Doula Support Services
Los Angeles Doula Collective
Birth Doula Support, Monitrice Support (Enhanced Labor Support), and Postpartum Doula Support
Services offered on a sliding scale fee rate, because every woman deserves labor support!
Nurturing the whole woman in body, mind and spirit.
[O]ne of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”
—“Safe Prevention of the Primary Cesarean Delivery,” Consensus Statement issued by the American Collegeof Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, February 2014
FOR MORE INFORMATION, SUBMIT: Birth form
ABOUT OUR SERVICES
Our Los Angeles Doulas are hand-picked by our director for their passion for supporting mothers, cultural sensitivity and dedication to service. Our Labor Doulas and Monitrices empower you with the confidence to give birth naturally and normally in the hospital, birth center or at home. We work with families of diverse ethnic, religious, socioeconomic and cultural backgrounds. Our service is unique in that we offer “name your own price” doula support. Our commitment is that every family who wants a doula will be able to have one. Therefore, we work on a sliding scale basis, from pro bono births for those with no ability to pay, to a full fee.
- Labor Doula Support
- Perinatal Support Specialists
- Monitrice Enhanced Labor Support by Licensed Midwives, Nurse-Midwives and Registered Nurses or Student Midwives
- Postpartum Doula Support
PAYING FOR DOULA SERVICES
We are committed that every woman who wants a Doula shall have one, regardless of her financial situation. This means we work on a sliding scale. Families can also make an extra donation to offset the cost of providing labor support to a family in need of doula services. Donations may be tax-deductible as we are a 501 c (3) non-profit organization.
FREQUENTLY ASKED QUESTIONS
What is a Doula?
In all cultures, from the dawn of time to the present, women have been assisted by other women during childbirth. Birth art and artifacts from around the world depict the laboring mother supported in an upright position (standing, hanging, kneeling or squatting) with a helper behind her and a woman at her feet. This points towards a human way of birth, and has been called “the classic pose.”The person at the woman’s feet was The Midwife, who caught the baby as s/he emerged from his/her mother’s body.The person standing behind or beside the mother was the midwife’s and the mother’s helper–an auntie, a sister, a grandmother, or a neighbor.
She is now known as a Doula, Professional Labor Companion, Perinatal Support Specialist, Labor Assistant or Monitrice.A Doula (pronounced “Doo-lah”), is Greek word meaning “woman servant”, she is a companion to a woman during labor and birth providing emotional support, physical comfort, education and advocacy. There are many names for these special women: “Doula”, “Childbirth Assistant”,”Labor Assistant”, “Labor Companion”, “Birth Partner”, “Birth Sister” or “Monitrice”. By any name, she is invaluable to the birthing woman.The Labor Assistant/Doula works collaboratively with the woman’s birth partner and her medical team to help her reach her birthing goals. The Doula’s presence helps to make childbirth the beautiful experience it is supposed to be.
What Do Birth Doulas Do?
The Birth Doula serves women during labor and birth, providing physical comfort, help with coping methods such as relaxation, breathing, massage, position changes and emotional support; she is an advocate for the laboring woman, helping to communicate her needs and desires to the hospital staff and help the woman achieve her birthing goals. Birth Doulas are also a support to the woman’s partner/father of the baby as well, giving him a needed break to eat or rest, reassuring him that labor is proceeding normally and advising him of ways to help the woman cope with labor. Birth Doulas know when to leave the couple alone, respecting their privacy. When labor presents challenges as it often does, the Birth Doula can help the couple understand their options and make an informed decision.
What Are the Differences Between Doulas and Midwives?
The Midwife is a skilled birth professional who is responsible for the safety of mother and fetus and as such, has extensive training and education. She may be licensed by the state where she practices and regulated by a professional certifying organization. Midwives provide prenatal care, labor management, postpartum care of mother and newborn and family planning services. She may also offer some labor support, but her primary role is to ensure the safe passage of woman and baby. She works in collaboration with Physicians to provide optimal care for women and infants.
The Birth Doula on the other hand, is not a licensed medical provider. She is a member of the birth team who provides emotional support, physical comfort during labor and may advocate on behalf of her clients. A Birth Doula does not make medical decisions or provide physical assessment of mother and fetus. Doula training and certification is attendance at a 3 day workshop, a certification exam and attending between 3 and 6 births.
What Are the Differences between Birth Doulas, Perinatal Support Specialists and Monitrices?
