WATERLOO - Expectant mother Sarah Twito Hess is anxiously awaiting the arrival of her first child in November. It's a time frought with emotions that range from elation to worry. But with the help of her doula, Janice Ephraim, Hess' fears are allayed.

"Perhaps the most crucial role of a doula is providing continuous emotional reassurance and comfort to the mother," said Ephraim, who is working to complete her doula certification.

The term "doula" is a Greek word meaning a woman who serves. In labor support terminology, a doula refers to a specially trained birth companion (not a friend or loved one) who provides labor support. Doulas specialize in non-medical skills and do not perform clinical tasks. A postpartum doula may assist the mother with newborn care, breastfeeding support and advice, cooking, child care, errands and light cleaning for the new family.

Recently, Hess met with Ephraim to discuss child birth plans. Ephraim offers Hess physical and emotional support and assists her in gathering information about her options during labor and delivery. She offers advice on comfort measures such as breathing, relaxation, movements and positioning during labor.

"I had heard a little about doulas before Janice gave me her brochure, but then I did some research," Hess said. "I see the role of a doula as a cheerleader or coach and a support person to help avoid unnecessary medications and procedures during labor and delivery."

Ephraim's goal is to help Hess have a safe and satisfying childbirth as Hess defines it. "I am there to help a mom become informed about various options and then to support her choices," she said.

Ephraim became interested in becoming a doula after entering the empty nest stage of her life. She always had been interested in working in a health care setting. Working with new moms seemed like the icing on the cake.

"Using Janice as my doula was a great experience," said Alli Spevick, of Hudson, who recently used Ephraim's services during the birth of her son, Peter. "The emotional and physical support that she gave was wonderful. She was a really calming presence and she knew some great massage techniques."

Like Ephraim, Leilani Hall is working on her doula certification. Trained as a registered nurse specializing in labor and delivery, she saw a need for doula services in the Cedar Valley.

"When I first moved here a year ago there was one lady that I knew of who was practicing as a doula, but she was moving away," Hall said.

Now, Hall said there are 11 women in the area who are expected to complete their doula certification by December.

"Studies show that having a doula present decreases the incidences of cesarean births and the need for pain medication during labor and delivery," Hall said. "Studies also show that women who have doulas report being more satisfied overall with their birth experience and that the overall perception of childbirth is more positive."

Buffy Constant, of Independence, has been a doula for seven years. She also is a childbirth educator for Covenant Medical Center. More and more women are recognizing the important role of a doula during childbirth, and even insurance companies are beginning to catch on.

"More and more health insurance companies are acknowledging the benefits of having a Doula on your labor and delivery team and are now covering the cost," Constant said. "It's well worth your time filling out the necessary paper work and giving it a try."