International Doula Institute | Doula Blog

A Historic Victory for Doulas and Birthing People in New York State: Medicaid to Cover Doula Support

March 16, 2023

Birthing person with doula

Today marks an unprecedented triumph for doulas and birthing people across New York State. A new bill has been passed, ensuring that Medicaid patients receive free doula support. This groundbreaking legislation will cover doulas at the highest reimbursement rate in the United States, a staggering $1930 per client. Doulas have worked tirelessly to achieve fair wages. This monumental achievement emphasizes the importance of doula services and the positive impact they have on birthing experiences.

The Importance of Doulas in the Birthing Process

Doulas are trained professionals who provide physical, emotional, and informational support to birthing people and their families throughout the prenatal period, labor, and postpartum recovery. They work collaboratively with healthcare providers, offering a wide range of services that can help reduce stress, anxiety, and complications during childbirth. Research has shown that doula support can lead to shorter labor times, decreased cesarean rates, and improved overall maternal and infant outcomes.

The Fight for Doula Support

The journey to secure Medicaid coverage for doula services has been a long and arduous one. Advocates for this cause have emphasized the importance of doulas in improving health outcomes and reducing healthcare disparities, especially for low-income families and communities of color. This bill reflects the hard work of countless individuals who have been fighting for birthing peoples ability to access doula services for years.

The Impact of the New Bill

The passage of this bill is a significant step forward in making doula support accessible to all birthing people in New York State, regardless of their financial situation. By covering doula services at the highest rate in the country, New York is setting a powerful example for other states to follow suit. This legislation will not only benefit the birthing people but also the doulas themselves, as they will receive fair compensation for their essential work.

In addition to improving the financial accessibility of doula support, this bill also aims to address existing disparities in maternal and infant health outcomes. It acknowledges the crucial role doulas play in reducing the risk of complications and providing much-needed support to marginalized communities.

The Future of Doula Support

As New York State leads the way in prioritizing doula support for Medicaid patients, it is crucial to continue advocating for the expansion of such policies nationwide. The passage of this bill serves as a testament to the importance of doulas in the birthing process and the incredible impact they have on the lives of families.

Acknowledging the Champions of Doula Support

It is essential to express our gratitude to the tireless professionals and organizations that have worked relentlessly to make this historic win possible. In particular, we would like to extend our heartfelt thanks to the New York Coalition for Doula Access, the core team, Maris Gelman, Patrizia Bernard, Jennifer Gonzalez, Mary-Powel Thomas, Michelle Zambrano, Alison Whitney and Veronica Zeno, which has been at the forefront of this movement. Their advocacy, dedication, and commitment have played an instrumental role in the passage of this bill, ensuring that more birthing people have access to the invaluable support doulas provide. Additionally, we would like to recognize the legislators who have championed this cause. The unwavering determination and collaborative efforts of these individuals and organizations have paved the way for a brighter and more equitable future for doulas and the families they serve.

This is a Big Deal

The passage of this bill in New York State marks a significant victory for doulas and birthing people, especially those covered by Medicaid. By providing free doula support to medicaid clients and fair compensation for doulas, this legislation sets a new standard for how our society values the critical role of these professionals in the childbirth experience. As we celebrate this historic win, let us continue pushing for more inclusive policies and equitable access to doula services across the United States.

Expanding Doula Training to Meet the Growing Demand

In light of todays legislation, the International Doula Institute (IDI) is announcing plans to expand its doula training programs for the Spring and Summer 2023. Recognizing the need to prepare and support an increased number of doulas to accommodate the approximately 96,000 annual new Medicaid-covered clients, IDI is committed to offering comprehensive and accessible training opportunities. This initiative will build the doula workforce so that there is a sufficient number of skilled doulas to provide essential support to the growing number of birthing people now eligible for doula services. By investing in the education and development of new doulas, the International Doula Institute is playing a critical role in promoting the well-being of families and fostering a more inclusive and equitable healthcare landscape for all. To enroll in our Spring or Summer Doula training sessions, please apply online or call 484-278-1648 to speak with one of our helpful admissions counselors.

The bill can be found here: https://www.nysenate.gov/legislation/resolutions/2023/r555.

New study on community based approaches to breastfeeding and safe sleep.

March 8, 2023

A wonderful study was just published in BMC Health today. This is incredibly important for doulas and breastfeeding counselors.

Menon, M., Huber, R., West, D.D. et al. Community-based approaches to infant safe sleep and breastfeeding promotion: a qualitative study. BMC Public Health 23, 437 (2023). https://doi.org/10.1186/s12889-023-15227-4

The article “Community-based approaches to infant safe sleep and breastfeeding promotion: a qualitative study” is a really interesting study that explores how communities can help new parents keep their babies safe while they sleep and encourage them to breastfeed.

The authors talked to 22 people from different backgrounds who are involved in promoting infant safe sleep and breastfeeding in the United States. They found that community-based approaches were really effective in promoting safe sleep and breastfeeding.

Community Based Approach

Community-based approaches mean that people in the community come together to help each other out. For example, they might have meetings or workshops where they talk about how to keep babies safe when they sleep or how to breastfeed.

The authors found that building trust and relationships with families is really important, because then parents are more likely to listen to what they have to say. If they feel like they’re being judged or criticized, they might be less likely to participate in community programs.

They also found that it’s important to tailor interventions to meet the needs of different communities. Different groups of people might have different beliefs or practices around baby care, so it’s important to take this into account when designing programs.