The Birth Doula, is a trained professional who provides emotional support, physical comfort and advocacy for women during labor and the immediate postpartum period. She is skilled in breathing techniques, positions to facilitate an easier delivery, and other comfort measures. She helps families make informed decisions during childbirth and immediately postpartum and may help with breastfeeding. She works collaboratively with the woman’s primary care provider but does not make medical decisions or perform any clinical skills.
Perinatal Support Specialists have a broader focus than birth doulas. They begin working with women during pregnancy and often share a cultural identity and language with the women they serve and have been trained in cultural awareness and social determinants of health. They are working as community health promoters to address perinatal health inequities and disparities among specific groups of pregnant women who are at risk for poor birth outcomes. By providing more intensive and a longer period of support they help mitigate the impact of social stressors such as poverty, racism, or lack of family involvement. They are also trained in labor support methods, childbirth education and breastfeeding counseling. Groups they may work with are teen mothers, incarcerated women, or a specific religious or ethnic community.
The Monitrice Provides Enhanced Labor Support. A Monitrice is an advanced labor assistant who provides skilled, clinical care during pregnancy, labor and/or postpartum.These services are provided by a Student Midwife, Licensed Midwife, Nurse-Midwife, or Registered Nurse with labor and delivery experience. Monitrices provide emotional support, physical comfort and advocacy just as a doula does, but utilize clinical skills. This allows the mother remain at home longer, thus avoiding unnecessary medical interventions which often occur when women go to the hospital too soon. The Monitrice also provides in-home postpartum.
Registered Nurses with experience in maternity care nursing and lactation consulting may also provide support to pregnant women having high-risk pregnancies and are on bed rest. The RN/Monitrice can provide fetal monitoring and check vital signs at home, working in collaboration with the woman’s perinatologist.
In this capacity, The Monitrice is not acting as the woman’s primary care provider. Instead, she works collaboratively with the pregnant woman and her primary care provider to help her achieve her birthing goals by providing clinical expertise and skilled labor assistance. She does not make any medical decisions and encourages the woman to follow the instructions of her primary care provider.
A Monitrice offers skilled support during pregnancy, labor and postpartum in the following ways:
- During pregnancy, provides fetal assessment and monitoring of the mother’s vital signs ( if she’s on bed rest), working in collaboration with the woman’s obstetrician or perinatologist.
- During labor, monitoring the woman’s vital signs (blood pressure, temperature and pulse, etc.)
- During labor, checking the laboring woman’s cervical dilation (opening of the mothers cervix) and assessing the baby’s descent.; helping the mother to remain at home longer before going to the hospital.
- Listening to baby’s heartbeat during labor to ensure that he/she is tolerating labor well.
- After the birth, she will make home visits to assess mother and baby: providing physical examination of the newborn, weighing and measuring the baby, monitoring mother’s postpartum recovery, giving breastfeeding instruction and emotional support.
BENEFITS OF LABOR SUPPORT
With a Monitrice or Birth Doula present during labor, the woman and her family can relax. She will assure them that everything is okay.
Fathers and other family members may feel uneasy at home while the mother is in labor, as labor can be quite intense for some women. Because of this, expectant parents may go to the hospital too soon. For many mothers, the early part of labor can take many hours. During this time, mothers are usually more relaxed in their own homes where they can eat and drink, walk, rest and wait for active labor. A calm environment helps labor progress. The Monitrice helps create an atmosphere of trust and tranquility, and helps boost the mother’s confidence and puts the father and/or other family members at ease.
Going to the hospital in early labor can lead to unnecessary medical procedures such as cesarean section surgery. There may be strict time limits for labor progress, restrictions on the mother’s movement, and eating or drinking in labor may not be allowed. The presence of a professional labor companion can help the woman cope with these obstacles. These restrictions of movement and imposed time limits can either slow labor down, make labor more painful and harder for the woman to tolerate, and increase the possibility of receiving pitocin to make labor stronger and go faster (“augmentation”). This can make labor more painful for the mother. As time passes, and labor becomes more intense, the woman may want pain medication. While that is always an option, there are side-effects on labor, woman and baby. The Monitrice can offer education, helping the woman and her partner make informed choices.
Furthermore, Doulas are trained to recognize danger signs. If anything is abnormal during labor or postpartum, she can help the family access medical help in a timely manner. She can also help communicate with the woman’s doctor, and will work collaboratively as part of the birth team.
