"Doula comes from the Greek word which means a female servant," said Caroline Fea, owner of Cup of Tea Birth Doulas in Danville. "We've taken it in modern times to mean someone who supports a woman in labor and childbirth.
"I really believe that every childbirth, every pregnancy is unique and that experience has to be lived through positively. It's frightening -- the pain, the unknown. New parenthood can be very bewildering."
A British expatriate and former lawyer, Fea established Cup of Tea with her friend Alison Wong, another expat, with the goal of providing support and information to moms in a changing world. While doulas do not assist in the birthing process, they collaborate with doctors and nurses to advocate for the mother's desires.
"You're mothering the mother. You're really helping a family have the best birth they can have by making sure they have all the information," Fea said. "We see ourselves as facilitators. Anything that can bridge a gap between how a mother wants the birth to be and the final result, which isn't easy to express in the moment."
Livermore resident Crystal Langen had her second child at home in March 2012 after a negative experience at a local hospital where she fractured her tailbone during delivery. She met Stacy Hattori of Tri Valley Doula at a local breastfeeding group and decided a doula would be an excellent addition to her birthing team.
"Had I had a doula with my first hospital experience, I think my birth would have been completely different," Langen said, adding that labor was induced although she was already physically in labor. "I tried to question but didn't really know what to ask or how to ask it and I think a doula knows that language."
A doula will typically meet with a client several times to discuss a birth plan, ideas on pain relief and general concerns around pregnancy. For Fea and Hattori, the ultimate goal is to get to know the mothers and their partners to establish a connection that will facilitate better communication.
"I think in general there are a lot of ladies that are afraid of childbirth. When there's fear involved there's usually more pain and their bodies don't go into labor as naturally as it could, because fear kind of holds our bodies back a bit,"said Hattori, who has helped over 150 women. "By helping ladies address a little what their fears are ... a doula helps them safely figure out an appropriate means to take care of that."
Hattori operates a private doula practice and is also part of a circle, where several doulas will share the responsibility of caring for an expectant mother and being on call. Like many other doulas, Hattori said she is not anti-hospital but sees herself as glue to the birthing team.
"A lot of times women get nervous talking to doctors or nurses. There's a respect piece that the doctor is going to keep me safe and keep my baby safe so I've got to do everything they suggest," Hattori said. "Doctors are more than willing to do the things they want ... but don't necessarily have that much of an opportunity to get to know their clients at that level. They can't spend an hour or two hours with a certain woman getting to know her."
Langen said she could have benefited from a doula's undivided attention before and after the birth of her first child. Langen's fractured tailbone made breastfeeding uncomfortable and awkward, but she missed the hospital's lactation consultant. Cup of Tea doulas provide breastfeeding support while Hattori is a member of La Leche League in Livermore.
Private doulas and groups throughout the area also offer postpartum support services, which can range from general encouragement to advice and help with baby care, nutrition and healing. Between 10 and 15% of women experience postpartum depression (PPD) according to the Centers for Disease Control; that number increases to 41% among women who have already experienced PPD during a previous pregnancy.
"Our women are expected to be back doing their normal life after six weeks and it's so challenging because our hormones are going crazy. Often depression doesn't set in until babies are 6 months old," Hattori said. "Mamas that are postpartum depressed or anxiety ridden or have the baby blues, they don't bond with their babies as well. It affects the breastfeeding experience and every relationship they have with everyone that lives at home."
A woman could then talk to her postpartum doula and receive support or information on support resources. Because many area families live away from relatives, they lack essential postpartum support and comfort -- both physically and emotionally -- a mother or sister might be able to provide. Also, pressures to work, parent and be a good spouse put additional stress on new parents.
"Mothers have difficulty advocating for themselves ... and people think that they can't ask for help," Fea, a mother of four, said. "We all have this idea that we need to be the perfect parent, and the longer I'm a parent, I realize there's no such thing. Everyone pushes themselves, women in particular, but we can all help each other. It is such a relief to have that support."
Fea's ultimate doula goal and philosophy boils down to trust, both in the doula and in the mother's inherent skills. Moms are always questioning and self-doubting, especially when it comes to what other people are doing, but they should instead trust their instincts.
"Only you know your body, your child, your partner. When it comes to mothering, you have to hear that, you have to listen to that voice," Fea said.
Hattori, who has two children and has been in practice for 13 years, said she feels honored to help families start off on the right foot.
"Once a woman is an a safe environment and is surrounded by people that truly support her ... (birth) shouldn't be traumatic. It should be an experience women look forward to," she said.