Martina Smolova | babynightdoula

On the morning of the day Marisa Pizarro gave birth, the usual tumult reigned in her apartment in Lower Manhattan’s financial district. Her husband, a music producer known as J Grand, in shower sandals and gym shorts, was busy tending to their toddler daughter, the financial news on TV and his iPad, where he was still rearranging tracks on a forthcoming release.

His wife, her contractions now 10 minutes apart, was almost an afterthought. But who could blame him? Ms. Pizarro had her doula, Domino Kirke, attending to her every need, absorbing every hint of snappishness.

So Mr. Grand seemed thrilled to be needed when the doula finally turned to him and said, “J?”

“Car?” he replied.

“Soon,” Ms. Kirke said.

“I’m ready!” he said. “Would you like the finest that Uber has to offer, babe? V.I.P. S.U.V.? What’s the name of this hospital?”

Doulas are a growing force in the ever-changing culture of maternity, at once a manifestation of the growing demand for personal service (the doorman, the yoga teacher, Amazon Prime) and a backlash against the perceived overmedicalization of birth, with its high rates of cesarean sections.

But because of resistance from the medical profession and lack of insurance reimbursement, they are still a small part of the system. A recent report estimated that there are as many as 400 doulas working in New York City who attend about 5,600 births a year, or about 5 percent of all births.

Now they are organizing into formal networks, agitating for insurance coverage and making the case that they can improve maternal health and make the process of giving birth safer for the mother and the baby. The medical establishment has kept its distance, though, wary of adding a new member to the birth team and the bill.

For many women, the doula (an antiquated Greek word for a female servant) offers less-fraught emotional support than do sisters, mothers or husbands. They offer tactics to help women manage the pain of labor, as Lamaze breathing classes did to a previous generation. They are familiar faces and patient advocates in a situation where the patient may be meeting the nurses or the obstetrician on call for the first time during the birth. They also consult on prenatal subjects like nutrition and postpartum challenges like breast-feeding.

“We’re not there to change what the parents get,” said Adele Loux-Turner, a doula based in Brooklyn. “We’re there to help get what they want. If there’s a conversation to be had, we do and can let it be known that we’re there to kind of eliminate the hidden menu items.”

Doulas do not need a license to practice, but many of them receive certification through doula organizations like Dona International.

Some doctors say they understand how doulas fill a need in an impersonal hospital setting, and at the very least, feel obliged to honor their presence because they are what the patients want.

“Having a baby in New York City is a very lonely thing,” Dr. Jacques Moritz, an obstetrician at Mount Sinai Roosevelt hospital in Manhattan, said. “A doula is like a personal trainer. Not that you can’t do it yourself; it’s just nicer if you have a personal coach for it.”

At the same time, he and other doctors said doulas sometimes tried to insert themselves between the patient and the doctor in the name of protecting the patient. Yet in the end, they say, it is the medical personnel who are responsible for bad outcomes.

Dr. Amos Grunebaum, director of obstetrics at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, said as long as doulas were not subject to licensing and credentialing requirements, it was hard for him to imagine how they could be fully recognized by insurance companies or hospitals.

He said many doulas might be surprised to find they would have to take a cut in pay if they switched from cash to insurance. The $2,000 fee commanded by some experienced New York City doulas, he said, was “not far away” from his insurance fee for a normal birth, excluding prenatal care.

Some hospitals hand out identity badges to doulas who work closely with their obstetricians. But others do not acknowledge them as part of the delivery team and count doulas as part of the mother’s quota of friends and family members allowed in the room, often forcing women to choose between them.

Doulas are asking for more recognition and for states to have Medicaid cover their services. But insurance coverage is still rare, according to Choices in Childbirth, a maternal advocacy group that released a report promoting doula care last year.

Oregon’s Medicaid program covers doulas, but it is hard to trace how frequently they are used because their services are often encompassed in a more general bill for maternity services, a spokeswoman for the Oregon Health Authority, Stephanie Tripp, said.

In New York, the By My Side Birth Support Program, which has provided free doula services to more than 400 low-income women in Brooklyn, has found that doulas led to a “definite improvement” in breast-feeding, but only a slight reduction in C-sections, perhaps because doulas could not influence hospital policy, said Mary-Powel Thomas, director of the program, a federal and city partnership.

Two years ago, Ms. Kirke set up a doula collective, Carriage House Birth, with two partners, and they have attracted about 35 members.

On a recent Saturday, about a dozen people, half doulas and half potential clients, gathered at the group’s headquarters, the garden apartment of a townhouse tucked among the flea markets and artists’ lofts of Williamsburg, Brooklyn. Embroidered pillows, a rocking chair, a terra-cotta figurine squatting to give birth, and other birth talismans decorated the space.

The doulas could be distinguished from the clients just by their facial expressions; one group looked serene, the other anxious.

For many doulas, their work is a second job, the new waitressing, conducted only with a sense of higher purpose. Ms. Kirke is a singer. Ms. Loux-Turner came to New York to be a dancer. Jill Silberstein tells the attentive couples that she is a producer in advertising, “but doula work is my passion and I do that at night and on weekends.”

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Some of the expectant couples wonder about the difference between a midwife, who is medically trained to deliver a baby, and a doula, who is not. Ms. Loux-Turner told the group that even with a midwife attending the birth, they may need a doula. “A good midwife is pretty hands-off,” she said. “There’s warmth there, but they are really for the waist down, and doulas are for the waist up.”

Ms. Pizarro, the mother in the financial district, had found Ms. Kirke through word of mouth before the birth of her first child. Even though she was determined to give birth without painkillers, one nurse constantly offered epidural anesthesia, she said. Ms. Kirke gave her the strength to refuse. “I feel like doulas put the ball back in the mom’s court,” Ms. Kirke said. “They trust you to normalize the high drama.”

A few hours before her recent delivery, Ms. Pizarro and Ms. Kirke walked around the block in a light snow, pausing for contractions, prompting one passer-by to ask whether they needed an ambulance.

Mr. Grand called Uber when contractions were five minutes apart, and they arrived at Mount Sinai Roosevelt hospital at 11:44 a.m. A nurse took Ms. Pizarro into the examination room, then returned to point a finger at Ms. Kirke and say, “She wants you.”

The baby, a boy, was born three hours after their arrival. Mr. Grand kissed his wife and called out for sushi.

A version of this article appears in print on February 11, 2015, on page A20 of the New York edition with the headline: Doulas, a Growing Force in Maternity Culture, Seek Greater Acceptance.

http://www.nytimes.com/2015/02/11/nyregion/doulas-the-latest-wave-in-maternity-culture-are-organizing-for-more-recognition.html?smid=fb-share&_r=0