Several studies have shown that women who are attended by Doulas have:
- Shorter Labors
- Less Pain Medication
- Fewer Medical Procedures
- Decreased Rates of Cesarean Sections
- Decreased Augmentation of Labor with Oxytocin
- Increased Satisfaction with their Birth Experience
- Better Infant-Mother Interaction
- Increased Breastfeeding Success
- Decreased Postpartum Depression
* From the studies by Kennell and Klaus
Childbirth Connection’s Cochrane Review of studies on continuous labor support* (2003, 2007) summarized outcomes reported in at least 4 studies involving at least 1,000 women. Women who received continuous support were less likely than women who did not to:
- Have regional analgesia
- Have any analgesia/anesthesia
- Give birth with vacuum extraction or forceps
- Give birth by cesarean
- Report dissatisfaction or a negative rating of their experience.
*Research by Kennel and Klaus of Continuous Labor Support
“Outcomes include, but are not limited to, lower rates of analgesia and anesthesia use, lower operative birth [cesarean section] rates, shorter labors, fewer newborns with 5-minute Apgar scores less than 7, increased maternal satisfaction with the birthing process, and much more.” (from the abstract of Journal of Obstetric, Gynecologic, & Neonatal Nursing, Volume 31 Issue 6, Pages 733 – 741. Published Online: 9 Mar 2006).
American College of Obstetricians and Gynecologists (ACOG) Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery but acknowledges that this approach is under-utilized.Read more at: ACOG’s website (from “Safe Prevention of the Primary Cesarean” Obstetric Care Concensus, American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine, Aaron B. Caughey, MD, PhD; Alison G. Cahill, MD, MSCI; Jeanne-Marie Guise, MD, MPH; and Dwight J. Rouse, MD, MSPH, March 2014).
Results from the Listening to Mothers Survey II (2006) conducted by Childbirth Connection of 1573 mothers who gave birth in 2005 revealed that technological birth is the norm in the U.S.
The executive summary of the report states,”despite the primarily healthy population and the fact that birth is not intrinsically pathologic, technology-intensive childbirth care was the norm. Each of the following interventions was experienced by most mothers: continuous electronic fetal monitoring, one or more vaginal exams, intravenous drip, epidural or spinal analgesia and urine catheter. Half the mothers experienced one or more methods of inducing labor…and a notable minority experienced each of the following: labor that was induced with synthetic oxytocin (pitocin) during labor, artificial rupture of membranes, narcotics, cesarean section (32%), episiotomy, perineal stitches, staff directed pushing and staff member pushing on mother’s belly to help push baby out. Only 11% had Vaginal Birth After Cesarean.” One quarter of the women surveyed said they felt “weak” and “overwhelmed” and used other negative words to describe their feelings about their births.
With few exceptions, the report states, “the forms of care appropriate to low-risk women were not used”. These include use of the birth ball, immersion in a watertub or shower, monitoring baby with hand held devise, eating, drinking, ambulating and laboring in an upright positions and self-directed pushing.
Childbirth Connection states only “a very tiny minority (2%) experienced all of the care practices that promote natural birth.”
Such care practices are endorsed by Lamaze International and the Coalition for Improving Maternity Services (CIMS), which developed the Mother Friendly Childbirth Initiative, 10 evidence-based steps to improve maternity care.
Lamaze’s “Six Care Practices That Support Normal Birth” represent “evidence-based care which is the gold standard for maternity care worldwide. Evidence-based care means using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making.” (Lamaze, 2009). The practices are:
1. Labor begins on its own.
2. Freedom of movement throughout labor.
3. Continuous labor support.
4. No routine interventions.
5. Spontaneous pushing in upright or gravity-neutral positions.
6. No separation of mother and baby after birth with unlimited opportunities for breastfeeding.
The Coalition for Improving Maternity Services (CIMS), “a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families” developed The Mother-Friendly Childbirth Initiative (MFCI) and “The Ten Steps to Mother-Friendly Care” which are evidence-based recommendations for maternity and newborn care (CIMS, 2009). The evidence for the recommendations were published in the peer-reviewed Journal of Perinatal Education (2007). To download the document: click here
This snapshot of birth in America sounds grim indeed, but the presence of a Monitrice or Doula can help mitigate these interventions.
If you want natural childbirth and are planning a hospital birth, you need a skilled professional who can do more for you than hold your hand and wipe your brow. You need a strong advocate to help negotiate with the hospital staff and help facilitate the normal process of labor, birth, breastfeeding and mother-infant bonding.
