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Official Response to Bill S03344-B

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

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

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/ )

 

4 FAQs About Working as a Doula

doula salary

Having a career that is centered around helping and supporting other women during their birthing experience is exciting and exhilarating. And doulas get to do it every day. But before you jump in with both feet, you may have some questions about training, certification, what a doula salary looks like, what a typical month looks like, how many hours doulas work, and how to have a successful doula career.

How Many Births Do You Attend Each Month?

The number of births you attend every month depends on you and how many clients you take on. It is important to remember that every client you take on requires a lot of dedicated time, including prenatal visits, the birth itself, and post-natal visits.

The more time you are able to spend with each client prior to birth the more they will feel comfortable around you and trust your judgment. When first starting out as a doula, it is advised that you start with only one birth per month, as each birth will vary in length. Some births can be quick and straightforward, whereas others can be long and physically and emotionally draining. Starting with only one birth will give you a good indication of how a doula career will fit your lifestyle. Also, when first starting out, doula work can take a lot out of you both physically and emotionally, so it is good to start slow and work your way up. Industry standard dictates that you can take up to 6 clients per month, with a great doula network to provide back up in the case that you have two clients in labor at the same time.

How Much Can You Expect to Earn Per Birth?

Because your doula business is your own, you can set your prices based on the services you offer. Most doulas offer different packages to accommodate different clients’ budgets and needs. Additionally, the cost can be determined by the different qualifications each doula has, such as massage, nursing, photography, or childbirth education.

An ideal birth package should include a minimum of two prenatal visits, the birth, and one post-natal visit. This can be customized as some clients will want less contact, and others will want more. Extra post-natal visits can be beneficial, as many new parents may need extra support following birth. Because most new parents don’t realize how important this can be until after the baby arrives, consider charging an hourly rate for post-natal visits instead of adding them to your birth packages.

Ultimately, the rates you can charge as a doula will depend on your experience level, location considerations, demand considerations, and other qualifications you have.

How Do I Get Started?

Once you have decided that a doula career is a good fit for you, start by browsing our doula courses to determine which is right for you. The more opportunities you have to gain hands-on experience, the more confidence you’ll have and the more likely you’ll be to have a successful and rewarding doula salary and career. At International Doula Institute, we offer quality doula training online that allows women to train at their own pace. If you are interested in learning more about the International Doula Institute program, check out internationaldoulainstitute.com today!

 

Doulas and Midwives: Their Roles During Birth

online doula training

Many women elect to become a doula because they want to help other women during a vulnerable time in their lives. As part of an online doula training program, doulas in training will learn all about the birthing process, but they will also learn about the role of midwives and how they work together. It is critical for doulas to know and understand the role they play in birth, the role midwives play, and how they can work together to help both mom and baby have a safe experience.

Role of a Doula

Although doulas are trained and certified, it is not the same training and certification as a midwife. Doulas are not required to have a medical background. This is because the primary role of a doula during labor and delivery is to provide the mother with physical and emotional support. Prior to labor, a doula can help a woman develop a birth plan outlining her wishes for the birthing experience.

Throughout the childbirth process, doulas are trained to use techniques and tools to help mothers effectively manage stress and pain. These methods may include massages, deep breathing, and visualization. Doulas also know different birthing positions so they can make suggestions throughout labor to facilitate the birthing process. A doula’s primary concern is to help both the mother and their partner remain calm and feel supported throughout labor.

Role of a Midwife

A midwife is a trained healthcare professional who provides medical care to the mother and baby from preconception through the postpartum phase. Midwives are able to run prenatal tests and perform gynecological exams. They can also prescribe medications and supplements before conception and during pregnancy. Another important part of a midwife’s job is to educate patients by providing advice for staying healthy during pregnancy. They are responsible for monitoring both the mom and the baby throughout labor, along with assisting with the birth.

How They Work Together

The decision to have both a midwife and a doula can help make the birthing process easier for everyone involved. Although each play different roles, they are both incredibly important. Midwives are responsible for monitoring the health and safety of both mom and baby, and a doula is responsible for offering support throughout the process. The two work well together and complement each other.

Examples of how the two can work effectively together include when the midwife cannot provide attention to the emotional or physical comfort needs of the mom. This is generally because her attention is needed to be focused on the mother or baby’s safety. During these times, the doula is able to continue focusing on the emotional and physical comfort needs of the mother. When a woman feels emotionally supported and knows how to deal with the pain, the birthing process goes smoother.

During some stages of labor, such as pushing, mothers can feel out of control. When possible, helping a woman feel relaxed and in control of her pain will result in more effective pushing and faster childbirth. Doulas are able to offer suggestions about different positions that can help facilitate birth, making the process go more smoothly.

