Dear Governor Cuomo,
On June 18, 2019, the doula profession became aware of that New York Legislators approved the House Bill A00364B and its counterpart in the Senate S03344-B.

While the doula profession commends New York state for attempting to address the serious impact our poor maternal and fetal health outcomes, especially in relation to racial disparities, has on our society, we have major concerns about some of the chosen language in the bill.

We would like to invite you, Governor Cuomo and all sponsors of this bill, into a conversation about how to achieve these important goals and how doulas can be a part of this, without inadvertently having an adverse effect on doulas and the community that you are trying to help.

There was a time where all women were simply supported from the start of labor through the postpartum period by other women. Eventually, modern obstetrics became the norm and giving birth in a hospital with only the support of staff became the social norm for birth. In just a few generations, women lost continuous labor support. Our current maternal health statistics reflect the lack of proper and continuous support for laboring and postpartum women.
Doulas, professional labor support, have sought to be part of the solution to poor maternal health outcomes and increased risks related to racial disparities.

We strongly believe every woman who desires a doula for continuous labor support be given access to one. Unfortunately, there are many circumstances which funds simply aren’t available.
Once again, we commend the effort to find a solution to grant more access to doula support, which is proven to improve outcomes, but we must address some concerns. Concerns which we feel could further limit access to doula care.

Our concerns include:
The Concerning Definition of ‘Certified Doula’ – The current language is concerning. It reads: “It provides the definitions of certified doulas and certified doula services and states that only a doula certified under this article shall be authorized to use the title of certified doula.”

Currently, doulas are not regulated in the United States. Several training and certification agencies exist to help bring a level of professionalism and education to the doula community.

Women certified by training organizations regularly refer to themselves as certified doulas as they have completed professional, peer-approved requirements.

Doulas provide non-medical support and thus to date, there have been no certification requirements in order to provide doula services. While this means consumers should do their due diligence during the hiring process, it means those with skills to provide continuous labor support are able to provide such services regardless of access to state certification programs.

While providing an opportunity to become state certified is a great step towards professionalism, will this language set the stage for potentially criminalizing doulas who do not pursue certification under the state of NY?

We feel different language provides more protection from unnecessary requirements to provide labor support. Perhaps, ‘State Certified Doula’ while allowing other certified doulas to continue referring to themselves appropriately as they have completed peer-recognized certifications.

The Potential to Further Disparities Among Minorities – It is proven that there are severe disparities in birth outcomes for women of color, especially African American women.

Regardless of their education, employment and age, African American women have the highest maternal mortality rate and at no fault to them.

It is well known that a level of systematic racism plays a role in these outcomes. While we aren’t certain exactly how and why, nor do we know the exact solution to end this, we do know changes need to be made.

It is imperative that more women of color be able to provide professional labor support for other women of color.

The language in this bill currently reads: “being of good moral character as defined by the department.” How is good moral character defined? Will the board deciding who is approved be diverse and reduce the risk for discrimination or biases?

Will this exclude anyone with a previous criminal history? We know for a fact that women of color are disproportionally criminalized putting them at a disadvantage in building a career. Women of color are best suited to support other women of color in an effort to reduce disparities in maternity care.

What negative impact will this have on the very population we need to improve outcomes for?

The Impact on Those in Poverty and With Other Disadvantages – Exam and fee requirements to become certified through the state should this bill pass. Will these requirements reduce the number of women in poverty able to pursue certification? What will happen to the community doulas already serving women if they’re unable to afford exams and fees?

Doulas are non-medical providers. While many certification agencies require submitting proof of knowledge regarding evidenced based birth practices and clear understanding of scope of practice, none currently require a supervised, formal exam.

Will a well skilled doula who is not a native speaker be intimated by the exam requirement? Will this exclude an extremely qualified and skilled doula who happens to have a learning disability?

Adjusting these requirements could be vital to ensuring adequately skilled doulas can continue to practice, especially within their own communities, to be part of the solution to our poor maternity care outcomes.

The Bill Is Modeled After Struggling Pilot Programs – Several community doula and Medicaid covered doula programs have attempted to provide continuous labor support to as many women as possible regardless of a mother’s personal ability to pay. Unfortunately, many of these programs are not sustainable.

This bill is modeled with the idea these pilot programs have been successful. However, if they are not sustainable, is modeling this bill after that style program a benefit to anyone?

While many doulas enter the profession as a calling and with a desire to help, they cannot continue to practice long term without proper compensation. The nominal reimbursement of many pilot Medicaid programs became a hurdle to these programs lasting long-term. Modeling this bill after such programs may set up the entire doula profession in the state of NY to struggle.
The bill does attempt to address the need for continuous labor support for women. However, we feel very strongly that changes need to be made.
Any bill which leaves the opportunity for further racial disparities, socioeconomic discrimination and poor compensation for doulas, is not a bill which can have a positive impact on maternity care.
We ask that you, Governor Cuomo, and the New York State Legislators consider the importance of the language of this bill and how we can protect birthing women, women in all communities, and doulas.

On behalf of all of our New York Members,

Sincerely,

Aliza Bancoff, Director,

International Doula Institute

484-278-1648 x402

Why Amy Schumer Is Thankful She Used A Birth Doula

If you follow celebrity news, it’s no surprise Amy Schumer is more than thankful her pregnancy is over. Schumer reportedly suffered from hyperemesis gravidarum throughout her pregnancy; meaning she had relentless nausea and vomiting necessitating hospitalization and IV treatment.

