Nadia Stein (r) teaching women what to expect during pregnancy

Nadia Stein serves sandwiches to women who attend Community Doula Program (CDP) classes. She explains, “I serve andwiches because I don’t want pregnant women to come here for two or three hours without eating or drinking. Pregnant women need to eat very often in order to stay healthy.”

Proper nutrition during pregnancy is one of many topics taught to the hundreds of expectant women who attend free CDP classes at the Magnolia Multi-Service Center in the Second Ward. Most of the women speak only Spanish, and all of them are from low-income families. They have the fewest resources and the greatest need for help.

When Ms. Stein—a certified childbirth educator and lactation consultant—was project coordinator for a study at Ben Taub Hospital during the 1990s, she noticed that the pregnant women coming in were getting younger and younger. She remembers, “I learned what happened to them during pregnancy, saw what happened in the
delivery room and was concerned about what happened to the babies after they left the hospital. I realized that if women were better prepared, they would do much better for themselves and their children.”

With a grant from the March of Dimes, Ms. Stein established CDP in 1996 to educate women—and a few of their husbands—about childbirth. “It’s rare for husbands to attend, because missing a day’s work has strong consequences,” says Ms. Stein. “But as the women become educated, they talk to their husbands about what they’ve learned and some of them want to get involved. At first they don’t know what to expect, but with
knowledge we dispel a lot of fear. It’s not unusual for a husband to say to his wife when she has a question, ‘Call Señora Nadia. She will know.’”

Through discussions, posters and videos, Ms. Stein and the other doulas (“in service” in Greek or, commonly, “mothering the mother”) demystify birth by explaining the physiology of the process so women know what to expect. “Most women don’t know how their bodies function,” says Ms. Stein. “For instance, they don’t know that their contractions, which are produced by hormones, cause the cervix to open and relax so the baby can come through. The baby inside simultaneously puts pressure on the cervix with its head and also helps it to open. The more women understand, the easier it is for them to relax and not be so afraid about what’s happening.”

The doulas also teach women about warning signs. Karla Tapia, a former client and current doula, remembers, “Before I came to the Community Doula Program, I thought it was normal that my hands and feet were swollen. I learned that it was a very dangerous sign. I also learned to look at the color of the water when it breaks. If it’s yellow, like mustard, it’s very dangerous because the baby can get an infection. I never heard about this before.”

In addition to showing women what to expect physically and emotionally during pregnancy, how to relax during delivery and how to breast-feed and care for a child after birth, CDP also encourages and trains participants to become doulas. Ms Stein says, “I want to teach those women who come through the program to become doulas so they can reach out into the community. Not all mothers can afford to become doulas because we can’t give everyone a salary, and many of the mothers must return to work. But in their own way, they all become doulas.”

CDP’s contribution to the well-being of families and communities extends far beyond Houston. Officials from Azerbijan have visited several times and plan to duplicate the program in their impoverished nation. The World Health Organization may establish similar programs in far-away places throughout the globe. Ms. Stein states simply, “The first person who provides health care is the mother in the family, and this is a vital link that we often forget. Whether in Texas or Azerbijan, it is a link that we cannot ignore.”

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