It is no secret that the maternal infant mortality and morbidity outcomes in the United States need to be improved. It’s also no secret that we see significant disparities among black, indigenous, and non-white women when compared to white peers, even when we account for income and education.

We also see concerning outcomes among women with maternity care provided by Medicaid insurance programs. The Doula Medicaid Project hopes to address some of these disparities on a national level. While many programs exist at the local and state levels throughout the US, there is not a national program truly addressing maternity care concerns.

What Is The Doula Medicaid Project?

The Doula Medicaid Project states, “The National Health Law Program’s Doula Medicaid Project seeks to improve health outcomes for pregnant Medicaid enrollees by ensuring that all pregnant individuals enrolled in Medicaid who want access to a doula will have one.”

Simply, their goal is that women desiring doula support have access to doula support. While on one hand doula support seems like a luxury, the evidence shows doulas play a huge role in maternity care.

Both the World Health Organization (WHO) and ACOG recognize continuous labor support, like that of a doula, improves maternal infant health outcomes. This means that from a medical ethics standpoint, and a public health standpoint, access to doula support simply makes sense.

Continuous labor support poses no risks. However, it does provide many benefits including but not limited to:

• Lower risk of c-section birth
• Increased likelihood of reporting a positive birth experience
• Lower rate of pharmacological pain relief
• Increased breastfeeding initiation and duration
• Shorter duration of labor
• Increased likelihood of spontaneous vaginal birth

All those outcomes, and others, are important markers for maternal health outcomes. The WHO recommends a c-section rate of about 10-15%. The US has about an overall 30% c-section rate, meaning half of all c-sections may be medically unnecessary.

Who Is Involved With The Doula Medicaid Project?

Surprisingly, doulas do not run the Doula Medicaid Project. Clearly, doulas are pivotal to projects related to doula care. However, other professionals run the national level program.

They explain on their site:

“We are lawyers, researchers, and policy advocates. We are not doulas. As such, we seek to do all our work in partnership with and with the guidance of community doula groups, doula collectives, and individual doulas, especially Black doulas and Black-led doula groups, as well as doulas and doula groups serving low-income clients.”

Given the complexities of national level healthcare initiatives and programs, the work of lawyers, researchers and policy advocates is vital. They maintain understanding of the importance of doulas in this process however, and work in close contact with them.

What Outcome Does The Doula Medicaid Project Hope To Achieve?

In short, their goal is that every woman on Medicaid who desires a birth doula have access to one. Their reasoning is not just that each woman feels supported, but that we see improved maternal infant health outcomes.

In their own words, the reason for this program goal:

“Low-income women are at the highest risk of poor birth outcomes in the United States, and women of color, especially Black women, are especially vulnerable. Doula care is among the most promising approaches to combating disparities in maternal health. Women receiving doula care have been found to have improved health outcomes for both themselves and their infants, including higher breastfeeding initiation rates, fewer low-birth weight babies, and lower rates of cesarean sections. Doulas can also help reduce the impacts of racism and racial bias in health care on pregnant women of color by providing individually tailored, culturally appropriate, and patient centered care and advocacy.”

What Is The Doula Medicaid Project Doing To Achieve Their Goal?

Unfortunately, making change on the national level can take quite a bit of time. However, as experienced attorney, researchers and policy advocates, they are working hard to implement change.

They are currently:

• Working with doulas to find and remove barriers for an equitable and sustainable Medicaid doula coverage program
• Educating legislators about the disparities and problems with our current maternal infant health outcomes
• Facilitating information gathering across states and counties that have Medicaid doula programs
• Advocating on the state level for Medicaid coverage of doula care

To learn more, visit the Doula Medicaid Project Website.

While doula is quickly becoming a household word, the exact role of a doula isn’t always understood. Individual doulas and organizations have differing definitions for a doula. This can further confusion about a doula’s scope of practice. Many wonder if birth doulas are advocates or activists.

One of the most common misconceptions about birth doulas is that they’re equivalent to a midwife. Doulas are completely non-medical and do not offer clinical care, while midwives are clinical healthcare providers.

The other common misconception is related to a doula’s role at a birth. Is a birth doula there to be an advocate for her client? Is she meant to be an activist as well?

At the International Doula Institute (IDI), we strive to provide a clear scope of practice for our doulas. We work to provide training in-line with the long history of birth doula care. Birth doula support, advocacy, and activism sometimes coexist but there are differences.

Here we explain each role and what it means as a birth doula:

Are Birth Doulas Advocates?

Many women seek a birth doula because they desire a certain type of birth experience. They hope to have an empowering and positive birth experience, whether it be unmedicated or medicated. Fear about c-section rates, episiotomy rates, and more, some seek to hire a doula to advocate on their behalf.

However, the role of a birth doula is not to advocate in place of a mother or her birth support person (significant other, friend, or relative). Instead, a birth doula’s role is to equip and empower a client and her family to self-advocate.

The difference between a positive birth experience and a negative one often comes down to how a birthing mother was treated. Was she heard? Did everyone treat her with respect? Did she have an active role in decision making?

