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The Professional Birth Assistant:
Your Partner in Achieving
the Birth You Desire
by Mayri Sagady

Last updated 7/3/95 by Donna Dolezal Zelzer,


In the last twenty years, giving birth in America has been in a state of continuous transformation. Key factors in this evolution have been the countless changes in medical technology associated with labor and delivery, the virtual explosion of a childbirth education movement, public acceptance of the invaluable role of fathers at birth, and most recently, the new consumerism among educated, well informed parents claiming their right to determine the course of their birth experience.

One of the most recent offspring of this renaissance is the Professional Birth Assistant. The newest member of the childbirth team, the birth assistant can bridge a multitude of gaps in the care of the laboring couple, bringing essential added support not only to the mother, but also to the primary caregiver (doctor or midwife), to the hospital staff, and especially the father. Yet, the foundations of birth assisting carry on a tradition thousands of years old.

In the twentieth century hospitalization of birth, it seems we have forgotten that for most of our race's history women in labor have been attended throughout by other women. In 1989, Marshall Klaus, M.D., cited a study of 127 non- industrialized cultures. Of those, 126 cultures featured childbirth practices where the mother is attended continously during labor by another woman. The concept of "mothering the mother" is nothing new. What is new, however, is the statistical evidence of just how effective this kind of support is.

In two separate studies of over 1,000 births, women in labor attended throughout by a birth assistant had consistently shorter labors (7.7 vs. 15.5 hours), used pain relief medication less often (11% vs. 64%), required less pitocin augmentation (2.4% vs. 13.3%), had fewer deliveries with forceps (7.5% vs. 22.1%) and had fewer cesarean sections (8.1% vs. 18%).

What is a Birth Assistant?

The professional birth assistant is a woman who attends the birthing family from early labor until the baby is born. She is trained to deliver continuity of care from home to hospital, ease the transition into the hospital environment, be there through changing hospital shifts and alternating physician schedules serve as advocate, labor coach, and support partner to give the parents-to-be the freedom to focus inward as they meet the challenges and rewards of their unique birthing experience.

There are a variety of titles used by women offering these kinds of services such as "birth assistant," "labor support" and "doula" . (Doulas, however, usually also offer support services to the family in the weeks following the birth and may or may not perform the actual birth assisting.)

Who Uses a Birth Assistant?

Generally, birth assistants are used by people having their baby in the hospital, desiring as natural a childbirth as possible with minimal use of medical technology. These couples recognize the value of staying at home during the first part of labor, but may not feel confident in being completely alone once the labor gets going. Fathers are often concerned, at first, that a birth assistant may somehow replace their role as the primary support person. They find out quickly, however, that a birth assistant helps insure the sanctity of that role by handling the logistics surrounding the birth and by drawing on her experience to reassure and guide both father and mother through the natural challenges their birth will present to them.

What Does a Birth Assistant Do?

The nature of their practices vary somewhat and the following is a general description of what you might expect should you decide to use a birth assistant.

Typically, birth assistants meet with the parents in the second or third trimester of the pregnancy to get acquainted and to learn about prior birth experiences and the history of this pregnancy as well. She may help you develop your birth plan, provide you with a supply list for laboring at home and in the hospital, and teach you relaxation, visualization, and breathing skills useful for labor.

Some birth assistants will also accompany you to one of your prenatal visits with your doctor or midwife, to meet them and answer any questions they may have.

When you go into labor, or wonder if you might be in labor, your birth assistant can help you to determine prelabor from true labor and early labor from active labor. At some point, determined by you, she will come to your home and begin by encouraging you to get adequate rest, nutrition and fluids in early labor, assist you in using a variety of positions that are conducive to effective laboring; constantly forcus on the comfort of both you and your spouse/partner, utilizing pillows, adjusting temperatures, making sure your environment is one in which you feel comfortable and safe, keep fluids such as juices, teas, and water constantly available; keep track of contraction frequency and duration; remind you to go to the bathroom consistently throughout; call the hospital once the decision has been made to go, letting them know how your labor has been so far and that you are on your way; and assist in the move from home to hospital.

At the hospital, a birthing assistant works cooperatively with the hospital staff in getting you settled and completing the initial paperwork and procedures. Continuing the kind of care she gave you at home, she will also be able to coach you and your birthing partner in breathing and position changes as you approach transition and the second stage of labor. During pushing, your birth assistant may assist by helping hold your legs, applying warm compresses to assist the perineum in stretching and encouraging you to listen to your body in pushing your baby out the way that works best for you. In the event of a complication, she can be a great help in understanding what is happening and what options you have for affecting the circumstances at hand. Keeping in mind your birth plan, she will support your and the staff in seeing that your baby's birth is gentle and that you get the baby in your arms as soon as possible. Finally, birth assistants will help with the first breastfeeding and in preserving the privacy of your new family during the first hours after birth.

Some birth assistants may provide follow up support with breastfeeding and the early postpartum days at home. Some also offer other services such as photography, childbirth education, sibling support, etc.

How Does One Choose a Birth Assistant?

First, work on being clear what kind of birth you desire, choosing your caregiver and place of birth with that in mind. Then meet with one or more potential birth assistants--most are willing to come to your home and meet with you in a two-way interview at no charge. Talk to people who work with a lot of birthing couples such as childbirth educators, prenatal exercise instructors, etc., and get their recommendations. Also talk with other couples who have used a birth assistant to get a feel for how it worked for them.

When you meet with a specific birth assistant, tell her about the kind of birth you want and about any prior birth experiences, including any differences you would like to see from your last birth. The following is a list of questions you might want to ask:

What Do Birth Assistants Charge?

Most charge on an hourly basis ranging from $15 to $25 per hour during active labor. Home visits and follow up visits may be charged hourly or on a per visit fee. Some birth assistants also offer "package deals" with a guaranteed number of services and hours for a reduced fee. Insurance coverage for the support of a birth assistant is generally not available unless the person is also a licensed health care provider delivering other services as well.

Where Do I Find a Birth Assistant?

Since this is a relatively new field and not yet subject to government licencses, standards of practice, peer review, etc., it is very important to choose your birth assistant carefully, checking references and discussing your choice with your doctor or midwife.

For more information, or for help in finding a birth assistant, conact ALACE at or DONA (Doula Organization of North America) at You may also get referrals from childbirth educators, prenatal instructors and many health care providers as well.

For More Information

Read Special Women--the Role of the Professional Birthing Assistant by Perez and Snedeker.

Statistics cited are from Sosa, R. et al, New England Journal of Medicine, 1980.303: 597-600 and Klaus, M. et al, The Houston Study, presented at Birth Conference 1989, San Francisco.

Mayri Sagady is a professional birth assistant trained by IBP. She is also a Childbirth Educator, Lactation Educator and Birth Photographer
This article was originally published in Special Delivery, Vol. 16, No. 1, Winter 1992-93.

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