Giving birth, getting support

Doula program provides coaching for moms-to-be in Cook County Jail
By Connie Lauerman-Tribune staff reporter

Agnes Perry was discussing child-birth with a 20-year-old pregnant woman whose close-cropped hair curled flat on her forehead.
“Exercising with that blue ball over there can make labor pain more bearable,” Perry, a nurse, told her.
Another woman, a 30-year-old veteran mother with long straight hair, nodded.
“The exercise ball was excellent for me,” she told the rookie. “I was able to sit on the ball and rock in slow motion as the contractions came.
“He was by biggest baby and I thought I’d need an epidural, but I didn’t need any (pain) medication.”
Her labor and delivery did not occur in a normal setting, nor will it for the 20-year-old. As a detainee awaiting trial in Cook County Jail, she will give birth under armed guard. Neither the baby’s father nor any other family members will be allowed in the labor and delivery rooms.
However, the expectant mom will be allowed to have another king of friend, a “Doula”, or a woman trained to provide continuous emotional and physical support and information before, during and immediately after childbirth.
It may be Perry or Shawn Withers, another nurse and doula, who also met with the two women in a classroom in one of the women’s divisions of the jail to discuss the younger woman’s birth plan.
The 30-year-old was there to provide some support and talk about her own experience with the program, which is sponsored by the Cook County Bureau of Health Services.
“You are allowed to decide what will happen during the labor,” Perry said. For an inmate or detainee giving birth, that may be as detailed as whether she wants to talk during labor, hold her baby immediately or have music playing during labor.
Other options include massage, breathing techniques, hydrotherapy, aromatherapy and exercises to take the focus off the pain.
“I had one mother who liked to color a Pooh coloring book,” Withers said.
The older mother, who gave birth to one child while in the jail, mentioned the difficulty of “not being able to have family at the hospital with us. To hold our hand, feed us ice chips, rub our back. It was hard for me at first, pushing. It was a seven-hour labor. I was saying, “I can’t do it.” (Withers) encouraged me. “You can,” she said. “You’ve gotta do it.” She never left my side.”
The Cook County doula program has transformed what once was an isolated, lonely birth experience for detainees to one that proponents say has a lasting positive impact on the physical and mental health of mother and baby and their relationship.

SUPPORT

Doulas on call for mothers behind bars

It is believed to be one of the first ones in correctional institutions. There is one in Washington State and another just starting in Tampa.
Perry, a nurse at John H. Stroger Jr. Hospital of Cook County, along with other full-time employees at the hospital, doubles as a doula. That means she is often on call and rousted out of bed in the night, to rush to the side of a woman in the jail who has gone into labor.
The program’s six doulas will not be strangers to the women. They will have met them all and worked one-on-one with some of them during the last months of their pregnancies.
As Perry said: The doulas “are all the same, the same kind of touch and nurturing.”

The roots of doulas

The roofs of doulas go back centuries. Nearly every culture has had women who assisted other women during childbirth. Doulas differ from midwives, who are responsible for the delivery. A doula is more of a birth coach who comforts and reassures the mother and advocates for her. But dould do not give medical advice or make decisions for the mother.
The coula program was started two years ago after those who provide health-care services to Cook County Jail detainees began seeing an increase in pregnant women staying in the facility throughout their pregnancy and delivery.
“The women mentioned the isolation that they experienced during child birth and the postpartum period,” said Martha Gottlieb, coordinator of maternal and infant services for the Cook County Bureau of Health Services. “The benefits of a doula are providing a good birth experience and then encouraging maternal-infant bonding.
“These are women who only have a 48-hour period with their baby after delivery and to maximize that we work with them during the postpartum period. After that the babies usually go to a family member but sometimes to foster care.”

Changing the birth experience

The doula program also changed the birth experience for jailed women in another way, said Gottlieb, who is also a doula.
“Part of what has been important to us is that the women be allowed to be up and moving around during labor. They used to be shackled (during active labor). They still will always have an officer outside their room, but now the officers are used to working with us. “Dr. Maureen Ruder, an obstetrician-gynecologist at Stroger, said she prefers that a woman have a family member or doula with her during labor and delivery.
“Most women who have someone supporting them are in better control with or without pain medication. A woman who has a support person separate from the medical provider usually isn’t so scared during labor and is more in control.”
Ruder said she has such positive regard for the doula program that she would like to see it expanded so that it is a part of obstetrical care for mothers who are alone but not in jail. “They could use some help, too,” she said.

Doulas benefit moms, babies

Doulas are becoming much more common in the United States. Jennifer Nunn, president of Doulas of North America, said the concept grew out of the childbirth education movement of the 1970s and 1980s.
“Women would attend classed and then they would ask the instructors if the would come and help them during the actual childbirth.
“Back then dads were getting into the delivery rooms and women were much more interested in being more participatory in the decision-making process during childbirth.”
Research studies have shown that doulas attended births reduce the number of Caesarean sections, Nunn said.
“Labors are shorter because with women have that support, they’re much more comfortable and they relax more so the natural processes take over. There is less medical intervention to augment labor,” she said.
DONA, which was founded in 1992, has 4,500 members, mainly in the U.S., and membership has been growing by about 15 percent a year, Nunn said.
More hospitals are adding doula programs and more women are seeking doulas on their own, she added.
Chicago Health Connection, based in the West Loop, organizes doula programs in neighborhoods in conjunction with community agencies. Women from the community, usually mothers themselves, are recruited and trained to be doulas.
“The program is relationship-based, which means the doulas establish a relationship as early as possible in the pregnancy and extend at least into the postpartum period and then hopefully in the context of long-term social support for the families,” said Rachel Abramson, executive director of the agency.
A professional evaluation of the pilot project (almost 300 births at three sites) showed that not only were rates of C-sections and the use of pain killers lower than average, but also that 80 percent of the mothers breast-fed their babies.
“We also saw different attachment behaviors,” Abramson said. “All the sites reported more holding of babies, more talking to babies. Mothers were more comfortable talking about their births.”
In short, she said, “There was a difference in the way parenting was unfolding.”