Birth doulas seek to provide prenatal education about birth options and patients’ rights so clients are confident in advocating for themselves. A birth doula does not want to take power away from a client but help her use her own power. In the event the client is unable to advocate for herself, her birth partner is also equipped to advocate for her.

During the birth, a doula also reminds clients of their right to ask questions and make informed decisions. Rather than saying, “My client does not want an episiotomy,” when the topic comes up, she might say, “Sarah, the doctor is discussing an episiotomy. You mentioned you did not want one, do you have any questions for your doctor?”

In the first example, the doula is speaking for the client. In the second she is reminding the client of her right to ask questions and to consent or deny a procedure. This gives the power back to the birthing woman.

Are Birth Doulas Activists?

In short, some are and some are not. The more nuanced answer is there is a time and place for activism and during a client’s birth is not typically the place.

Many birth doulas take part in improving birth outcomes through social, NGO, and government based programs. Some birth doulas work on public education and awareness about maternal infant health and disparities or challenges their clients may face. There are also birth doulas who take part in lobbying at the local and even federal government levels.

A professional birth doula isn’t going to push any activism during a client’s birth as it would be distracting. However, if they noticed concerns about policies while attending birth, they might pursue community based action outside of a birth.

As a professional doula, you can decide how much or how little activism you participate in. It’s rare for a birth doula to see disparities and not desire to be part of activism on some level. The most important thing to remember, however, is that you never do something during a birth which would take away from your role of birth support.

What Do Doulas Do When They See Something Negative During A Birth?

One of the hardest things about supporting births is knowing that not all births unfold perfectly. A doula may see her client being treated unfairly. Doulas also witness birth trauma.

It can be extremely difficult as secondary trauma is a real thing. Each birth doula handles these scenarios slightly differently and may do so based on any guidelines their certifying organization has in place.

In some cases, doulas will speak up. However, a doula should support and encourage a mother in an empowering way. Other doulas simply support their client through the challenge and help them debrief afterwards.

As a doula, if you witness a difficult birth or unfair circumstances, be sure you have a doula partner or mentor you can debrief with. If a mother feels her birth was okay, even if it seemed unpleasant to you, it’s important you do not impact her view.

It can be extremely difficult but one saying some doulas use is, “Not my body, not my baby, not my birth,” as a reminder to simply be present and supporting. Your biggest role will be prenatal education and support that encourages self-advocacy.

Use your time outside of birth to be an activist and community advocate to help improve overall birth outcomes.

Whether you’re a prospective student or parent to be, you may be wondering what exactly a doula is. While the name is quickly becoming a household term, the definition and role of a doula isn’t always known. There are many frequently asked questions about doula care. We want to share the most common FAQs and answers with you.

Often, doulas are confused as being the same as midwives. Occasionally, people think doulas are only associated with water births, out-of-hospital births, or even unassisted birth. While some doulas work in those scenarios, the average doula does far more.

Here are 6 FAQs about doula care:

Is A Doula The Same As A Midwife?

The short answer, no, a doula is not the same as a midwife. A midwife is a healthcare provider you choose instead of or in addition to an OB physician.

Midwives are trained clinical providers. They provide medical care before, during and after pregnancy. Midwives are qualified to do everything an OB physician does during birth with the exception of performing a c-section.

A doula is a non-medical provider. Doulas offer physical and emotional support before, during and after birth. A doula is qualified to:

• Provide evidenced-based prenatal education (excluding medical advice)
• Give resources on nutrition and lifestyle
• Share information about exercise during pregnancy
• Help families understand their birthing options
• Provide physical and emotional support during labor
• Help with comfort techniques during labor
• Coach and support the birth partner/significant other in supporting the birthing person
• Help a birthing person find a comfortable position
• Provide continuous labor support
• Help with breastfeeding initiation
• Provide in-home postpartum recovery and infant care support

Doulas play a vital, but non-clinical role, in care for pregnant, laboring, and postpartum women.

Why Do Doula Attended Births Have Better Outcomes?

Research shows that when there is continuous labor support, birth outcomes are improved. Multiple randomized and control studies have found the presence of a trained birth doula improves birth outcomes.

Doula care can mean:

• Shorter labors
• Reduced likelihood of using an epidural and other pains meds
• Lower episiotomy rates
• A reduction in c-section rates, possibly up to a 50% reduced risk

Women who give birth with a doula attending also often report higher satisfaction in their birth experience. Research has also found there are less NICU admissions, improved breastfeeding rates, and even improved family bonding.

Both mothers and their partners are more likely to have a positive birth experience with a doula present. Doulas actually decrease the hospital’s cost of supporting a birthing woman while also increasing patient satisfaction. Doulas improve birth for parents and professionals alike.

Can A Doula Help With Epidural Births?

Absolutely! In fact, there are no births that contradict the use of a doula. During an epidural birth, doulas still provide physical and emotional support. Having an epidural doesn’t mean labor is uneventful nor does it mean less support is needed.

