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Doulas provide support to mothers before, during and just after birth

Rhonda Huot, an experienced doula, listens to Jessica Levenhagen, whose baby is due next month, during a prenatal visit at the Levenhagen home. (Jesse Trelstad/Grand Forks Herald) 1 / 4
As part of her work as a doula, Rhonda Huot helps expectant couples create a birth plan, which reflects their wishes regarding childbirth, to share and discuss with their primary medical caregiver. (Jesse Trelstad/Grand Forks Herald)2 / 4
With help from 2-year-old Cooper Levenhagen, Rhonda Huot uses a rebozo scarf to try to re-position the baby Jessica Levenhagen is carrying. Jessica and Kyle Levenhagen (in background) are expecting their second child in mid-October. (Jesse Trelstad/Grand Forks Herald)3 / 4
Jessica Levenhagen and her husband, Kyle, talk about their experiences with a doula when they were preparing for the birth of their first child, Cooper, now 2. They have engaged the doula, Rhonda Huot, again as they await the birth of their second child. (Jesse Trelstad/Grand Forks Herald)4 / 4

A few years ago, when Jessica Levenhagen of Grand Forks was eight weeks pregnant with her first child, she underwent an ultrasound procedure with her husband at her side. It was a little more than he could handle.

"Kyle just about passed out," she said.

If he had trouble with an ultrasound, she wondered, how was he going to deal with childbirth?

"I thought, I'm going to need some help."

Jessica went home after the appointment and began searching online for a doula. She found Rhonda Huot, of East Grand Forks, whom the couple enlisted "before we told anybody we were expecting a baby," Jessica said. "We broadened our team a little bit."

Huot met with the couple many times, answering questions, providing information and helping them formulate a birth plan that reflected their values and wishes for the day their son would be born.

A birth plan "makes you think about what's important to you," Jessica said. "There's no right way to give birth. It's important that moms feel cared for and that they are part of the experience."

Doulas are trained in childbirth and provide continuous support to a mother before, during and just after birth, according to the Doulas of North America organization. In essence, they mother the mother.

"A doula provides physical, emotional and informational support," said Huot, who has been working as a doula for 12 years and has attended 160 births. "We advocate to (help mothers) find their voice to ask the doctor questions."

A doula uses "comfort measures," such as breathing and relaxation techniques, movement exercises and positioning, to ease the stress of pregnancy.

A doula does not provide medical care, diagnose conditions or give medical advice.

Huot meets with couples to talk about their expectations about childbirth and explain hospital protocols, she said. "Moms who are healthy have choices."

"It's not always black and white," Jessica said, noting flexibility is possible in such things as physical movement, drinking water and eating during labor and how soon the umbilical cord is cut.

Huot also sees her role as easing parents' fears, "because most first-time parents have fear," she said.

Supporting dad, too

In her role as Jessica's doula, Huot was equally supportive of and helpful to Kyle.

"She met with us and explained what to expect," Jessica said. "Whenever Kyle had questions, she could answer them."

Having Huot present during labor and delivery was very important to both parents.

"It's good to have someone who can translate what can be a foreign language for us," Jessica said. "I didn't feel we were asking her to make decisions, but she could provide information and find information so we could make decisions."

When the birth is imminent, "it's comforting to have someone you've known for almost a year there to help out," she said.

With a bevy of health providers performing various medical tasks on the laboring mom, "it's nice to have one person who's not doing that."

When their son, Cooper, was born, Jessica had complications that warranted emergency surgery and transfer to the hospital's intensive care unit.

"Kyle and Cooper were alone on the birthing floor," she said. "Rhonda was a good support during something that none of us had expected to happen."

"It all happened rather quickly," Kyle recalled. "It was a day and a half before I got to take a nap."

Huot arranged for him to feed Cooper with donated breast milk and told him what to do, how to do it and when.

She instructed him on how to diaper his son, who "was pretty little — I was afraid I was going to break him," Kyle said. "It was nice to have someone there to tell you how to do things.

"That's why I would say it's kind of a necessity (to have a doula). I was very comfortable asking questions, too."

Awareness lacking

"People in our area are still learning what a doula is," Jessica said.

