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Monnie Reba Efross has been a labor and delivery nurse at San Francisco General Hospital for the last 30 years. A petite woman sporting a red long-sleeve shirt, an orange fleece vest and green pants, she’s also a birth doula.

“This is my way of being revolutionary,” said Efross.

Not to be confused with midwives or nurses, nor meant to replace partners or eager grandmothers, birth doulas provide a mom-to-be with the emotional and physical support she needs to carry out a healthy delivery, which can also include prenatal care. Their role is to encourage the laboring mom, keep her informed, hold her hand and rub her back, and involve any relatives that are around in the birth.

Studies have shown that the presence of doulas decreases the number of caesarian sections and epidurals, increases breastfeeding rates and creates an overall positive birth experience. Some doulas also provide postpartum support, attending to the needs of both mom and baby.

“Doulas are doing the essence of women’s work,” said Efross. “Their skill, their presence is invaluable.”

An experienced doula can charge a private client anywhere between $300 and $750 to attend a birth. As a result, it’s traditionally been middle- and upper-income women who hire doulas, and most of the doulas in the Mission District are white women. Now, however, thanks to volunteer and community-based programs, more low-income and Latina mothers have access to doulas, and they are being trained right in the Mission.

That’s due in large part to Efross. Five years ago she founded a volunteer doula program at SFGH, where 70 to 80 percent of the women giving birth are Latina. Now the program is taking off, creating a cadre of doulas who are from the community.

Recently, she received a $29,000 grant from the San Francisco General Hospital Foundation – the first time it has funded the endeavor – to expand and strengthen the program. Thirty doulas are currently active, each working a 12-hour shift a month, and Efross’s goal is to have 60 by summer.

Her first order of business is “to train the same women who’ve had babies at the General,” she said.

Efross initially struggled to keep her volunteer program afloat. When she applied for the same SFGH Foundation grant five years ago, she was turned down. Running it single-handedly, she counted on only 10 doulas in the first three years.

Since then, however, the popularity of doulas has grown.

The Homeless Prenatal Project, a nonprofit in the Mission District that works with families with children, started its own volunteer doula program in 2006. Last year, the number of client requests for doulas more than doubled from 40 to 95, according to Beth Helton, the organization’s volunteer coordinator. This year, they’ve already had 17 requests. Thirty-four doulas are currently active, eight of whom joined the program in the last two months.

Doula services are also enjoying increased financial support nationwide.

In his budget for 2010, President Obama allocated $1.5 million to community-based doula programs. The first federal funding to be allotted specifically to doula programs was just two years ago, as part of the 2008 Omnibus Bill.

HealthConnect One, a Chicago-based nonprofit that promotes mother and infant health, led the advocacy efforts behind the bill. With the funds they initially received, they developed a model for what a community-based doula program should look like and defined who the doulas should be.

“I thought I was a community doula, but when I was servicing teenagers, I wasn’t going to their house, I didn’t grow up in that neighborhood. The language barrier is critical, too,” said Laura Alpine, HealthConnect One’s advocacy consultant, who was a doula for three years.

“A community-based doula is a woman from and of the community that she’s servicing,” she said.

In the Mission District, Efross is leading the way in efforts to train community-based doulas. Aided by the new grant, this month she held the first community volunteer doula training in the offices of the Homeless Prenatal Project and networked with organizations such as the Teenage Pregnancy and Parenting Project to recruit women.

Gina Padilla-Quintanar (left) watches as other doulas-in-training simulate helping a laboring mom.

Of the 14 doulas-in-training in attendance, five were Latina and bilingual.

“It’s been my dream,” said Gina Padilla-Quintanar, 55, of becoming a doula. An immigrant from Mexico, Padilla-Quintanar has been in San Francisco for the last 30 years. She’s a community relations specialist for the Migrant Education Program at Mission High School and serves as an English/Spanish interpreter at SFGH on the weekends.

“It’s important to give mothers an option,” she said. “This will give me more resources to offer the families I work with.”

Karent Novelo, originally from Yucatan, Mexico, gave birth to her twoyearold son at San Francisco General Hospital with the support of a volunteer doula from the Homeless Prenatal Project.

“My husband was there [at the birth],” said Novelo in Spanish, “but I didn’t have my mom with me so it was helpful to have a doula. It was really nice.”

Novelo now gives prenatal classes in Spanish at the Homeless Prenatal Project and was at Efross’s doula training. Like Padilla-Quintanar, she wants to extend the work she’s doing with Spanish-speaking mothers by becoming a doula who speaks their language.

Twenty-three-year-old Gaby Diaz was also at the training. Having been a teenage mother and working with the Teenage Pregnancy and Parenting Project, she’s seen the benefits of having a doula during birth.

“I want to offer that support,” said Diaz.

Over the next year, Efross will also develop Spanish-language doula trainings with the help of Maria Cardenas, 25, a bilingual doula currently on staff at SFGH. But Efross’s goals don’t end there.

“I want the doulas paid because I want that value out there,” said Efross, who intends to keep fundraising to that end.

Susan Arthur, who works part-time as a private doula as well as volunteers with the doula programs at SFGH and the Homeless Prenatal Project, agrees that doulas should be paid for their work.

“We make it really hard to be a mother in this country,” she said. “We’re all trying to do work that should be sanctioned and blessed and paid for and subsidized by the United States government.”