A doula can assist with position changes, guided relaxation, coach partner in gentle massage, run practical errands (such as grabbing you a drink), and assist after baby is born with breastfeeding initiation.

Regardless of how one plans to or ends up giving birth, a doula is a wonderful support.

Do Doulas Support C-Section Births?

This is one of the most frequently asked questions about doula care. Just like an epidural birth, doulas can support parents during a c-section. The nature of the c-section, the hospital policies and how everything unfolds may impact the doulas role. However, they still offer significant support.

Prior to a c-section they can help you make informed decisions about your care. They can assist with emotional and physical support should a partner need to go with baby. They assist with breastfeeding initiation and postpartum support as you recovery from major surgery.

Does A Doula Replace The Father or Partner?

Absolutely not. A doula provides support for the entire family unit. However, should a birthing woman be alone during birth, for any reason, a doula can provide excellent support.

In most cases, women have a partner, relative, or friend acting as their primary support. The doula is there to support that unit alongside supporting the mother. Doulas facilitate healthy couple and family bonds, they do not interfere with them.

How Do I Become A Doula?

Now that you’ve read through our frequently asked questions about doula care, you might be ready to jump into your new career! Becoming a doula allows you to take your passion for birth and turn it into a meaningful career. Many doulas choose this career because they understand the importance of supporting parents.

To become a doula, one must take a training and, in most cases, become certified through a recognized organization. At the International Doula Institute, we provide a comprehensive, fully online doula training and certification program.

With IDI, you can work at your own pace while developing all the knowledge and skills necessary to become a certified doula.

You can click here to register today.

Even in the most perfect circumstances, welcoming a new baby is intense. For parents welcoming a new child in 2020, the intensity is unlike anything we’ve seen before. Many doulas have become a lifeline during covid-19 as parents face unusual circumstances.

New parents can’t change the local safety restrictions. They can’t change hospital policies put in place to hopefully curb potential spread in labor and delivery units. However, parents can work with a doula to be fully supported throughout the pregnancy, birth and postpartum period.

In many areas, especially the hardest hit ones, doulas have become a lifeline during Covid-19.

How Have Doulas Become A Lifeline During Covid-19

Many women are facing prenatal appointments and even important scans all alone. Due to safety restrictions, partners are rarely allowed to attend. With both mothers and healthcare providers masked and often distancing, the prenatal experience has become less personable.

Even during typical appointments, it’s hard to remember to ask questions. During these less personal experiences, it’s even harder to remember. Appointments may also be rushed through to reduce the amount of time each person spends in an office.

Working with a doula allows new parents personalized care and support during this time. From common questions to fears and concerns, doulas have become a lifeline during Covid-19.

Doulas often provide comprehensive prenatal education and support. While this is always something they offer, it means even more during a time OB providers have less availability. Doulas are able to help build one’s confidence in their pregnancy, birth, and early parenting despite these unusual times.

Even in situations where it isn’t safe for doulas and clients to meet in-person, video meetings provide connections. Doulas can offer the same personalized prenatal information and birth prep via a video call.

How Can A Doula Provide Virtual Support?

Ideally, all women would have access to safe, in-person doula care. Unfortunately, that isn’t always the case as we continue to navigate this pandemic. When safe, many doulas are able to continue meeting with and supporting their clients in-person.

For those who cannot, video support is an excellent way to receive doula care. Prenatal education, learning about birth options, and creating a postpartum plan can all easily be done virtually.

In some situations, doulas are able to safely attend a birth in the hospital. In other situations, doulas are not permitted in the hospital. When the latter is the case, many clients opt for video, phone, and text support throughout the labor. A doula can guide the birth partner through position support, comfort measures, and encouraging words to help the birthing woman feel truly supported.

While it may feel unusual to provide such intimate support with technology, it is still extremely beneficial.

Be sure to read Providing Virtual Doula Support to learn more about offering virtual doula support.

Do Birthing Families Have Unique Needs During Covid-19 Restrictions?

Welcoming a baby is a vulnerable time. Parents should always have access to support during this time of transition. During a global pandemic, parents definitely need support.

While the pandemic itself reduces support options, doulas can offer significant support to new parents. In addition to educating parents about typical pregnancy, birth and parents, doulas are also providing extra reassurance during unprecedented times.

What each family needs remains unique, just like every passed client. However, checking in with clients more frequently and providing mental health resources may be more even more important now. Being a caring ear as they process and grieve the pregnancy and birth they expected can also be helpful.

As a doula, you can also support them in birth planning. Encouraging clients to ask questions and find out about hospital policies before they go into labor can help them be more prepared. Also, when a client knows which restrictions are in place, you can help them problem solve navigating each restriction.

It is absolutely an unusual time to be welcoming a new baby. However, it does not need to be a time with inadequate support. Doulas can be a true lifeline during covid-19, just as they are during typical times.

As doulas, we continue to provide non-medical support in all scenarios, including global pandemics. Our support is always valuable and vital, but perhaps even more so under the unpredictable times.