And while she’s more than relieved her pregnancy is over, she didn’t simply suffer through the birth process like some believe is the only option. Schumer, like many other celebrities, made use of a professional birth support known as a doula.

Schumer can even say she went the royal route, as Meghan Markel the Duchess of Sussex reportedly hired a doula to welcome her first born, Archie Harrison Mountbatten-Windsor.

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Ok here’s my post baby annoying post and my takeaway from pregnancy. Women are the shit. Men are cool and whatever but women are fucking warriors and capable of anything. I was lucky enough to get to have a doula. Her name @domino_kirke @carriagehousebirth what do doulas do? I don’t totally know But what she did was make me and Chris feel totally secure and supported throughout my pregnancy and the birth process. I really recommend getting one if you can. Doctor Brill and all the nurses and pediatricians at Lenox Hill and all the other hospitals i spent time in this year, thank you for everything. I did Pilates with strong women and went for walks. I threw up violently and felt sick mostly every day of my pregnancy. Hyperemesis is real and it’s awful. But fuck, what they say is true. The second you give birth it’s gone. @hgmoms has the best research I found on the condition The only thing that helped me with my nausea was products from @thelordjones I learned that globally 1 in 5 births take place without the assistance of a skilled birth attendant. @everymomcounts is a great place to donate $250 equips a midwife with a bag of medical equipment needed to provide care to hundreds of women and babies in Guatemala. All my friends. Friends I’ve had for 30 years or people who encouraged me to “keep going” or telling me “it will be worth it”. Thank you. Every woman I encountered is so willing to help and advise you and I felt all their strength. And you were right. Thank you ladies from my family. Chris, Gene and of course Tatiana #titsleaking #wearingadiaper

A post shared by @ amyschumer on May 11, 2019 at 11:13am PDT

Why Having A Doula Was Completely Worth It

Schumer faced a horribly challenging pregnancy. For many women facing HG, giving birth can be extra hard as they’re already feeling defeated by pregnancy. Many wonder if they’re going to be defeated by birth too.

Rather than waiting to see, Schumer made an excellent choice to set herself up with amazing support. With doula Domino Kirke of Carriage House Birth, Schumer was able to go through her birth set up to have a positive birth experience after a harrowing pregnancy experience.

What’s most amazing about doulas, you don’t even need to understand exactly what they do to fully benefit from their care.

Schumer wrote, “…what do doulas do? I don’t totally know. But what she did was make me and Chris feel totally secure and supported throughout my pregnancy and the birth process.

“I really recommend getting one if you can. Doctor Brill and all the nurses and pediatricians at Lenox Hill and all the other hospitals I spent time in this year, thank you for everything. I did Pilates with strong women and went for walks. I threw up violently and felt sick mostly every day of my pregnancy. Hyperemesis is real and it’s awful. But f***, what they say is true. The second you give birth it’s gone.”

A doula is support. A doula brings security. A doula is there throughout your pregnancy, your birth and during the postpartum period. Schumer may have had an incredibly hard pregnancy, but she had the best support available.

The most amazing thing about doulas, whether you’re a royal, a celebrity or an every day mom-to-be, you receive the same professional and personalized support.

Why Are Doulas Recommended?

The World Health Organization (WHO) recently shared a Cochrane Review comprised of 26 randomized controls including more than 15,800 women.

The WHO reported, “The authors found that women who received continuous labour support were more likely to give birth vaginally, and had fewer caesarean, forceps or assisted vacuum births. In addition, women were less likely to use pain medications, were more likely to be satisfied with their birth experience and had shorter labours. It was also found that newborn babies were less likely to have low ‘Apgar’ scores – a test for the vital signs of health and well-being in infants. No harms of continuous support were identified.”

Whether Schumer utilized medicinal pain relief or not, for a woman who battled HG for nine months, the extra support to reduce the risk of interventions could have been vital in helping her have a healthy birth.

Some research indicated an increased risk of perinatal complications in women suffering from HG, especially for those who suffer beyond the second trimester.

The American College of Obstetricians and Gynecologists (ACOG) released Approaches to Limit Intervention During Labor and Birth, a committee opinion. They wrote, “Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”

While anyone can hire a doula, access can vary in different communities. As professional support for births, most doulas do have a fee as it is their profession and livelihood. Continuous labor support is proven to improve birth outcomes, so slowly we’re seeing more initiatives to make doulas available to more women.

Should I Hire A Doula?

There are few times in most of our lives where we can say we hired or experienced something like a royal or a celebrity. By hiring a doula, you could say you did both.

Of course, for most birthing mothers, that’s the furthest thing from their minds. Most birthing mothers hope for a healthy birth and a positive experience along the way. While a doula can’t guarantee anything, evidence truly shows they improve birth outcomes.

Women who give birth with the non-medical support of a doula (alongside their medical care providers) can experience:

• A reduced likelihood of a c-section birth or assisted birth (forceps or vacuum)
• A reduced likelihood of using medicinal pain relief such as an epidural
• Reporting a positive birth experience, even when medical intervention is chosen or necessary
• A shorter duration of labor
• Increased breastfeeding success

Be sure to read Should I Hire A Birth Doula? Evidence, ACOG, And Celebrities Say, ‘Yes!’ to learn more.

And to Amy Schumer, happy first Mother’s Day warrior mom!

(embed – https://www.instagram.com/p/BxVPcp1l9jd/ )