POSTPARTUM DOULA SUPPORT
Meet our Postpartum Doulas
What is a Postpartum Doula?
Mothering the mother, Postpartum Doulas provide knowledgeable, nurturing care for the postpartum woman and her newborn. They may be RNs, LVNs with maternity and newborn nursery experience and certification as a Postpartum Doula. Alternately, they may not be a nurse, but who has received special training in the care of postpartum women and newborns. Postpartum Doulas may instruct on baby care and breastfeeding, cook nutritious meals and run light errands.
Studies by Kennel and Klaus showed that Doula Support improved breastfeeding success, decreased postpartum depression, increased maternal satisfaction and promoted better mother-infant interaction (from: Mothering the Mother, by MH Klaus, JH Kennell and PH Klaus, Addison- Wesley Publishing Company, 1993).
Postpartum Doulas nurture new mothers and newborn children with tender loving care. “Mothering the Mother” allows the new mom to focus on recovering from childbirth and nurturing her baby. Postpartum Doulas help new dads too! Fathers can enjoy their newborn knowing that meals are being prepared and their newborn baby and his/her mother are in good hands while they’re at work.
- Breastfeeding Consultation and Instruction
- Grocery Shopping & Errands
- Meal Preparation
- Herbology & Homeopathy
- Baby-Friendly Approach in Hospital
- Kangaroo Mother Care
- Baby Laundry
- Physical Care of Mother and Newborn
- Newborn Assessment
- Emotional Support for New Moms (and Dads too!)
- Referrals to complimentary services (massage, acupuncture, chiropractic, herbal medicine, natropathic practitioners, etc.)
- Full Day, Half Day, Overnight, Weekly Rates
- Makes a Great Baby Shower Gift for the New Family!
Labor Support Services are offered on a sliding scale, please call us to determine the price. Those on Medi-Cal may receive free/reduced cost services. Contact us for details. Your donation may be tax deductible, check with your tax professional.
We have two options for Labor Support Services:
Option A: Labor Support Only, includes prenatal, labor, and postpartum support (sliding scale; fee to be determined);
Option B: Labor Support + 6 hours of private childbirth education classes (add $300.00 to labor support fee).
Pay By Check
Make checks payable to The Association for Wholistic Maternal and Newborn Health (AWMNH).
Send checks to:
Cordelia Hanna, MPH
The Association for Wholistic Maternal and Newborn Health
Los Angeles, CA 90050-0630
As labor support services fees are sliding scale, please enter the amount agreed upon in the box below. Then click on the “BUY NOW” button. You will be taken to Paypal’s secure site, where you can pay using your Paypal account (if you do not have a Paypal account you can set one up in minutes), or you can pay using your debit or credit card.
|Labor Support Services|
PAY FOR POSTPARTUM DOULA SUPPORT
We have half day, full day, weekly, and overnight rates. Please use the pull down menu below to select your choice:, then select “ADD TO CART” button. You will be taken to Paypal’s secure site, where you can pay using your Paypal account (if you do not have a Paypal account you can set one up in minutes), or you can pay using your debit or credit card.
|PAY FOR CLASSES AND SERVICES|
ABOUT THE COORDINATOR OF OUR LABOR SUPPORT SERVICES
Cordelia Hanna, MPH, CHES, ICCE, CLE, CBA
Is a Certified Childbirth Educator (ICEA), Certified Birth Assistant (ALACE), Certified Lactation Educator (CAPPA), Postpartum Doula and Assistant Midwife. She has taught hundreds of couples and attended births as an Assistant Midwife and Doula/Monitrice in hospitals, homes and birth centers throughout Los Angeles County since 1991. She has a Masters in Public Health (MPH) in Health Education and Promotion/Maternal Child Health from Loma Linda University. She is a Certified Health Education Specialist (CHES) accredited by NCHEC, the gold standard for professional health educators. She has extensive experience working in the public health arena in Los Angeles as a Perinatal and Women’s Health Education Consultant, Trainer and Workshop Leader. Cordelia is married and the mother of two home-born, family bedded, breastfed children, who are now capable and bright young adults. Learn more about Cordelia
If you are a L.A. doula, and would like to join our team of labor support professionals, please contact us for details.
Valuable Resources about Doulas:
- International Birth and Wellness Project
- Doula Association of Southern California
- Doulas of North America