Women have always assisted other women during the time giving birth.  The former Childbirth Education Association and the former Birth Community, Inc. were organizations from which Minnesota parents could find birth companions in the 1970s and 80s respectively. The labor support/doula community began to grow in Minnesota in 1992 when,

then aspiring midwife, Kerry Dixon arranged a weekend labor support training with the Association of Labor Assistants and Childbirth Educators. Gail Tully then asked the large gathering of women if they wanted to meet again and Kerry set up the first few monthly meetings in St. Paul.

Kerry moved on while Gail continued to organize around the idea of social support in birth for social change and improved birth outcomes.
 The name Childbirth Assistants Collective was chosen to reflect an inclusive approach to promoting labor support and alternative providers of pregnancy and newborn related services. Members wanted a safe place to talk about birth and the deep feelings that go with this work. Kerry and Gail are midwives, but did not form the Collective as a midwife group. Now state wide and called The Childbirth Collective, this non-profit organization continues to center around labor support while nurturing an informal network of providers of medical, alternative and complimentary care.

In 1996, The Collective was approached by nurse Dorothy Walden-Woodworth, RNC, then of Allina Health System, to provide doulas (coordinated by Gail Tully with the support of Julie Haberman) for a cesarean reduction pilot program endorsed by Abbott NW's Chief of OB Staff, Dr. Emmanuel Gaziano. Under the care of these visionary medical professionals, the pilot project supported 51 birthing couples and single moms. These doula-supported mothers had a cesarean rate of 3.92% compared to 10.87% among 46 "control" mothers (birthing on the same days in the same two hospitals without doulas). This was not a stringent control study, however, so our fine results didn't hit the medical journals. [These numbers are from the unpublished report, "Presence of the Doula During Labor-Its effect on the labor and birthing experience" Allina Health System March 1, 1997 Nancy Dickerson, MD et al.]

The 64% reduction in cesarean surgery for the Allina mothers is every bit as real for them, though, whether or not the numbers were reported in a medical journal. The success inspired one of the hospitals, Unity in Fridley, to pay for their own small program. In 1999, under new sponsorship, with the nation's increasing acceptance of surgical birth, and a new set of doulas the cesarean rate at 15.90% still compared quite well to 26% for non-doula supported mothers in the same hospital that year. The Unity program has changed to a combination parent and hospital payment today. Taken from an inhouse table, "1999 Doula Statistics-Unity Hospital."

The Childbirth Collective went on to incorporate as a non-profit organization under the leadership of Susan Lane. The Collective sponsors weekly meetings in the Twin Cities, and frequent meetings around the state, for parents and the public who seek information and education about and for doulas and holistic pregnancy and birth topics. See more at www.childbirthcollective.org

Hennepin County Medical Center allowed employee Lynn Oman to attend 20 labors, including some births, in a doula capacity which inspired then Supervising Nurse Laura Ridgely to kick off their doula program in 1998, under Gail Tully's leadership. Nickie Kerrigan, CD (DONA) took over this program until 2009 when HCMC cut her position to reduce cost. Remaining doulas are paid completely by the hospital. (All patients also have the option of bringing in a private doula if they prefer). The HCMC doulas are on the staff payroll and some are bilingual. They are on-call and often there around the clock.

In the first three months of 1999, HCMC doulas helped at 133 births. It cost HCMC $10,320 to pay their doulas for the 688 hours of labor support they provided these 133 mothers ($15 per hour average pay). The doula-supported moms had a 7% cesarean rate compared to 15% of the non-doula-supported moms. By estimating that the hospital's costs of each cesarean were $5,000 an operation, a hospital representative estimated that their doulas had saved their hospital $49,680 on surgical expenses for the 12 cesareans THAT DIDN'T HAPPEN because the doulas were there. Nickie Kerrigan observed, "From October 1999 to March 2000, among the 162 doula-assisted births we had 9 cesareans. And right about half have no meds at all. There were 17 epidurals."

"Mothers can have medication if they want to, right?" Gail Tully asked.

"Oh, absolutely, they are told quite often that medications are available." Nickie affirms. Yet, as with the Allina mothers in 1996, the HCMC doula mothers may be perceiving less pain in their labors. Emotional support is associated with fewer stress hormones in the blood. Less stress may be the reason less pain is reported and fewer medications are requested.

Today, about 35% of the mothers birthing with HCMC doctors use the provided doulas. In 2004, HCMC doulas helped at 638 births. Nickie perceives the cesarean rate for doula supported HCMC moms remains about 7% comparing to a still impressive 17% rate for the non-doula supported HCMC moms. The doulas, nurses and doctors continue to have a mutually supportive relationship as reflected by wonderful outcomes for mothers and babies. If you are a mother planning to birth at Hennepin County Medical Center and are interested in having a doula, call Labor and Delivery at 612-873-4104.

