The doula, which translated from an ancient Greek word meaning slave, is quickly emerging as a positive contribution to the care of women in labor in a number of countries across the world. The purpose of a doula differs from that of a mid-wife, in that the former does not deliver the child, but is present throughout the birth process.

Trained and experienced in childbirth, the role of a doula is to provide physical, emotional, and informational support to women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning.

Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. They do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman.

Over the past several years, an increasing number of Shanghai women have begun to retain the assistance of a doula during childbirth, which in China has been described for thousands of years as "setting one foot in the coffin."

The doula has both psychological and practical applications. Due to a shortage of doctors and wards in many local hospitals, only one family member is allowed in the delivery rooms and, as a result, many women are often surrounded by strangers at the time of giving birth.

"Without my husband, without my mom, without any one to say caring and encouraging words, I felt so helpless in the noisy delivery room. With other lying-in women crying in every corner of the expecting ward, I was very tense from beginning to the end," said Chen Hua, who gave birth to a child nine years ago.

Hospital officials said shortages of staff and a lack of available space, along with a significant boom in childbirth during the 1980s, overburdened the hospitals and made childbirth more difficult for expecting mothers.

"It was very common to have five or six expecting women staying in one room by themselves years ago," says Zhang Ningjuan, a senior nurse with the International Peace Maternity & Child Health Hospital. "There were so many pregnant women and sometimes we would deliver 19 babies a night."

"Under those conditions, nurses didn't have the time or energy to care what our patients wanted and how they felt at all, we just did things necessary to keep them safe," Zhang said. "The most common response to patients was 'it's naturally painful to give birth.'"

But the times are changing. Three major hospitals in the city, including Zhang's hospital, the Shanghai No. 1 Maternity & Child Health Hospital and the Gynecology and Obstetrics Hospital, are offering doulas to assist in childbearing and birth. For a modest charge, mothers can choose from a variety of different services offered by the doulas at these hospitals.

According to Zhang, the introduction of doulas to her hospital has greatly improved the process of childbirth, by easing the emotional burdens of expecting mothers and allowing the physicians to focus on the medical aspects of delivering babies. She said mothers now are less concerned about the labor in giving birth because they have a sympathetic shoulder to lean on.

"Few people have stayed in the delivery room longer than eight hours in our hospital," Zhang said. "But before, it was very common."

Now, more than 60 percent of women who will give a natural birth ask for the doula service in these three hospitals.

Although the role of the doula is not clinical in nature, an increasing number of physicians, both in China and other countries, claim the childbirth assistants have noticeable clinical benefits.

Clinical trials conducted in the United States showed the presence of a doula clearly benefits the mother during labor and delivery. There were 50 percent fewer caesarean-sections, a 25 percent reduction in the length of labor, 30 percent less pain medication, 40 percent decrease in Pitocin (artificial hormone to stimulate contractions) use, 40 percent reduction in forceps use, and 60 percent fewer requests for epidural anesthesia.

Chen Daning, a spokesperson for the International Peace Maternity & Child Health Hospital, said the doulas can encourage women not to have caesarean-sections, opting instead for more natural means of giving birth.

"The increased requests for the operation are mainly caused by the fact that the operation brings less pain during the delivery," Chen said. "But popular misunderstandings about the ways of giving birth are also to blame."

"Many believe a baby who comes out from the abdomen is smarter than that from the vagina because the head shape of the former, which is usually round, seems more normal than that of the latter, which is longer."

"Many people think the doctors' insistence on natural delivery is to help the hospital avoid being downgraded," Chen said. "So many women insist on and even try to pay extra money to doctors to receive an operation although their bodies are quite fit for giving a natural birth."

"Whatever they think, our hospital will try to persuade expecting mothers to give birth naturally if they are fit enough. We will provide more education to them. We believe our work can make women and their babies healthier."

Li Tiane, a doula at the No.1 Maternity & Child Health Hospital since 1996, finds that fewer people ask for a Caesarean operation during the delivery even if it is a hard labor of natural delivery.

"We encourage them again and again," Li said. "Before, women like this gave up quickly."

Parents who have taken advantage of the doula service said they are impressed with the results. Yang Hui, who gave birth to a daughter one week ago at the No.1 Maternity & Child Health Hospital, spent only four hours in the delivery room, which she attributed to the assistance of a doula.

"It went far more smoothly than I had thought it would," she said. "When I was carrying the baby, many people told me it might last seven or eight hours or even more than a day."

"The doula did a lot and was very experienced," said Yang's husband, who accompanied her in the delivery room.

Wang Jinzhou, a Taiwan businessman working in Shanghai said his wife gave birth to a boy last Tuesday in Zhang's hospital and said the doula they hired was very helpful. "We didn't know the hospital provided the doula service at first," Wang said. "But later I found the service information in the hospital and invited a doula."

(Eastday.com 03/20/2001)