Agonizing in pain, the 16-year-old woman can only see a group hovered over her covered from head to toe in monochromatic garb. She observes their eyes affixed on her alone. Through the swarm of people, she feels one of them gently massaging her feet. The soothing stranger then puts a cold compress on her head and tells her in a mild voice to relax. The pain is too much to bear as she begins to sweat and pant with every push. "Sacarlo!," she cries in Spanish, meaning to "take it out." After six and a half hours of intense mental and physical strain, the patient is a new mother.
"That was the first time I'd ever coached anyone in labor," says Childbirth Assistant and nursing student Anna Vela. "It was so hard for the mother, but when that baby finally came out it was the most beautiful thing I'd ever seen. From that moment I knew it was something I wanted to do, especially for the mothers who don't have any support at all."
Though some may call themselves childbirth assistants, labor coaches or dulas, the common goal they all share is to provide continuous support to women during the laboring process. The support varies from the gentle massaging of the patient's tense areas such as the feet and neck, reminding the woman to breathe, putting warm and cold compresses on her forehead, or just being at the woman's side to hold her hand.
"Because the patient is brought into a system where she is not given continuous support, our goal is to provide it in order for the mother to have an easier time giving birth," says Margie Hutchinson, midwife and founder of the Childbirth Assistance Program at San Francisco General Hospital.
Founded in 1993, the program was originally developed to give pregnant teens support. However, because of the demand for labor assistants, it expanded support to all pregnant women at SF General. The labor coaches offer their support on a voluntary basis, allowing the patients to receive the service free of charge.
"It never crossed our minds to charge, because a majority of our patients would not be able to afford this service if we did. The Bay Area has a huge untapped resource of people who want to be involved with the birthing process and are willing to do it voluntarily," says Hutchinson.
SF General is the only one of its kind to offer this service free of charge. Of the total births at the hospital, 30-40 percent have been assisted by a labor coach. The only similar program to SF General is the Dulas Research Project at Kaiser Hospital in San Francisco. Not every mother is assigned a labor coach, because this is a research project to study the effects of dulas during labor. For their services, the dulas are paid $40 per birth, unlike SF General's labor coaches, who are volunteers.
There are also childbirth assistants who offer their support on a private basis, but charge a fee. Nancy Myrick, a labor coach at SF General, says that the fee scale varies depending on the person. Myrick charges on a sliding scale from $200-$300, but says she knows of other labor coaches who charge up to $500.
The labor coach program at SF General has 62 volunteers. The profile of labor coach varies; some are students, professionals, mothers or aspiring midwives. Although there are no rules against men joining, none have yet applied. The program consists of an orientation process and a mentor program where new volunteers are teamed up with someone experienced in observing births. An assistant must possess the ability to assess the patients efficiently so that the birth can go smoothly and be intimate for the mother and baby.
"Because we're scheduled on a 12-hour on-call basis, we do not know the mother prior to her being in labor," says Vela. "We need to be able to assess her condition quickly, like finding out how far into labor she is, or if she has any health problems, in order for us to meet her needs."
According to former labor coach coordinator Karen Sacksteder, the patients vary but are usually from a low-income background. "Many of the mothers are teen-agers, and about 50 percent are Spanish speaking. Many have a history of sexual and drug abuse, and some don't have any support at all. If they do, their partners can't come with them because they're watching the other children at home."
These volunteers don't know their patient's history beforehand, so they put themselves at risk because of the amount of blood and bodily fluid released during birth. "There was one time where I had to assist an HIV positive mother. Although I was fully protected and am educated about prevention, you still wonder about being safe," says Vela.
A general safety rule of the program is that labor coaches are not allowed to meet with mothers outside of the hospital. Nina Smith (not her real last name), a new mother who gave birth last December, recalls her coach as being completely supportive during her delivery. Diagnosed with preeclampsia, a pregnancy-induced condition that causes hypertension with swelling in the feet and hands, Smith's doctors had to administer a labor-inducing injection to start the contractions. Smith remembers her husband on one side of her during the delivery, and her coach on the other giving her unconditional support. Smith is trying to locate her labor coach to thank her for all of her support.
"I was in labor for almost 24 hours, but the one thing I remember was my labor coach," says Nina. " I think the name on her tag was Ann or something, but I'm not sure. What I remember most about her was her soft voice reminding me to be patient, massaging my swollen feet, and because I have polio, she held it [her leg] for my baby to come out. I never expected all this support from someone I didn't know." "Now, I'm just trying to find her to let her know how grateful I am."
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