At the turn of the new century, interests in doula effects are changing. Now it is improvement in maternal infant relationships attributed to doula care that have the attention of social services and funders. Mothers who receive continuous doula support report lower rates of postpartum depression and anxiety. Supported mothers make fewer visits to the emergency room or clinic for infant vomiting or diarrhea. They spend more time holding and smiling at their babies and fewer hours away from their babies in the first 6 weeks. Interestingly, a Johannesberg study found women more satisfied with their mates 6 weeks after birth if they had a doula with them at the birth!

The Turtle Women Project emerged in 1999. This Native American Doula Program was begun by Patricia Welch at the American Indian Family Center in St. Paul. Native and Native-centric doulas helped the mothers achieve a less than 2% prematurity rate, high breastfeeding rates, and high prenatal appointment attendance. These remarkable outcomes caught quite a lot of attention.

The Minnesota Department of Health, Office of Minority and Multicultural Health, Eliminating Health Disparities Initiative and the Greater Twin Cities Untied Way expanded funding to include St. Paul's 8 family centers. Jessica Atkins provided leadership for this expanded program. The Family Center Community Doula Program (FCCDP) . U-Care and Metropolitan Health Plan are two third party payers that have reimbursed doula care for certain high-need parents within their HMO and for which the FCCDP serves. Overall, 1200 St. Paul women received doula care who otherwise would not have been able to afford it. Jessica reported on some of the statistical highlights of the program in the Volume 13, No. 4 2005 Issue of International Doula. A low-birth weight rate of 5% in a selection of 750 women compared to 8.8% in Ramsey County, 10.4% among Ramsey County's African American babies and 9.4% for Native babies. Mothers in the program began breastfeeding at a 70% rate compared to 59% nationally, and 19% among America's Black families. The FCCDP doulas meet with the mother before and after labor as well as attending births in any of the cities hospitals. Now, Minnesota's largest health care payer, Health Partners, has joined FCCDP's efforts. Brilliantly, the FCCDP doulas are now partnering with the county WIC program to be breastfeeding peer counselors! The Family Center Community Doula Program received the 2005 Annie Kennedy Award from DONA International at the Washington, DC conference.
V. Nicole Wocelka now runs the program under the name Community Doulas. The many cultural backgrounds of St. Paul give the goal for doulas speaking many languages. See more at CommunityDoulas.net  or call the American Indian Family Center at (651)793-3803, Ext.3022


Fairview University Medical Center began a Somali Doula Program under Ann Shelp and Lora Harding Dundek. The cesarean rate with doula care for Somali women is 11% compared to 26% without doula care, about the same as for the rest of the hospital's moms. This is a unique program with DONA certified doulas of the same nationality and language as the mothers they help. Patient satisfaction may be the most dramatic benefit. One mother said, "God gave me help: The doula."

Several social service agencies are exploring doula programs and benefits to the families they serve. Way to Grow of Minneapolis has trained all their family advocates with Gail's DONA training and on-going support. Division of Indian Work is gathering doulas and offering trainings in their Minneapolis community. Birthline of St. Cloud has a well trained and active doula corp also making a huge difference in the lives of young childbearing women and their babies.
Nurses from Redwood Falls began and run SW Minnesota Doula Connection as a volunteer organization. Grant monies help these doulas serve families birthing in several SW towns and cities from Morton to Hutchinson, Marshall to Hector. Contact Jayme Schultz at 320-848-6480 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Everyday Miracles blossomed in the kitchens of Deb Prudhomme and Mary Williams.  Serving low-income families and pregnant teens with pregnancy support, doula care, car seat installation and breastfeeding help, Everyday Miracles covers Anoka, Hennepin, Wright and Carver Counties.  Donations are welcome and help a wide variety of multilingual doulas make a direct difference in the lives of families. Contact Debbie at This e-mail address is being protected from spambots. You need JavaScript enabled to view it and Mary at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Third party payment, which means insurance and HMO coverage, is growing. This help is needed to provide every woman who wants a doula with doula care. The potential savings seem obvious but accurate statistics are being gathered by Minnesota Health Plan as they run a test program in 4 counties. With all these benefits the main challenge we have as doulas is in becoming an accepted member of Maternity Care without losing our peer advantage. We may be professional but we are not medical professionals. That is our strength and it is also why it is hard to include doulas quickly in health care plans. We don't fit in a handy financial or medical category. We are as unique as we are effective.

Maternity Center Association led a national survey called "Listening to Mothers," first reported in 2002. While 50% of American mothers had heard of a doula, only 5% chose to use one. You can download the pdf. file and see many other important maternity topics at http://www.childbirthconnection.org

Our current challenge, as doulas, is to obtain third party reimbursement so that more birthing women have access to the benefits of social support. Doulas have been proven to improve mother-infant interactions and health. The potential savings are huge. And, the human benefits are likely to last a generation. With doula care as a regular part of care for mothers and babies we can imagine a new world.

Susan Lane, now state coordinator for the Minnesota State DONA doula group, has formulated the Minnesota Better Birth Coalition to advance the goals of a doula for every woman who wants one, the rights of all Minnesota women to continuous doula care during their hospital births, and third party reimbursement for doula care as well as a myriad of other evidence-based maternity goals.
Won't you be a part of it?