When you have a midwife and a doula on your birthing team, the mother will feel safe and supported, making the birthing experience a positive one. International Doula Institute offers an online doula training program that can be completed from anywhere in the world. Start helping other women through their birthing experience by becoming a certified doula.

What You Need to Know About a Water Birth

doula course
Beautiful young woman during labour, having painful cramps, giving birth in water.

Water birth is the practice of spending part of labor and/or delivery in a pool filled with warm water. Many laboring moms enjoy a water birth because the warm water helps their body relax, making it easier to handle contractions. Water birth is a practice widely practiced by midwives and is an important part of the curriculum in any doula course. If you are new to the idea of water birth, you might be wondering what it entails and how safe it is for mom and baby.

What is a Water Birth?

A water birth is when an expectant mother experiences labor in a warm bath of water, ultimately delivering the baby in the water. The tub can be a permanent fixture in a birthing center, or in the event of home birth, even specially erected to fit the mother’s needs. The water will be warm with coarse rock salt added.

Benefits of a Water Birth

There are a few benefits that come along with having a water birth, including the following:

  • Warm water can help ease some of the discomforts of labor and serve as pain management for the mother.
  • Water provides the mother with the ability to experience weightlessness while in the water, allowing her to get into comfortable labor positions.
  • It creates a calm environment for the baby to be born.

Can My Baby Drown During a Water Birth?

A common concern that many expectant mothers have regarding a water birth is whether there is a risk of their new baby dying. When delivered correctly, the baby will go from one fluid environment in-utero to another. When this happens, the baby is still attached to the umbilical cord, which means that they are still receiving oxygen from the mother. Newborns also have something that is known as “dive reflex,” what this means is that any water that the baby encounters will be swallowed and not inhaled. A baby will only take its first breath once it is taken out of the water or is exposed to a temperature change.

How Long Do You Stay in the Water?

Another common question or concern that many expectant mothers have is how long they are going to stay in the water. Many want to know if they can spend the entire duration of their labor in the water, or if they are restricted to a limited time period or stage of labor. For mothers that are experiencing pain, and determine that they need some form of pain management, such as an epidural, can leave the birthing bath. If at any point you feel unhappy or uncomfortable, you can get out of the bath and try to find comfort and happiness in another position. If there are any complications with either the delivery or with the baby, the mother may have to get out of the water.

Can I Have a Water Birth in my Tub at Home?

When considering a water birth at home, there are a few things to consider. A trained medical professional with experience with water birthing should attend. It is important that both the mother and the baby be closely monitored throughout the process. If at any time there are signs of problems or complications, the birth may need to be managed differently. That is why it is important that you have a doula on your birthing team who knows your wishes and will help you advocate for them. Yet, it is equally important to listen to the medical professionals who are advising you on your birthing options, and what is best for both you and your baby.

Many women elect to have a home birth because it is an intimate and personalized experience. When monitored by a midwife and supported by a woman who has completed a certified doula course, mother and baby are in good hands. If you are considering having a water birth for your labor and delivery, talk to your doula about what you need to know to determine if a water birth is right for you.

FDA Approve New PPD Drug – What Doulas And Birth Professionals Need To Know

FDA Approve New PPD Drug – What Doulas And Birth Professionals Need To Know

The first drug designed to treat postpartum depression (PPD) recently received FDA approval.  This debilitating form of depression impacts around 16% of new mothers, making it one of the most common pregnancy complications.

Kellie Wicklund, MA, NCP, LPC, a licensed psychotherapist and clinical director of the Maternal Wellness Center said, “The FDA’s approval of Zulessro (brexanolone), a new drug to treat postpartum depression (PPD) is exciting in that it legitimizes PPD as a disease in the medical model.”

One of the biggest struggles for women and families impacted by PPD is finding adequate treatment in a world that’s just beginning to recognize our mental health crisis.

We’ve made great strides in recent years with PPD screenings, education and awareness. However, the FDA approval of this drug says that we recognize it as a true and legitimate medical condition – an extremely important step in tackling this crisis.

However, will this drug be the solution many women are hoping for?

What Is Zulessro?

While many depression, anxiety, and general mood disorder medications exist, Zulessro is the first drug FDA approved specifically to treat PPD.

PPD is a unique form of depression in that it occurs within a year of giving birth and we aren’t certain why it occurs. We have theories, we know of some risk factors, but we aren’t certain exactly why it happens and the exact best course of treatment.

To date, the only pharmaceutical treatment options are medications approved to treat other forms of depression. While this works for some women, there are women with severe PPD that doesn’t respond to treatment.

Zulresso is an intravenous (IV) administered medication that can only be given in an inpatient setting.

The FDA said, “Zulresso will be available only through a restricted program called the Zulresso REMS Program that requires the drug to be administered by a health care provider in a certified health care facility. The REMS requires that patients be enrolled in the program prior to administration of the drug.”

