Eighteen years ago, when Jessica Koester searched for a doula ahead of her third child's birth, she had the choice between three in her area.

Today, she can enter her ZIP code and find nearly 80 certified women who want to support a laboring mother before, during and even after they've given birth.

"I think part of that is because there's a lot more acceptance in the medical community for doulas than there was years ago," Koester, a Parlin-based birth doula/doula trainer, told New Jersey 101.5. "It's a lot more mainstream than it had been."

General perception of the non-medical profession has evolved over time as well, she said. Doulas provide emotional, physical and informational support — they're wrongly associated with unmedicated or home births.

Demand for Koester's services have increased, she said, particularly over the past few years. Some clients have used her expertise for a number of births. She still receives Christmas cards from the first person whose birth she attended 17 years ago.

Through her business, Your Best Birth, Koester offers birth-doula training to women looking to maximize their success in the field. Participants attend a three-day workshop towards a Doulas of North America certification. The cost is $500, an investment one can make back in one or two births.

Certification is not mandatory — anyone can claim to be a doula — but Koester said certification is valued by clients and medical professionals.

Almost always on hand for the birth itself, beyond support leading up to the big day, birth doulas also arrange for a visit in the days or weeks following birth, Koester said.

Postpartum support, however, can require much more than one chat. In shorter supply are postpartum doulas, trained to lead a mother in the weeks or months immediately following the major life change.

"The moment your baby is born, you go from being pregnant to recovering from labor, and possibly even surgery, to lactating," said Beth Salerno, a postpartum doula out of Farmingdale. "It's just a tremendous amount of physical and emotional demands that require support and care."

Beth Salerno (right), of Farmingdale, has served as a postpartum doula for 15 years.

And not only first-time mothers need a hand to hold, Salerno said. Last winter, she assisted a woman who had just given birth to her fifth child.

"When I come in, my first priority and my primary priority is the mom because the baby's survival depends on the mom being healthy," Salerno said.

Salerno said her services are crucial in a country that doesn't do much for new moms, while other parts of the world offer women forty days of rest and recuperation.

In July, the state Department of Health announced that $450,000 would be devoted to a doula pilot program in municipalities with high mortality rates among black infants. Part of the funding would pay an independent evaluator to examine the effectiveness of the program in reducing the likelihood of certain birth and labor outcomes such as C-sections.