The Doula - Everyone likes to talk about the magic of birth. But if you've ever given birth, you know there is another side. The labor itself can be endlessly long, frightening and lonely.

You may be in hospital, hooked up to fetal monitors and the nurses come and go. But for the most part you can feel alone, until the time when you are fully dilated, in active labor, finally ready to give birth any minute now.

Your family may be around you, but you wish you had someone who's been through this process before and will stay with you throughout the many hours of labor, making you comfortable, encouraging you, coaxing you to go on and calming your innermost fears.

This is exactly where a birth doula comes into the picture. Derived from the Greek word for "woman servant," doulas are essentially labor assistants. They are knowledgeable, wise, encouraging and experienced companions who help you through pregnancy, labor and beyond.

Doulas are not medically trained to take blood pressure, do vaginal exams, fetal monitoring or perform any medical tasks or procedures. Instead they guard the mother's emotional state of mind through what can be the most empowering stage in a woman's life - the birth process.

Anita Nenonen, a certified birth doula from Harrisburg, attends births throughout the Southern Illinois area. "I just got done with a birth this week," she says. "The new mom and dad said just my being there helped them tremendously on an emotional level."

While some believe a doula isn't necessary for those with family by their side, experts say a doula plays a crucial role in supporting the mother and her partner and in helping a partner become involved in the birth to the extent he/she feels comfortable.

Little touches make a difference, whether it is massage, aromatherapy, turning down the lights, positioning suggestions, rubbing the mom's back or helping to ease the pain caused by contractions, by using warm water in a shower or tub.

"I just let the mom do the job she needs to do, without being distracted by other things," Nenonen says. Having had four children of her own, she knows exactly what a woman goes through during labor.

In addition to a birth doula, one can now hire a post partum doula who essentially continues to provide emotional support and guidance to the mother and family, once the child is born. She helps facilitate a smooth transition into new parenthood and may also do some light housework, fix a quick meal and help out with an older child. A newer type of doula available today is the antepartum doula who helps a mother during her actual pregnancy.

A growing body of research shows that the use of a doula has clear benefits for families during childbirth and postpartum, with no known risks. DONA (Doulas of North America) International, the oldest and largest doula association in the world, cites several national clinical studies that say a doula's presence at birth tends to result in shorter labors with fewer complications, reduces negative feelings about one's childbirth experience, reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans, and reduces the mother's request for pain medication and/or epidurals.

Using a doula is not a magic phenomenon. "Our bodies are meant to have babies," Nenonen says. "We encourage women to trust their bodies, to go with their instincts."

"While most people who hire doulas are thinking more natural, in terms of the birth process, we don't put a guilt a trip on them if they choose otherwise," Nenonen says. "After all, it's their pregnancy, not ours!"

On call two weeks before and two weeks after the due date, Nenonen knows she is in for the long haul, forming a constant support system of sorts. "The main thing we do is mother the mother," she says.

Since people have different needs and expectations, doulas first have a frank talk with the parents-to-be. This enables them to give them exactly what they need during labor or the post partum period.

Nenonen encourages moms-to-be to call her after every visit to the OB and keep her updated on what's happening on the phone.

"While most women are antsy and get to hospital as soon as their contractions start, there are others who choose to labor at home for a while before getting to hospital," Nenonen says.

Whatever the case, the doula can meet the mother right away in her home or at the hospital. Other services a doula offers is staying on a few hours after the birth and helping with breastfeeding.

Having been to over 30 births, Nenonen would love to do more. "But with the economy we live in today, especially in Southern Illinois, the common thinking is that the baby will come out one way or the other," she shrugs.

If the mom-to-be wants a doula but cannot afford the service, it's good to know that doulas are often open to offering a payment plan or negotiating their rates, since they believe in following the DONA International model of a doula for every mother.

Some hospitals, such as the Barnes Jewish Hospital in St. Louis, for example, provide doulas for every patient who asks for the service. But the use of doulas hasn't as yet caught on in Southern Illinois, if one is to go by the low number of doulas available.

Since a doula's education, training, experience and credentials are important, check to see if she is certified, before hiring her.

Doula services are also offered by The United Methodist Children's Home in Mt. Vernon. Two doulas, Sandy Byers and Krista Payne, provide assistance to first time teen parents of newborns who live in Marion and Jefferson counties. This program, which is staffed by nurses, is funded by a grant awarded through the Illinois Department of Human Services and the Illinois State Board of Education.

