Doulas provide options, support

By Tammy Keith Originally Published April 28, 2013 at 12:00 a.m.
Updated April 26, 2013 at 9:41 a.m.
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PHOTO BY: Rusty Hubbard

Nicolle Fletcher of Conway is a childbirth educator and a certified doula. A doula provides information during a woman’s pregnancy, as well as emotional and physical support for the woman during labor and childbirth, Fletcher said.

Nicolle Fletcher said that after a friend had a home birth, Fletcher joked about becoming a midwife.

Then, Fletcher’s husband, Phillip, brought home a midwife’s business card one day.

“It was my 30th birthday, almost seven years ago,” Nicolle Fletcher, now 36, said.

She met with the midwife, Kim Jacob, at the woman’s office in Conway.

“She talked to me about doula services before making the time and energy investment in becoming a midwife,” Fletcher said.

It takes three to five years to become a midwife, Fletcher said; it can take one year to become a doula.

Fletcher said the word “doula” originates from a Greek word meaning “a woman who serves.”

“A midwife is the OB-GYN of home births. A doula is a supplement or complement to both of those, whether in the hospital or at home,” Fletcher said.

“Doula is labor support. You don’t want to wear your midwife out by having her actually labor with you,” Fletcher said.

Fletcher, who is married and has three children, was certified as a doula in 2010 through a Little Rock company.

In 2012, Fletcher started her own company, Birth by Design Doula Services, which is a network of about six doulas.

Fletcher has about 16 pregnant clients herself right now, and most will have hospital births, she said.

She said doulas use “various comfort techniques such as breathing, relaxation, movement, visualization and positioning.”

Fletcher said using a doula can reduce the need for pain medication or epidural requests and lessen the chance of induced labor and cesarean births.

It takes the pressure off husbands as coaches, too, Fletcher said.

“Wives will look at their

husbands, ‘Can you fix this? Can you help me?’ I’ll say, ‘Hey, why don’t you try some double hip squeezes right now? OK, let’s do some side lunges.’”

The cost to hire a doula ranges from $350 to $700, Fletcher said.

“The more experience [the doula has], the higher the fee,” she said.

Birth by Design also trains doulas, which includes a series of workshops, as well as required reading, written reports and a research paper. Trainees attend a minimum of 10 births with other certified doulas in a hospital or at home.

“Finally, [trainees] will sit for an exam,” Fletcher said.

Fletcher said one of her goals is to develop relationships with physicians to let them know a doula “doesn’t mean long skirts, hairy armpits and weird stuff.”

“It means women want options, and they don’t want to be considered a routine procedure; they want to be considered individually,” she said.

“We’re kind of able to come in and supplement a lot of that information and kind of filter the language that they don’t really understand, that may be over their head or ‘Why do I need this?’”

Fletcher said she has found support from some OB-GYNs, especially Drs. Amy Johnson, Josh Ward and Brandie Martin, who practice together in Conway.

“They have, I feel like, embraced a lot of the benefits of having a doula with their patients,” Fletcher said.

She said that once when she was with a laboring client, the woman had been pushing for a long time and thought she might have to have a cesarean section.

Before the doctor intervened, Fletcher asked the doctor for some time to help the woman.

“[The doctor] said, ‘Well, you’re the position expert,’” Fletcher said. “That made my heart melt. That’s awesome, because there’s an appreciation. … Each person has a different skill set. I can respect what you do because you’re a surgeon, and sometimes women need medicine, and you’ve studied that and I haven’t.

“All of us working together has been awesome,” Fletcher said.

Fletcher said she goes to maybe one doctor’s appointment with the mother-to-be, “if I don’t have a relationship with the doctor already.”

The best time to hire a doula is when a woman is about 20 weeks pregnant, Fletcher said.

“I’ve had clients come at 40 weeks and go, ‘I need a doula.’ I say, ‘OK, let’s rapid-fire this information,” Fletcher said.

Anna and Kraig Bowden, both 24, of Conway, hired Fletcher as their doula.

Their daughter, Bell Ivy, is 7 weeks old.

Anna said they had a home birth with Kim Jacob as their midwife.

“Pregnancy can be a stressful time, just trying to get everything prepared and everything ready,” Anna Bowden said. “We wanted a doula to take that stress away.”

She said Fletcher called often and checked on her physically and emotionally to ask, “Are you stressed? Are you happy? Are you worried about anything at all?”

“When it got closer to time to give birth,” Anna said, “I was right to trust in her. She took away so much of the stress — ‘Am I going to be ready for this? Am I going to have everything?’

“She made sure Kraig had a good experience as well, instead of him feeling like he had everything on his shoulders to worry about me.

“It just made it such a better experience. I cannot imagine having a baby without a doula. It was amazing.”

To help get the word out about doulas and other aspects of birth, Fletcher has planned a free event, the Arkansas Birth Fair, to be held from 10 a.m. to 2 p.m. May 18 at The Village at Hendrix in Conway. Participants will include midwives, representatives from hospitals and nonprofit organizations, and photographers. Vendors will offer makeup, music, baby supplies and more.

“The goal of this birth fair is to have a variety of pregnancy, birth and child-rearing resources available for families planning a pregnancy, currently pregnant and young families,” Fletcher said.

“Doula-supported births are on the rise. I think more women are looking at their options,” she said.

Fletcher said more information about doulas can be found at, and

Senior writer Tammy Keith can be reached at (501) 327-0370 or

Niche Publications Senior Writer Tammy Keith can be reached at 501-327-0370 or

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