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Dave and Cassie Liss with daughter Alexandra, 14 months, play after dinner Wednesday December 7, 2016 in their SW Rochester home. Doula

When Cassie Liss got pregnant roughly two years ago, the Rochester woman knew she wanted a doula to help her through the birthing process. There was just one problem — the idea initially flummoxed her husband.

While Cassie worked closely with doulas as a certified nurse midwife at Mayo Clinic, her husband, Dave, had no idea what the under-the-radar professional had to offer his wife during one of the most intimate, stressful times of their lives.

He's not alone. Only about 5 percent of births in Olmsted County are assisted by doulas, Cassie says. Mayo Clinic doesn't offer on-site doulas and Olmsted Medical Center offers them only on the basis of need, though both institutions do offer referrals.

As the Liss family raises a healthy 14-month-old girl named Alexandra, they are among those singing the praises of doulas. While Cassie had the luxury of professional insight and a pre-existing relationship with her doula, Kristi Urban, she feels it's an underutilized asset for expecting parents.

"After the fact, (Dave) was the one who said 'That was so worth it,'" Cassie said. "Part of her job is helping coach the partner. She would help guide him on what to do to be more helpful. Dads sometimes say some really interesting things because it's kind of out of their element. He felt like having her there was phenomenal."

DONA International, which has been training doulas for 25 years, defines the role as "a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible." They often assist during the prenatal visits, labor and postpartum care, and studies have shown they reduce the risk of C-sections, among other benefits.

Becoming a doula requires the equivalent training of an associate's degree, which is significantly less specialized than a midwife, which typically requires a master's degree in nursing.

Ancient Greeks viewed doulas as "female slaves" — the literal Latin translation of doula — but the practice has evolved to the point where doulas are welcomed and respected at virtually every medical facility to assist professionals during childbirth.

There are a dozen practicing doulas in the Rochester area, according to the Southeast Minnesota Childbirth Network, and nearly 300 across Minnesota. Most of those are concentrated in the Twin Cities.

Cost varies widely based on experience and services, with posted prices starting as low as $100 and ranging up to over $1,000. It's not currently covered by insurance providers.

Though the profession has been around for ages, awareness is lacking and misconceptions abound, according to Med City Doulas' co-owner Brittany Baker, who recently opened Rochester's first doula agency. Baker and co-owner Amanda Steele have hosted multiple community forums in hopes of spreading the word and helping to legitimize their business venture in the eyes of a skeptical public.

The next closest doula agency in the Midwest is located in Eau Claire, Wis.

"Honestly, it really has been battling some of the perceptions that are already in place in our medical community," Baker said of the biggest challenge. "People inquire about our services and then say, 'Well, I can find someone who does that for free.' That's been the biggest struggle. We're not someone who just holds your hand (through labor)."

Steele finds herself in a unique position to speak on doulas. She works in OMC's perinatal education department and is one of three doulas on staff. However, her doula skills are only used by OMC patients with extenuating circumstances, such as those with mental illness or whose partners are deployed.

Steele joined with Baker to create Med City Doulas in June, in part to help combat the profession's negative stigma and to make the services more readily accessible to expecting mothers.

"I knew there was a need," Steele said. "We can be trusted, we have training and we're not just attending births because we want to be there — we want to serve these moms and their families. It's not being utilized to its full potential."

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