Conscious Choice: Doula Rebirth

November 2004 | Cover Story

Doula Rebirth

The ancient system of women helping other women is an effective way to help inner city expectant mothers, especially those in Latino neighborhoods

by Belia Ortega

Rosalba Felix, 29, knows firsthand the challenges a teen mother faces. When she was 19 years old and working part time at Chuck E. Cheese, Felix became pregnant with her first child. Living in a tiny Cicero apartment with her boyfriend, she barely scraped by and certainly didn’t have the resources to provide for a baby. The cramped three-room apartment received very little light through its few windows, and the young couple couldn’t even fit a crib in any of the rooms. It was the most they could afford since Felix earned about $400 a month, and her boyfriend had equally small earnings.”It was frightening living on my own and being pregnant. I was lonely being away from my parents,” said Felix, recalling her teenage pregnancy. But then Felix was referred to a program at Alivio Medical Center in Little Village that provided her with a “doula,” or experienced birthing coach.

Although the doula system can trace its roots to ancient Greek times, it’s now being revisited as a very effective way to tend to the needs of modern urban mothers. Doulas are trained to give mothers support during labor and postpartum. Their role is to give physical and emotional support and to inform and emotionally assist mothers before, during and after labor. Unlike a midwife, a doula does not perform medical procedures.

Following the birth of her son, Christian, the nurses from the medical center asked Felix if she was interested in becoming a doula herself. She completed a training program at Chicago Health Connection, a non-profit health education and advocacy organization. Felix, who eventually married her boyfriend in 1995 and had a second child, Daisy, now works full-time as a doula at El Centro de Servicios La Villita, a health-care facility in Chicago’s Little Village community.

“Our clients are younger. Their parents were immigrants and many of the clients have been born here or were born in Mexico and brought here as children,” said Brenda Humber, director of midwifery services for Access Community Health Network.

Promising Intervention

Felix’s work extends well beyond the clinic as she reaches out to teen mothers through the Chicago Public School system, teaching classes about the importance of breastfeeding and encouraging teen fathers to participate in the pregnancy.

“The doula program is the single most promising intervention that we have seen in a long time,” said Mike Burke, communications director at the Chicago-based Ounce of Prevention Fund. “For 30 years, society has struggled to reach young low-income moms and their children. If you’re young and you’re poor, it’s hard to choose the quality care that you want.”

The Ounce of Prevention is a non-profit advocacy organization for mothers. Last year it launched a program to expand services to 17 doula centers throughout Illinois. This year the program received additional funding from the Illinois Board of Education for early childhood services at the Will County Health Department, which will include doula services. Because funding to support doula programs comes from more than one source and pre-natal services are combined, it is hard to get an exact figure on the cost of receiving doula services, said Burke.

Burke said the doula model works because the doula is present at the birth, something a mother will never forget. For many expecting mothers, the doula system offers one of the few safe places they can go for help to navigate through the difficulties and challenges of pregnancy and childbirth.

In the Delivery Room

For instance, Raquel Guzman, 22, came to Chicago from Zacatecas, Mexico, with her husband as undocumented immigrants shortly after Guzman completed high school at the age of 17. Guzman (whose name has been changed for this article) has no family members in this country and doesn’t speak or read English. When she became pregnant, Guzman signed up for doula services at La Villita Medical Center, and Felix became her doula. So at midnight on a brisk October evening last year, when Guzman began to experience contractions, the only phone call she made was to Felix, who rushed to Mount Sinai Hospital.

“I was in pain and had an oxygen mask on because my blood pressure rose, but through all that I could still hear Rosalba encouraging me to keep going,” said Guzman in Spanish.

Guzman squeezed Felix’s hand as her contractions got stronger. Her husband held her other hand. They were all the support Guzman had. As the pain escalated, she yelled out Felix’s name. “She held my hand tight and closed her eyes as tears were coming down her cheeks,” said Felix. “I put Carmex on her cracked lips and fed her ice chips to cool her down.”

Guzman cried out: “Ay Dios mio! I can’t do this anymore!” Felix said.

“She asked for medication but it was too late to give it to her,” said Felix. So instead Felix tried to comfort her by gently brushing Guzman’s perspiration-soaked hair from her face. Felix encouraged her to relax and ran through the breathing techniques they had practiced.

“It feels good to know that the mothers are talking and focusing on you during such a personal moment,” said Felix. “Being at ... any birth, is a gift because the mothers allow you to be there to share the intimacy.” Felix considers her participation in the process a privilege, almost a ritualistic honor, and — as she sees it — her responsibility does not end there. Since then Felix has helped Guzman with information on employment, medical and welfare assistance, immunization schedules and has served as a translator during routine doctor visits.

Doulas as Role Models

“One of the main objectives of the doula service is to improve a child’s school readiness through maternal and family attachment,” said Rachel Abramson, executive director of the Chicago Health Connection. “(Doulas) were teen moms and faced the same problems. The doulas are role models because they’ve succeeded.” Doulas also provide support by keeping clients in care longer. “It’s different than a lot of programs that come out of our American culture. We like things that are easy, quick and sometimes superficial and shrink-wrapped. This is just the opposite. It’s very human and very powerful,” said Abramson. “It’s not high-tech, it’s high touch and uses resources that are in the communities. It uses natural leaders who already live in those communities.”

Although teen birth rates in Chicago have dropped by almost 16 percent, African American and Latino women continue to lead in birthrates for women under the age of 20 with 24 and 16 percent, respectively, according to Big Cities Health Inventory, a report issued by the National Association of County and City Health Officials.

Felix has encountered many women who have little formal education. Some of her clients come from Mexico with boyfriends who later leave them. Felix said she works with many immigrant women who are discouraged from speaking up. Some have escaped abusive relationships and need more than just medical care. Others are illiterate in their native language and don’t speak English. Many have no financial or familial support.

During home visits, Felix has encountered poor living conditions that include extreme roach and rodent problems.”Sometimes these women live in a house with seven people. They have a small room to live in where they keep all the food that they eat,” said Felix. “I had a client that was in an abusive relationship. It was a complicated situation, but she came from Mexico and had nowhere to stay,” said Felix. “We found a shelter for her, while I gave her prenatal classes and was with her for the labor.” Felix said that the client joined a missionary group at the shelter where she now works as a missionary.

Belia Ortega is a Chicago freelancer who is a regular contributor to Extra a Chicago-based bilingual English/Spanish publication.

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