The obvious question is, why? With Mom and her supporting cast all devoted to changing the address of her in utero tenant, why bring in another player? With Dad more involved with birth than ever in roles from labor coach to videographer, isn't a doula redundant?

"Not at all," says Janet Hall, founding member and director of Birth Partners, a doula service based in Naugatuck that serves all of Connecticut, Westchester County and western Massachusetts. "This is the most commonly asked question about doulas." The midwife or physician is focused primarily on the medical aspect of the birth and the infant's health and well-being throughout labor and delivery; the other parent may be uneasy with the expectation that he or she will meet all of Mom's emotional and physical needs throughout labor. Mom might feel concerned that she'll be distracted, worrying about how her partner's holding up. "The doula and the partner work together to give the laboring mother a comfortable, well-rounded, safe and secure atmosphere in which to labor and give birth."

Study results as to the efficacy of doulas are compelling. According to Marshall H. Klaus, M.D., John H. Kennell, M.D., and Phyllis H. Klaus, M. Ed., C.S.W., the presence of a birth doula can result in 50 percent reduction on cesarean rates, 25 percent shorter labor, 60 percent reduction in epidural requests, 40 percent reduction in oxytocin (pitocin) use, 30 percent reduction in analgesia use and 40 percent reduction in forceps delivery (Mothering The Mother, Perseus Books).

DONA states, "The benefit of continuous support in labor is recognized by the World Health Organization and the Medical Leadership Council (an organization of over 1,200 U.S. Hospitals)."

Just as pregnancy doesn't begin in the delivery room, neither does a doula's work. "We at Birth Partners view our prenatal work as the biggest part of the job," says Janet Hall. (The first certified doula in the state, Hall has been in the business of "mothering the mothers" for 17 years.) "Our doulas go to the home an unlimited number of times prenatally. From the first or second visit, the partner is involved. It is so important not to step on any toes. These visits lay the foundation of trust, build the rapport that is needed during labor. They will establish a birth plan by walking through the entire process and discussing what role the partner wants to take, what the vision of the doula's role is and what the couples' thoughts are on pain medication, epidurals, and episiotomy. A visit might just be the couple and doula hanging out over dinner, getting to know one another."

Birth Partners' other prenatal offerings include unlimited phone consultations; private and group prenatal workshops in childbirth and breastfeeding education; and prenatal services including belly masks (a plaster casting of the belly made in the final months of pregnancy. It can then be painted, bronzed, decoupaged, used as a future Halloween costume, given to the birth father to wear for nine months...) and professional photography. They also present seminars twice yearly for health-care professionals and curious consumers.

Labor support begins at home, then continues on to the hospital room.

"Our role is to help the parent(s) feel as comfy as possible at home, to help them to not get to the hospital too early. Or too late, for that matter," says Hall. Though Birthing Partners doulas attend home births, the vast majority of their clients opt for hospital or birthing center deliveries. The doula provides physical support throughout the birth (massage for both parents, hand holding, helping Mom reposition herself or walk around during labor), verbal encouragement (reassurance, humor, relaxation techniques and affirmations), and a soothing, constant presence in a realm that can border on chaos, between heightened emotions and hospital shift changes.

Just when you think you've got the concept down, "doula" also refers to a person paid to help out after the fact. A postpartum doula, according to DONA, is "a woman trained to care for new families in the first weeks after birth providing household help, advice with newborn care and infant feeding, and emotional support." She may care for the infant while Mom naps, showers, or has a few quiet moments with her partner. She may prepare meals, run errands, help with diapering, cord care and the baby's first bath, do laundry, even provide overnight visits--anything to help Mom and all involved ease into their new family roles.

"Maybe there are older siblings," Hall explains. "The doula may care for the baby while Mom spends time connecting with them. She'll address other basic child-care needs too, like providing rides or fixing a child a sandwich."

All members of Birth Partners are certified by either DONA or the Association of Labor Assistants and Childbirth Educators (ALACE). In addition they must complete a rigorous yearlong internship, during which they sit in on births, assist with postpartum care, and attend workshops on a variety of topics, including grief and loss counseling, multiple births, breastfeeding, massage, exercise and nutrition. "Our completion rate is only 30 percent," reports Hall. "Not everyone is meant to do this work. Birth is a passionate subject, and some can't put aside their own beliefs about what a birth should look like or their particular biases."

What should someone keep in mind when looking for a doula? "Buyer beware," Hall says. "Interview your doula. How many births has she attended? Is she certified? Make sure she is well trained. Remember, a true professional doesn't have her own agenda; she knows the birthing couples' needs and is there solely for them."