"I remember thinking how cool the female reproductive system was in biology class when I was a sophomore in school," Nenonen says. It's almost as if she has come full circle today, dealing with pregnant women and helping them through the birth process.

The midwife

Through the centuries, Midwives have been known as the guardians of birth.

Interestingly enough, midwifery and obstetrics were at odds, in a traditional sense, because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless it is medically necessary to do so.

However, the two professions can complement each other and work very well as a team, as illustrated by the midwifery programs in local area hospitals, such as Memorial Hospital of Carbondale and Heartland Regional Medical Center in Marion.

Today, nurse-midwives take care of women throughout their entire lifespan, whether it is caring for adolescents, women of childbearing age or menopausal women. They focus on the prevention of disease and the promotion of health.

Qualified to take a complete family and personal medical history, give you a thorough and gentle examination, counsel you about birth control, hand out prescriptions and do follow-up examinations; nurse-midwives take care of all your gynecological needs (outside of surgery), and also help you with your pregnancy, antepartum and post partum care.

In case you develop a medical condition that needs more specialized treatment, the midwife will then refer you to a gynecologist. Tracy Carr, Certified Nurse-Midwife (CNM), at Heartland Women's Healthcare in Marion says she has three back-up physicians on call, during a birth. If things start looking complicated, she immediately notifies one of them who comes in and decides if a C-section is necessary and do it if needed.

Experts say that one of the main benefits of using a midwife is the personalized care you will receive, (since the midwife has more time to spend with you than the average physician does) and the role you get to play in decisions surrounding your care.

The law and midwives

The modern day midwife falls under one of two broad categories: she can be a nurse-midwife or a direct-entry midwife. While nurse-midwives are educated in nursing and midwifery, direct-entry midwives focus their training on midwifery alone.

Direct-entry midwives then fall under a broad umbrella of official terms such as Certified Professional Midwifes (CPMs), Licensed Midwifes, Lay Midwifes, and Certified Midwifes (CMs).

The thing to keep in mind though is that licensing and credentialing for midwives differs from State to State. In Illinois, only certified nurse-midwives (CNMs) are allowed to deliver on condition they have physician backup of course.

Certified nurse-midwives go to school to get licensed and to practice. Educated in the two disciplines of midwifery and nursing, CNMs are specialists in the care of healthy women; this includes gynecological care, obstetrics and family planning.

The good news is that many major insurance companies and Medicaid cover certified nurse-midwife services.

Often doulas and midwives work well as a team in the birthing room, because their philosophy and practice harmonize with each other. Sometimes, a midwife may need extra help simply because of the competing needs of more than one woman and the fact that labor is no simple process; in such a situation a doula may come in handy.

Top myths about midwifery

* Myth: You can't have an epidural or pain medication

A common myth about midwifery is that you need to believe in natural methods and have a healthy disdain for modern medical interventions and management of care.

This is far from true says Carr, who believes in helping her patients, whatever their choices are. "Whether you are more into natural methods or want all the ultrasounds and epidurals - that's fine with me - it's your choice," she says.

"In fact the last several deliveries I've done were inductions," Carr says. Inductions refer to the medication given to the mother to start labor, when she chooses to have her baby on a specific day.

"Strangely enough, most of the mothers under my care elected to take an epidural, this month," Carr says. "My last natural delivery was a water birth. My patient had an induction. But the rest was natural and it went really smooth."

* Myth: All midwives just deliver at home

"This is not the case for a lot of midwife-assisted births are in hospitals." Carr says.

The American College of Nurse-Midwives reports that CNMs attend over 10 percent of births in the United States; 96 percent of these births are in hospitals.

Doulas & Midwives in Southern Illinois

Doulas in Southern Illinois

• Anita Nenonen, certified birth doula, Harrisburg: 618- 926-0552

• Carolyn Fasnacht, certified labor doula, Carbondale: 618-967-1294

• Krista Payne and Sandy Byers, certified birth doulas, Best Beginnings Doula Program, United Methodist Children's Home, Mt. Vernon: 618-242-1070

• Nina Dunavan, certified birth doula, Carbondale: 618-529-5044

Midwives in Southern Illinois

• Joy Wayman, CNM, Shawnee Women's Health and Family Medicine, Carbondale: 618-457-0465 extn. 229

• Tracy Carr, CNM, Heartland Women's Healthcare, Marion: 618-997-5266

• Sandra Poland, Webber Clinic, Olney: 618-395-5222

• Nikki Nance, Metropolis and Paducah: 502-444-2444

*Note: This is not an exhaustive list.