Doulas: For pregnant women, for babies, for public health

By Gregory Kantor
BU News Service

More and more American women are turning to a relatively unknown source for support during their pregnancy. No, not their OB/GYN, but their doula. And as doulas continue to grow in popularity, questions surrounding their role are generating new discussions in maternal healthcare.

Doulas are non-medical birth coaches who support pregnant women before, during, and after childbirth. In fact, a common refrain is that, while doctors and nurses focus on the waist-down, doulas are there to support the waist-up.

“You’re not making decisions for the mom,” says Jenn Conti, a local Boston doula, “but you’re helping them figure out what is the best thing for them at a given moment. Then, a doula can help express those wishes to others.”

But there is plenty of evidence to suggest that doulas do more than just provide peace-of-mind. For example, continuous labor support, or ongoing, one-to-one care during labor and birth, involves the doula providing emotional support, comfort measures, and pain coping techniques. The practice recently received the support of the American College of Obstetricians and Gynecologists.

Recent studies also suggest that doulas can help improve a variety of maternal outcomes, including lower rates of Caesarian-sections and preterm births. Importantly, doulas may also help improve post-partum satisfaction.

But doulas can also be controversial. Some medical providers resent doulas, particularly if the doula is offering clinical advice, which Conti understands.

“Some providers are just like, ‘You stay out of my way. I make the decisions’,” says Conti. “And there are some providers who are kind of supportive of it … but at the end of the day it’s really just about what the pregnant person wants and what’s going to make her feel better.”

Open since 1997, the Cambridge Birth Center, affiliated with the Cambridge Health Alliance, is reflective of the increased use of doulas. Staffed by midwives and doulas, the Center offers a homelike birth experience with the convenience and safety of being next to a local hospital. (Photo by Gregory Kantor /BU News Service)

Another criticism of doulas is their cost, which can range from $500 to $2,500, depending on where you live. With this in mind, some states have expanded Medicaid to cover doula services and city-level programs also exist. The hope, experts say, is that subsidizing or eliminating the cost entirely will help poor or uninsured women access what might be a crucial piece of healthcare during their pregnancy. In fact, the benefits might also be passed along to the healthcare industry: By lowering C-section and preterm birth rates, doulas may be able to save hospitals and insurers up to $1,000 a birth.

A common goal of these programs is to combat the disturbingly high maternal death rates amongst women of color, which, in the United States, is four times that of white women.

And Lorenza Holt, a doula trainer and director of the Boston Association for Childbirth Education, uses these financial arguments in her advocacy efforts.

“Is our healthcare system going to want to pay to expand doula access for everyone? Probably not,” Holt adds. “But they’re already paying that and more with the poor outcomes that they’re that they’re creating. They’re failing mothers right and left.”

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