves "doula" without being certificated. So ask about training, experience, references, and perspectives to understand what each can offer.