Thank you for this article raising awareness of the importance of doulas and the wonderful program from Open Arms (Herald, July 9).

I read this article over and over again, as I am myself a doula, childbirth educator, and provide lactation support. I'd like to add a little bit more.

As the article alludes, there are two types of doulas, birth doulas and postpartum doulas. A birth doula visits with a pregnant woman, sometimes offering massage, and learns what the mother hopes for in her birth. Does she want to take full advantage of the medical pain relief available to her at a hospital? Does she want to avoid the drugs? Does she plan to birth at an out of hospital birth center with a midwife, or at home?

The doula is on call, along with the midwife or doctor, until the mother goes into labor. The doula is often the first person to attend the laboring mother. If mom is intending to birth outside of her home, the doula normally goes to her home in early-to-mid labor, to support the family and help ease the challenges of this part of labor. She also helps the family pack last minute items to take, and helps them decide when to call in the midwife or leave for the birthplace.

Doulas do laundry, cook meals, massage moms (and partners), help mom in and out of the tub or shower, go for walks with mom, remember the little details like drying off her legs, changing the CD in the player, offering her a drink, putting food in her mouth, keeping her hair out of her eyes and putting on her lip balm. These small but important details may seem trivial, but they emphasize that the laboring woman is not in any way suffering from a disease. She is a normal person undergoing a physically daunting event.

When the family moves on to their birthplace, the doula goes along, helping ease the transition into the bright lights of the hospital or the excitement of the birth center. She helps the mom stay calm and find her center once she has transferred, and continues offering massage, helping mom stay upright and active, suggesting non-drug pain management techniques such as relaxation and visualization, and helping the mom (and partner) ask questions of the birth team. If anesthesia is wanted, the doula may help mom stay in the proper position for the insertion of the catheter. The doula is totally hands on! During the pushing stage the doula is often holding one of mom's legs or helping mom stand or squat. Doulas help remember the little details throughout the birth.

In contrast, a post-partum doula serves in the capacity of an old-fashioned baby nurse, comforting baby at night and bringing baby to mom for night breastfeeding, helping parents become comfortable with bathing, cord care, and diaper change, supporting breastfeeding, providing meals, doing laundry, baking cookies, and generally acting as a grandma but who may stay up all night and has detailed knowledge of breastfeeding.

I take exception to the comment, "But a mid-wife or a doula can't perform a Caesarean Section in the event of fetal distress, or save a mother from a post-partum hemorrhage." This comment is not relevant to the article. Midwives have a far lower rate of cesarean birth outcomes than do their obstetric colleagues. Midwives are professionals trained in and dedicated to normal birth outcomes, that is, vaginal birth, normally without medication.

In the rare, unlikely situation that baby is not responding well and needs assistance, midwives in out of hospital settings are extremely conservative. Laboring moms are transferred to the hospital at the earliest sign of challenge to the baby and no risks are taken. Midwives do not perform cesarean surgeries, but they are trained to recognize risks and take steps to avoid them. In the case of post-partum hemorrhage, midwives know that the first step is to get the baby breastfeeding, the second step is to vigorously massage the uterus, and the third step is to get rapid emergency transport to an appropriate hospital for Pitocin and other treatment. Some midwives do have Pitocin with them. Midwives all have oxygen tanks on hand along with an enormous assortment of medical gear, as well as alternative remedies such as homeopathics, herbs, and even acupuncture.

No doula would ever be expected to perform surgery.

Every laboring and new mother deserves a doula, and I applaud this initiative to provide doula services to the White Center Community. Thank you for providing more information about the program.

Betsy Hoffmeister

West Seattle