The Doula’s Contribution to Mamatoto
by Gail Tully, BS, CD (DONA), CPM

[Editor’s note: This article first appeared in Midwifery Today Issue 58, Summer 2001.]

Being both a midwife and a doula gives me a wide range of serving mamatoto in my Minneapolis/St. Paul community.

In 1992 I founded The Childbirth Collective, a nonprofit doula networking and outreach group. The Collective has blossomed and many doulas are busy.

Now the need here in Minnesota is to increase opportunities for third-party payment for doulas. This will allow poor women, especially women of color, to have and also become doulas. Without a dependable income, a poor working mother cannot risk the rent to give up her job and become a doula.

In December 2000 I founded the nonprofit Mamatoto Birth and Bonding Support group. Most doula groups around the country attend to white women. Mamatoto is developing video and written material for teens and women of color. Doulas have much to offer the mamatoto.

The Healing of Story

Even as midwives we can underestimate the long-term grace brought through the presence of a doula at a mother’s side. This is a curious blind spot in our maternity care. As a homebirth parent and midwife, I came to this realization slowly, even though I was a doula myself! The continual emotional support from a peer enables the cultural healing of motherhood. Midwifery does, too, but in a different way. While midwifery heals inner power, the doula affirms the healing of “story.” As women we share our stories by verbalizing our experiences, and the quality of feedback shapes and reshapes our view of ourselves. The affirmation and perspective of the doula come to the mother as from a peer. And therein is the gift.

The praise and perspective of a doula give buoyancy to the mother’s memory of her birth. A doula also increases the respect given to a mother when that doula nurtures emotional connections between hospital staff and family. Many studies show the effects in higher rates of self-esteem and lower rates of depression in mothers. Doula-supported mothers feel their babies are prettier and smarter than what they perceive the “average baby” to be, make fewer trips to the emergency room and enjoy longer exclusive breastfeeding.

Appropriate Timing

As a midwife I have a bit of control over the situations around the birth. My style is to honor the parents as having the locus of control, but nevertheless, they look to me as a guide and guardian. I must be conscious that I don’t treat this trust casually. As midwives we guard the immediate reuniting of mamatoto. Skin to skin, quiet and dim, the mother and baby unfold into the mystery of their united duality.

But what of 10 minutes later, 30 minutes, an hour? Is Dad on the phone, are visitors coming in, is the baby in Sister’s arms? These events can act as an assault on the subtle yet vital needs of mamatoto and will not be regained, but only “patched up” psychologically with breastfeeding and a generally healthy esteem in the homebirth family.

Sadly, Americans have lost the sense of the appropriate timing of the first separation of mother and baby. As a midwife and a doula I am a fanatic about the first two hours of mamatoto. If I relax the standards they slip away fast. Who will speak for mamatoto if we midwives/doulas don’t? As I explain the importance of this time to nurses at hospital births, their willingness to attend to baby in mother’s arms increases. I preach these concepts at our doula trainings, which the majority of area doulas take from my partner and me.

At the beginning of our first Mamatoto Birth and Bonding newsletter is this bit:

This is Mamatoto. Love is recreated at the birth. Or, love is lost, missed. Pediatrician Marshall Klaus says the mother in labor is in a “Sensitive Period.” Educator Maria Montessori coined a Sensitive Period as a time of acute sensitivity during which the person can absorb modeled behavior and information to be expressed in their future behavior. It is a phenomenon that recurs over the life span. The newborn is in a tremendous Sensitive Period accentuated by the “quiet alert state” that lasts about two hours. Here the baby first learns what level of intimacy or separation one can hope from “Mother,” and so is the child introduced to the relative emotional safety of life.

At the same time, the birthing woman takes in the events and feels, perhaps for the first time, the texture of motherhood. Does she feel a sense of accomplishment? Does she trust herself after this experience? How does she now see herself as a woman? As a mother? What affirmations did she hear as she absorbed her role during this Sensitive Period? What behaviors were modeled by the hospital staff and others around her? Does danger or trust fill the room? And how is her child presented to her? Will nurturing embrace the future, or will raw survival set the tone of parenting?

Such are the concerns of Mamatoto Birth and Bonding Support. A supported birth is not only vital to the mother but enhances the baby, too. A confident new mamatoto pair grows the family, and the family grows the community.

Gail Tully, BS, CD (DONA), CPM, has been a doula for 21 years and a midwife for 12 years. Her bachelor’s degree is in social work.


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