What is a doula? Cheryl Orengo shares the ancient roll of helping a mother through the birth process.

On October 24th, results from the first national survey of women's childbearing experiences were released. Nearly 1,600 women from across the United States participated in the Maternity Center Association conducted survey entitled "Listening to Mothers." All women had given birth within the previous 24 months of completing the survey and described their pregnancy, labor and birth, and postpartum experience. The highest rating for quality of supportive care during the birth process went to a little-known but growing resource: doula care. A doula is someone who provides continuous physical, emotional, and informational support to a new mother before, during, and just after childbirth. The doula's encouragement, reassurance, and practical knowledge of comfort measures and labor enhancing techniques can decrease pain and anxiety for the laboring mother. Although women helping women during labor is an ancient practice, this vital service disappeared when most births moved from home to hospital years ago. Childbirth is now more stressful than it was for the many women who gave birth in their homes. Fathers are expected to play an unfamiliar and challenging role in helping their partner bring their child into the world. Because most births continue to take place in hospitals and because mothers and fathers need support and guidance, the hospital setting is where doulas provide labor support most of the time.

A typical doula "package" will cost doula clients anywhere from $200-$800 across the U.S. Locally, most doulas charge around $300, but many will use a sliding fee scale according to client income. An average doula "package" consists of the following:

* One prenatal home visit lasting one to two hours

* Weekly phone calls or brief visits

* Other visits if necessary, including a medical visit with the client to her physician or midwife

* Continuous labor and birth attendance, including a minimum of one hour postpartum

* A follow-up home visit about one to two weeks after birth

The cost of the package may rise if the expecting family requires additional help either before or after the birth.

A doula should generally be contacted about two to four months prior to the woman's due date, although the doula may not be able to offer her services until about 1-2 months prior to birth because of her work with other clients. It is important to select a doula who has been properly trained to work as part of a woman's "birth team," which includes the expecting woman's medical caregivers and family. Doulas trained by a nationally recognized certification program have the best background for this role. Doula trainers with these organizations must be certified childbirth educators as well as certified doulas and have been professionally trained to teach women to become doulas. The doula training program is scrutinized by the trainer's member organization, and she must be recertified every few years through continuing education and evaluations by workshop participants. An expecting woman can locate a certified doula online at the following websites: Birthworks.org, DONA.org, the CAPPA WebsiteLabordoula.com, ICEA.org, and other nationally recognized doula websites.

Although there are several national organizations that provide membership opportunities as well as professional training for doulas, Doulas of North America (DONA), continues to be the premier doula organization worldwide. With over 4,000 members and 2,300 certified doulas, DONA sets the standards for professional doula membership. In many cities nationwide, there are local organizations providing professional membership opportunities similar to DONA. Membership in these organizations maintains the professionalism of local doulas and provides assistance for work towards certification, continuing education and client referrals.

The Doula Association of the Asheville, NC area is currently accepting members who wish to be part of a professional doula organization, which will work closely with area hospitals and medical caregivers. Local doula groups, independent doulas, and doula trainees are invited to join the association. All professional members (certified doulas) will be listed on the upcoming website. A brochure listing all members is being developed and the association will have a phone number, For more information or to join, please contact Cheryl Orengo at 828-250-5290 or [e-mail].

Cheryl Thomas Orengo, BS, ICCE, CD (DONA) is a certified childbirth educator, doula and doula trainer, with 25 years experience as a public health educator and 18 years experience as a childbirth educator. She coordinates BCHC Birth Companions, a volunteer doula program for spanish speaking women sponsored by the Buncombe County Health Center, in Asheville NC. She is also currently coordinating a task force to form the Doula Association of the Asheville Area and provides DONA certified doula trainings every September and March in the Asheville area. Contact Cheryl about doulas by calling: 828-250-5290 or by email at [e-mail]. Also, look at the DONA.com website for reference to the study mentioned in the first paragraph, to locate a doula and other doula links.