Doulas aid young mothers
When Tracy Wilhoite was 16 she gave birth to
the first of eight children. The young woman’s life changed
completely—even more than most mothers—because of the
emotional and social challenges unique to being a teenager. “I
felt undervalued and underrespected,” Wilhoite says 21 years
later. “That’s something I seek never to do to the mothers
I work with. I teach them to gain respect.”
Wilhoite is one of three doulas working with
poor, unmarried, pregnant adolescents at the University of Chicago
Hospitals as part of the Chicago Doula Project. A doula is usually
a woman, someone other than a friend or family member, who provides
comfort, companionship, and emotional support during labor and delivery.
Rather than replacing medical staff such as nurses, doctors, or
midwives, doulas tend to the mother at home, often for hours before
delivery. Once at the hospital they care for her mental well-being
while the medical personnel see to her physical needs.
Doulas have become popular in recent years as
word of their benefits spreads. Research shows that doula-supported
labors are quicker, with mothers less likely to have pain medications,
forceps deliveries, and caesarean sections. Women assisted by doulas
feel better about their labor and childbirth, suffer less anxiety,
have a greater sense of control, and are less likely to experience
postpartum depression. They are also more likely to breastfeed.
Data even suggest that mothers who have a doula may bond with their
newborns faster, stroking, smiling, and talking to them more.
“There’s no question that having
a doula improves birth outcomes,” says Sydney Hans, associate
professor of psychiatry. Yet, she points out, the women who employ
doulas tend overwhelmingly to be white and affluent. The question
is, what kind of impact could a doula have on more fragile mothers
and their relationships with their infants?
Hans is leading a study in which Wilhoite and
the other University of Chicago doulas extend their interaction
with pregnant teenagers beyond the typical home-labor-and-delivery
routine. They attend prenatal appointments during the young women’s
last trimesters, continuing to see them and their babies three months
Hans’s research team, meanwhile, interviews
the mothers about their birth experiences and videotapes them interacting
with their babies, tracking the pairs until the children turn two.
The study, funded by the U.S. Bureau of Maternal and Child Health,
began in 2000, and so far 216 Chicago teens have agreed to use doulas.
It’s a random study, so not all participants receive a doula;
the half who don’t are also followed (they receive the normal
pre- and postnatal care offered by the Hospitals). The study will
continue through 32 more pregnant teens.
The study’s doulas were chosen not only
for their nurturing personalities but also because they mirror the
participants’ demographics: the doulas are all black mothers
who gave birth as teenagers; two remain single. During an intensive
four-month training program they learned about issues of normal
pregnancy, labor, and childbirth; pain-relief methods during birth;
breastfeeding; responsive parenting; and unique characteristics
of adolescent parents.
“I offer them compassion and respect,”
says Wilhoite. “I’m there to follow their orders. I
don’t shape their decisions. I teach them about their bodies,
about what to expect during the birth.” She helps the mothers
to embrace the idea of their unborn babies as actual people, holding
flashlights to their bellies or playing music and teaching them
to observe how the babies respond. During labor the doula offers
comfort: cold or warm compresses, a massage, ice chips. She helps
the mothers and newborns get the hang of breastfeeding and demonstrates
holding techniques. During the infant’s first months—as
in the third trimester—the doula suggests questions to ask
The early results are positive. “The mothers
overwhelmingly say that having a doula improved their experience
in the hospital and their experience of childbirth,” notes
Hans. In her 1998 pilot study the C-section rate was 6.45 percent,
compared to a national average of 15 percent for adolescent mothers.
Only 13 percent of the participants had epidural anesthesia during
delivery, compared to a national rate estimated at more than 50
percent. And more than half chose to breastfeed. Nationally, about
62 percent of American infants are breastfed, while only 26 percent
are breastfed through their sixth month.
The project has caught the attention of Illinois
state officials, who this fall agreed to fund two doulas’
salaries. In exchange the doulas spend about half their time in
the Chicago Public Schools’ Cradle to Classroom program. While
that program focuses on keeping teen mothers in school, the doulas
help them transition to motherhood—a shift that’s easiest,
Hans believes, “if we can start them out on the right foot”
with a positive labor and delivery experience.
At any given time the doulas’ caseloads
include six pregnant and six postpartum mothers, ranging in age
from 14 to 21. “Each mom is different,” says Wilhoite.
She tells of one 17-year-old high-school dropout who “was
so inquisitive. She read everything I gave her. In the delivery
room she said she didn’t want an epidural and was able to
say why.” Then there was a 14-year-old who was never home
for Wilhoite’s prenatal visits, who didn’t call her
when she went into labor or during her baby’s first three
months. Yet a year later that mother, a high-school freshman, appeared
in Wilhoite’s office and spent two-and-a-half hours talking
“The biggest challenge is establishing
that relationship and that trust,” says Wilhoite. “I
won’t measure my success on whether my mothers had a C-section
or an epidural. I judge it on whether I’m there in the delivery
room and on, watching them go from being clumsy and nervous to secure
and confident mothers.”—Sharla A. Stewart