When Wendy Smith Martin, 31, of Raleigh, North Carolina, gave birth to her first child, she found it a traumatic experience. Her midwife was not present for the entire duration of her labor and her husband, who had no guidance on how best to help her, spent most of the time massaging her back. Martin felt alone and missed having someone to comfort her and identify with this intense experience.

For the birth of her second child, Martin hired a doula. Originating from an ancient Greek word meaning 'to serve women', a doula refers to someone trained to support a woman emotionally, and also educated in childbirth and related areas. "The doula's presence filled in that extra role that was missing," recalls Martin. "I came out of the birth feeling empowered and joyful instead of wounded and traumatized like I had the first time." Under the doula's guidance, her husband gave her the support and reassurance that she needed. In fact, so much did Martin, formerly a PhD student of literature, enjoy the whole experience that she decided to become a doula herself.

There couldn't have been a better time for Martin to enter the field. The demand for doulas is growing as more and more women consider the advantages of having an experienced birth assistant. After participating in over 60 births, Martin often turns down clients because she doesn't have the time to take them all. Many of these are second-time mothers who missed out on a doula during their first pregnancy.

Doulas undergo intensive training before receiving their certification, which is provided by organizations such as DONA International, the world's largest doula association. It is headquartered in Jasper, Indiana. Doulas begin their education by participating in a childbirth workshop and then train either in childbirth education, midwifery, gain work experience in labor and delivery as a Registered
Nurse; or observe a childbirth preparation series.

Most doulas list their services on doula directories and personal websites. They often charge a flat fee - ranging from $300 to $800, which includes pre-natal and post-natal visits as well as their continuous presence at the birth.

"Every woman should have a doula. We believe that a doula's role is to 'mother the mother'," says Cheryl Orengo, 55, the North Carolina Representative of DONA International. Orengo, a doula trainer and mother of two with over 18 years of experience supporting women in labor, has seen women from various backgrounds - retired, professionals or stay-at-home mothers - take up doula training.

While there are a few male doulas in the US, Orengo says they are rare. In her eight years as a trainer, only one man took her doula training and he eventually went on to attend medical school.

Orengo stresses that a doula does not take away from the roles of others but instead, adds positively to the environment. "There is a nursing shortage in many places with nurses often having two or three patients to attend to at the same time," she explains. "Sometimes even midwives are stretched thin and can't always be with the mother during her entire labor. Doulas are a great resource for the medical staff as well. I train doulas to take a team approach. They are there for the mother first and foremost but if there is anything they can do to make the whole experience stress-free, they are there to help."

Jennifer Whitney, 28, heard about doulas from her childbirth instructor and found the idea of hiring one appealing. "Since this was my first child and I didn't know what to expect, I liked the thought of having another woman there who could relate to the birthing experience," she explains. "I interviewed a couple of doulas and chose one that I felt a connection with. We met several times prior to the birth and talked on the phone regularly."

Whitney found her doula's contribution invaluable. "She was emotionally reassuring for me and my husband, and encouraged my husband in ways that resulted in him being more involved in the whole process. She helped me through my labor with massages and aromatherapy. She also took pictures and detailed birth notes so now I have a complete birth story. I wish I could hire a doula for every friend having a baby."

Unlike Whitney, Ginni Sobti, 25, did not plan on hiring a doula for the birth of her son five months ago. But during her arduous labor, when the hospital offered her the services of a volunteer doula, Sobti grabbed the opportunity. "It was the best decision of my life," she recalls. "The doula never left my side. I had a long labor and she was there to help me brace it. I am so grateful to her because if it hadn't been for her I would have broken down and opted for a C-section." She says she will definitely hire a doula for her next pregnancy.

Dr Brad Imler, President of the American Pregnancy Association, agrees about the benefit of having a doula. "A doula can advocate for a mother when she is in labour," says Imler. "Statistics show that the rate of C-sections is reduced by 50 per cent when a doula is used. This is beneficial and healthy for the mother and the baby because it significantly decreases a number of risks. Because of their various techniques, the presence of a doula is shown to reduce the time a mother is in labor and also reduces the use of an epidural by 60 per cent."

Not only has the involvement of a doula shown benefits for women during birth but the consequent pleasurable birthing experience also leads to lower post- partum depression rates, according to Martin. "It is important that women come out of pregnancy feeling well cared for and strong," she says. "Birth is a profound emotional experience for the mother and her family. If you focus on just the medical care, so much more is lost out."