The word "doula" comes from a Greek word that means "a woman who serves" or "handmaiden."

The concept is not new, Huot said. In the past, it was common for a female member or friend to stay close at hand to calm, encourage and support the laboring mother in the home.

As hospitals replaced homes as the common birth site, that kind of ever-present support disappeared.

Some people assume a doula replaces the husband or partner, but that isn't the case, Jessica said. "Rhonda helped Kyle know how to help me."

Huot said part of her job "is to know when to be in the background and when to step forward."

Another misconception is that a doula functions as a midwife. Their roles are different, Huot said.

Some women believe that doulas only attend women who are planning a natural birth.

This also is untrue, Huot said. "Doulas support the birth no matter what that looks like."

To spread the word about doulas, Northern Valley Doulas was founded last year by Kjersti Eilers and Jessica Binstock. The group holds "meet and greet" get-togethers on the first Monday of the month in the Grand Cities Mall.

Eilers and Binstock, each with more than 10 years of experience as doulas, invite "parents, mothers and families to learn about doula care," Eilers said. "We offer free consults to see if you connect with a doula."

Eilers is certified through Still Birth Day, a national organization whose members "attend a birth through any gestational period and any outcome."


Several organizations provide certification for doulas, although certification is not required in North Dakota, Huot said. Generally, doula training for certification takes one to two years to complete.

Each organization has its own requirements for certification, including reading and attending workshops. Some require the candidate to be present and assist at a specific number of births; some don't require any.

Huot earned certification through the Doulas of North America International after working for 15 years as a medical transcriptionist.

"It took me two or three years to get my births in," Huot said. "It took that long for me to get three pregnant women to let me participate in the birth."

That was due, she said, to lack of awareness about the role of the doula in this area, coupled with her inexperience.

"I always wanted to be a laboring nurse," she said. "This is so much better. I can stay with (the mothers)."

Other benefits

More research is uncovering the health and financial benefits of the kind of constant care that doulas provide.

A 2012 study, led by Dr. Ellen Hodnett, professor of nursing at the University of Toronto, found that women who had continuous support during labor and delivery were more likely to have less pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births and Caesarean sections.

These women had a 31 percent decrease in the use of Pitocin, a drug that stimulates contractions of the uterus, and a 28 percent decrease in the risk of C-sections. They also had a 14 percent decrease in the risk of their newborns being admitted to a special care nursery.

Based on these findings—as well as her own experience—Jessica thinks that insurance companies should cover the cost of doula care.

"By having a doula, we saved our insurance company a lot of money," she said. "I didn't need pain medication—that would have cost a lot of money. Doulas help prevent C-sections—that saves everyone a lot of money."

Changing attitudes

In recent years, Huot, Eilers and others have seen an increase in the public's interest in doula services, as more expectant mothers in this area are turning to doulas to help them through pregnancy and the birthing experience.

The medical community, too, slowly has adopted a more welcoming attitude toward doulas.

"It's changed tenfold from when I started 12 years ago," Huot said of her experience with the local Altru Health System employees. "(At first) I'd walk into the hospital and they'd wonder why I was there. They were a bit standoffish.

"Now I'd argue that we make a great team. I haven't found a person—from the nurse to the doctor to the surgical tech—who doesn't think we're a really good team."

"We each have a role to play," she said. "They feel that they're a necessary part of the birth team, and I feel I'm a beneficial part of the birth team."

As a maternity patient, Jessica didn't notice any hesitancy or friction about Huot attending her childbirth experience.

"Everyone I've worked with is supportive," she said. "I felt like, when Cooper was born, we had a pretty big team. Everyone worked well together."

Jessica and Kyle, who are expecting their second child next month, have hired Huot again to act as their doula.

The cost of giving birth "can be daunting," she said. But the cost of hiring a doula "is a small fraction."

"I asked my husband not to buy me a gift (upon the birth of their child), but the doula was my gift. ... I always say having a doula is a necessary part of giving birth. To me, it's that valuable."

More info

For more information on doula care, contact:

• Rhonda Huot at (218) 779-5826 or go to

• Northern Valley Doulas at or email