Women could lose consciousness during administration and experience other side effects. Due to the risks, women must be monitored for their health and while they’re interacting with their child(ren) to ensure the safety of everyone.

8 Things Doulas Need to Know About Postpartum Mood Disorders

Who Is Eligible To Take Zulresso?

While around 16% of new mothers face PPD, severe PPD leading to self-harm or harm of others is rarer. For those with severe PPD resistant to previously available medication, and not fully helped by therapy and lifestyle support, Zulresso may offer much-needed relief.

Tiffany Farchione, M.D., acting director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research said, “Postpartum depression is a serious condition that, when severe, can be life-threatening. Women may experience thoughts about harming themselves or harming their child. Postpartum depression can also interfere with the maternal-infant bond. This approval marks the first time a drug has been specifically approved to treat postpartum depression, providing an important new treatment option.”

Wicklund, who regularly provides psychotherapy for women experiencing PPD, said, “It will be used on a very limited basis, and reserved for the most severe cases of PPD that have to that point been resistant to other forms of treatment.  It will save lives, and it is only the beginning of research and new medications that will become available to a broader population of those suffering from postpartum mood and anxiety disorders”.

For new mothers experiencing PPD, it’s likely their healthcare providers will recommend first-line treatments with few risks such as therapy, extra support and possibly lifestyle changes (e.g. finding ways to reduce stress). If they’ve tried those methods or their symptoms are severe, their healthcare provider may recommend previously available medications.

For those with severe symptoms, especially with concerns related to self-harm or harming others, with little to no relief from other medications, it’s possible they’ll be eligible to try Zulresso.

Is Zulresso The PPD Miracle We’ve All Been Waiting For?

If you’ve ever suffered from PPD, or you’re a birth professional supporting families through it, the thought of a 2.5-day treatment sounds miraculous. For those truly suffering from severe and persistent PPD, it very well may be a miracle.

However, overall, this may not be the solution for PPD. While we aren’t certain why we have such high rates of PPD in the US, we do know that rates vary in different countries, demographics, and communities.

We know that some things reduce the risk of developing PPD. We aren’t certain of the exact reasons, but we know women who have more support, more sleep, continuity of care, etc. may be less likely to develop PPD. And if they do have PPD, those things can be an aid in healing.

Many professionals value pharmaceuticals in treating mood disorders but recognize they aren’t fully effective when used alone.

Wicklund said, “While we already have a good arsenal of medications that work well for perinatal mood and anxiety disorders (PMADs), they demonstrate the best results when used in combination with specialized supportive counseling and psychotherapy.  

“The healing power of psychotherapy is in the person to person connection in the moment. We are social beings, and it is in relationships that we heal. When we are witnessed and understood with deep compassion and accurate clinical information, change inevitably begins to happen.

“It is powerful and altering to hear the supportive and informed words of a knowledgeable therapist letting a woman know that they understand what’s happening to her, and how to get her better asap.”

What Do Doulas And Birth Professionals Need To Know About Zulresso?

As a doula, you play a valuable role in supporting women and families during very vulnerable times. While doulas do not give medical advice or perform clinical or diagnostic tasks, knowing available treatment options can help you in supporting your client through decision making.

As a doula, in the prenatal period, you can support families by helping them be aware of risk factors, red flag symptoms, and normalizing seeking help and treatment.

Continuous support throughout labor, adequate support transitioning to life with baby, rest, support reaching personal breastfeeding goals, support when things don’t go as planned, etc., may reduce the risk of a mother developing severe PPD. If she does develop PPD, which can happen regardless of circumstances, those things can be valuable support during healing.

It’s important to be aware of resources in your community as well. Knowing which therapists and doctors treat PPD with evidenced-based and compassionate approaches is an important way to support your clients.

Do Women Using Medications For PPD Still Need Therapy?

Every case of PPD is unique. Every woman and family are unique. We can’t say across the board what is best for all, but we do know that therapy does work for many. Therapy plays a vital role in healing from PPD, with or without pharmaceutical use.

Some women successfully manage and heal from PPD with extra support and therapy. Other women find medication, in addition to her therapy, important. For women using Zulresso, their PPD is likely severe making the support of therapy important in overcoming the entire experience.

Wicklund said, “Therapy works because it validates and normalizes an experience that many women believe they should feel ashamed of. Therapy corrects the distorted thoughts and beliefs, it offers practical solutions, it holds sacred space for difficult feelings, and most importantly, it offers HOPE to a woman who is suffering – that she will indeed feel better again!

“Lastly, a good therapist will also acknowledge the broader context of modern mothering as well; that we do not have adequate policies or social supports in place to support women and families during their transition to parenthood, and we see very high rates of PMADs because of this gap in resources. We can do better than this for more moms and families, and policy-level change is sorely needed.”

While doulas can’t treat PPD, we can be a part of solving the gap in support and resources.