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Volume 96, Issue 2


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 after birth.

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 pediatrician.

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 about motherhood.

“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



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