Doulas and Their Potential Impact on the Maternal Health Crisis
Updated: Dec 30, 2021
Author: Michela Crowley
23 March 2021
What is a Doula?
Doulas provide support through major life transitions, most notably childbirth and the postpartum period. Doulas go through training to learn how to support folks through pregnancy, childbirth, postpartum, abortion, and even death.
A Birth Doula is essentially a birth coach hired by a birthing person (and partner) to assist them through pregnancy, continuously throughout labor and delivery, and during the immediate postpartum period. Doulas are not medical providers.
Birth doulas provide condensed childbirth and lactation education prenatally; physical and emotional support during labor and childbirth; attuned physical and emotional support in the immediate postpartum period; as well as advocacy at every step of the way. A doula is a member of your team and they work with you to help you feel agency and empowerment before during and after your birth.
Studies have shown that having a doula present throughout your birth can have an enormous impact on birth outcomes.
Participants who had a doula present throughout their birth showed:
39% decrease in the risk of Cesarean
15% increase in the likelihood of a spontaneous vaginal birth
10% decrease in the use of any medications for pain relief
Shorter labors by 41 minutes on average
38% decrease in the baby’s risk of a low five-minute Apgar score
31% decrease in the risk of being dissatisfied with the birth experience (https://pubmed.ncbi.nlm.nih.gov/28681500/)
The current state of maternal health in the United States is bleak. Despite spending more money on healthcare than any other country in the world, we rank 59th in the world for maternal mortality, and we are the first generation to be more likely to die in childbirth than a previous generation in US history. The CDC has concluded that 6 out of every 10 childbirth-related deaths are preventable. 50% of all pregnancy-related deaths occur postpartum, within the 42 days after childbirth (www.cdc.gov).
There are enormous racial disparities within the maternal mortality crisis. Nationally, Black women are almost 4x as likely to die from childbirth related complications than white women; in New York City, they are 12x as likely. This shocking statistic can be directly linked to factors such as: poverty, chronic stress/intergenerational trauma, lack of access to healthcare and medical racism.
Uplift and Amplify Black Birth-workers (doulas and midwives)
We know that Black mothers and infants are safer when cared for by Black providers. Uplift, meaning to fund, support, and pay reparations to Black birth-workers and community organizations that provide doulas or train doulas. Amplify, meaning promote, advertise, share, and refer the services of Black birth-workers. Engage with politicians and organizations advocating for changes that will protect Black mothers and infants (https://www.healthline.com/health/parenting/black-maternal-health).
Center Postpartum Care
A healthy baby is not all that matters. A healthy mom is absolutely crucial. Postpartum doulas, who are hired by a pregnant person to help with newborn care, lactation/feeding, cooking, some cleaning, and for emotional processing as well, tend to the mother to make sure that she is being nourished so that she can be present with her newborn. This support can also come from friends or family as well, however is most often not available to the extent at which it is needed in our culture.
Paid Family Leave
American College of Obstetricians and Gynecologists recommends a minimum of 6 weeks paid parental leave. Currently, the US is one of only three countries worldwide to guarantee 0 weeks paid family leave. Some benefits of paid family leave are a reduction in infant mortality, increased likelihood and duration of breastfeeding, and mental health benefits for mother (less postpartum depression).
Medicaid pays for more than 40% of births nationwide. Most women lose their Medicaid coverage within 60 days of giving birth. For many this means an end to all access to healthcare, and as we know half of pregnancy-related deaths occur during the year postpartum, a time when many women no longer have health insurance.
Examine Implicit and Explicit Biases
Implicit bias: attitudes and beliefs we associate with a person or group without conscious awareness
Explicit bias: attitudes and beliefs we have about a person or group on a conscious level
We all, specifically medical and mental health professionals, need to do our own personal anti-racism work. Anyone supporting BIPOC communities needs to actively work to unlearn racial biases, both implicit and explicit. Consult with Black educators, therapists, doctors, authors, teachers, and leaders to engage with anti-racism work. Listen and reflect- the work is personal. No one can opt out of anti-racism work without compromising the care they are providing to clients, friends, and family members.
Some resources on Anti-racism and Birth-work:
Birthing Advocacy @birthingadvocacy
Ancient Song Doula Services @ancientsong
Evidence Based Birth @ebbirth
Every Mother Counts @everymomcounts
Black Mamas Matter Alliance @blackmamasmatter
ShiShi Rose @shishi.rose
American Medical Association: https://www.ama-assn.org/about/leadership/our-black-maternal-health-crisis-american-tragedy
If you use these sources for your own anti-racism work, pay reparations directly to the Black person who has provided you with the information or, if applicable, to their organization.