Don't dilate without a doula

When Victoria Macioce-Stumpf gets a call in the middle of the night, it means a new life is beginning. Someone is about to have a baby. She packs up her birth ball and other assorted labor-easing tools and dashes off. There, the petite woman massages the expectant mom, keeps her hydrated, advocates on her behalf and does everything she can to keep her comfortable.

Such are the duties of a doula (pronounced doo-la), a unique profession that Macioce-Stumpf has been practicing for nearly 13 years. She is one of 2,000 certified doulas in the United States who have been assisting women during childbirth since the 1970s.

Doulas often are confused with midwives, but the roles are very different. A midwife delivers the baby, whereas the doula helps the expectant mom and her partner have the kind of birth experience they want. A doula does not perform any medical procedures.

Macioce-Stumpf stumbled onto her vocation by accident. She was teaching childbirth classes and wanted to update her credentials, which required attending six births. She thought that the only way women would allow her to be present was to offer them help during their labor.

“I did the first birth and that was it,” says Macioce-Stumpf. “I was totally euphoric.”

The term doula has Greek origins, deriving from a title given to a head servant woman, says Macioce-Stumpf, who initially resisted using the name because most people didn’t know what it meant.

As a doula, Macioce-Stumpf, 38, has assisted, on average, two to four births a month since 1990, including the delivery of Audrey Becker’s first child, Ivan.

Becker, who lives in Detroit, had never heard of a doula, like most other Americans — until she became pregnant. Doulas attend only one or two births out of 100 in the United States, according to Macioce-Stumpf.

“When I read the different things she would do as a doula … I knew for me she would be indispensable,” says Becker, who gave birth to Ivan last month.

Becker and her husband, Adam Druckman, decided to have their baby with as little medical intervention as possible. This meant having a midwife deliver their son at Providence Hospital in Southfield with a doctor standing by in case of complications. It also meant that Becker would not take pain medication. That’s where the doula was especially helpful. From the moment Macioce-Stumpf arrived at the hospital, she helped relieve Becker’s labor pains with massage.

“She walks in the room and … puts her hands on my shoulders and starts massaging me,” says Becker. “It was really incredible.”

The doula also suggested different body positions to alleviate Becker’s pain. Back pressure was relieved by sitting on a soft rubber ball, called a birth ball.

“What the doula ends up being is a giant-sized bottle of Valium,” says Druckman.

Macioce-Stumpf charges a flat $600 to meet with a couple three times, including a postpartum visit. Initially she meets with the couple to determine exactly what kind of delivery they want. She provides a detailed questionnaire that addresses such concerns as whether the expectant mom wants to wear her own clothes or a hospital gown, lights off or on, curtains drawn or open. Critical issues, among others, involve whether the mother-to-be wants pain medication, limited vaginal exams or an internal or external fetal monitor. The doula advocates on behalf of her clients by informing doctors or nurses of the expectant mother’s wishes.

Macioce-Stumpf says the doula’s role is not to direct the couple, but to educate them of their options and possible consequences.

Macioce-Stumpf says training for being a certified doula is minimal. Doulas of North America, the certifying body, requires specific reading on the subject, a 16-hour workshop, childbirth education and reference letters from at least three clients assisted during birth, doctor and nurse evaluations and a personal essay. Macioce-Stumpf, who has three children (the last two were delivered with a doula), believes that doulas should have a strong background in childbirth, anatomy and physiology. She says that couples should also educate themselves, as did Becker and Druckman.

Becker was about a week overdue when she went into labor. After seven hours of receiving a labor-inducing drug, her cervix was barely dilated. Her midwife wanted to rupture Becker’s membrane to move the labor along. Becker and her husband had hoped to avoid this intervention, since once the water is broken Becker would be held to a rigorous timetable to give birth. At about 2:30 a.m., Druckman called Macioce-Stumpf at home for her advice. (Macioce-Stumpf does not go to the birth site until labor begins in earnest.)

After consulting with Macioce-Stumpf, they decided to wait and break the membrane in the morning. Becker’s contractions increased at about 6 a.m., and the doula was summoned. She stayed through the early afternoon delivery.

“She sent me to get something to eat when I needed to recharge,” says Druckman.

Macioce-Stumpf says that some men don’t want a doula, fearing that there won’t be much for them to do. But she says there is plenty of work for both her and the partner.

“I also can never replace the support a partner gives,” she says.

Druckman was happy to have Macioce-Stumpf’s assistance.

“She showed me how to massage, where to apply pressure, and apply warm and cold compresses,” he says.

Druckman describes the doula’s role in terms he thinks men will understand.

“You’re a handy guy and decide to put an addition on your house. The smart handy guy, who is not a professional, realizes he needs someone to help him. That is what the doula was to me,” says Druckman.

If the doula had not been present, Becker thinks her experience would have been much different.

“I think maybe without the support, I may have opted for drugs,” says Becker. “I still would have a baby, but not the way I wanted to have it.”

For some couples, to whom Macioce-Stumpf becomes especially close, she writes a birth story.

“I think it’s important to preserve the memory of this joyous event,” she says.


To learn more about doulas, visit Macioce-Stumpf’s Web site is

Ann Mullen is a Metro Times staff writer. She can be reached at [email protected]. Editorial intern Peggy Geeseman contributed to this
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