Engaging Stakeholders

Engaging a diverse range of stakeholders, like healthcare providers, community leaders, and parents themselves, is also really important. Everyone has a role to play in promoting safe sleep and breastfeeding, and by working together, we can make a real difference.

The authors identified several key themes that emerged from their interviews, including the importance of addressing cultural beliefs and practices, leveraging existing resources and partnerships, and using innovative approaches to reach new parents.

Overall

Overall, the study shows that community-based approaches are a great way to promote infant safe sleep and breastfeeding. By working together and providing support, we can help new parents keep their babies safe and healthy, and build stronger, more connected communities in the process.

Doulas on Social Media – Is It a Must?

March 6, 2023

Social media has been popular for well over a decade now. With more platforms, engagement, and users than ever before, are doulas on social media a must?

To be a successful doula, do you need to be on social media? The answer will definitely vary depending on who you ask, where you ask, and what your business goals are.

As an online doula training organization, we clearly use the internet quite a bit. However, that does not always translate to a lot of social media use. In fact, the International Doula Institute’s online training program was quite successful before social media became extremely popular.

Here’s what new doulas need to know about doulas on social media.

#1: Understand Your Client Base

Whether or not you need a large social media presence sometimes comes down to your target demographic. Not all new parents use social media. In fact, plenty of people steer clear of social media.

However, many new parents still use a variety of social media platforms. If you hope to gain online presence, find out which social media platforms are trending. It is also important to know which age groups are using which platforms.

Some doulas find using Instagram can help establish not just a client base but also networking with other birth professionals.

#2: Doulas on Social Media – Follow the Evidence

If you choose to have a social media presence, it is vital that you stick with sharing evidenced-based information. If you are hoping to attract clients and network with other birth professionals, it is important you share appropriate information.

In an age of misinformation, it is important to stick with evidence. Certainly, how different professionals interpret the same data can vary. However, it is important to be able to cite reputable sources if you are sharing information.

You can absolutely share your opinions, anecdotal experience, etc. It is just important that you are clear about it being that versus peer reviewed evidence.

It is also vital you never give direct medical advice. For liability reasons, it is important you clarify that in posts, videos, etc.

#3: Have Fun!

Yes, as doulas we are sharing important and evidenced-based information. However, social media is also about having fun. When you are trying to engage clients and peers, it’s best to have a bit of fun. Be yourself. Let your personality shine in your content.

If you do not find social media fun to do, it may not be your best route for clients or networking. Doulas existed long before social media. It is completely possible to have a successful doula business without using social media.

If you find social media stressful but you want to reach people, consider:

Blogging
Attending birth worker meetups
Attend trainings and exchange contact information with fellow birth workers.
Learn more about birth workers in your area, as well as other professionals working with growing families such as chiropractors, physical therapists, lactation professionals, yoga and Pilates instructors, etc.

#4: Invest in Your Social Media Account – But Diversify

One of the biggest mistakes new doulas make is assuming you can network only online and fully expand your business. It takes more than a fun social media account to grow a business. If you invest time into your social media account, you can absolutely reach other professionals and potential clients.

However, if you only network online, these connections may not actually translate to work. It is important to meet people in-person, connect with professionals, and let people get to know you. Building trust within your community, both in-person and online, is important.

Another thing to know about social media is that their algorithms are ever changing. It is important to diversify your advertising and networking because a popular page can suddenly see minimal traffic with algorithm changes.

Ultimately, whether doulas on social media is a must or not comes down to personal preferences and goals. If you are unsure about whether social media advertising is for you, take time to follow and observe other accounts. Do NOT copy other accounts, however, you can get an idea of what it can entail to run a business social media account.

Safe Sleep – What Doulas Need to Know

March 5, 2023

As doulas, it is vital we help educate our clients about many infant care topics. This includes ensuring they understand the evidenced based information for safe sleep for babies. While different professionals and families have varying opinions, we must provide evidence to clients, not simply our opinions.

As doulas, we will often be the professional a client looks toward. As a professional, we have a responsibility to provide our clients with honest, evidenced-based answers to common questions.

However, as birth workers, we also understand that sleep and babies can be quite nuanced. The American Academy of Pediatrics says X and UNICEF UK says Y, while Dr. James Mckenna and anthropologists might say A. How do we know how to educate clients about safe sleep when there are clear guidelines at each organization, but variations between organizations?

Safe Sleep – Always Provide Clients With Current Recommendations For Their Location

If you are a doula in the United States, it is important you provide clients with current recommendations provided by the American Academy of Pediatrics, your local health departments, etc. If you are in the UK, be sure to provide information from NIH.

Currently, the American Academy of Pediatrics recommends:

Back to sleep for every sleep.
- This includes infants with reflux as there is no evidence to support side or inclined sleep is safe.
- All babies should be placed on their back to sleep until one year of age. If a child rolls to their side or stomach on their own, that is fine. However, caregivers should not place them on their side or stomach.
There should be no blankets, pillows, stuffed animals, etc., in the sleep surface with the baby.
Use a firm, flat sleep surface.
- Inclined sleepers and wedges, baby loungers, swings, car seats not on their base, etc., are not safe sleep surfaces.
It is recommended that babies sleep in the same room with their parents, but a different sleep surface, for ideally the first 6 months of life.
- “The AAP understands and respects that many parents choose to routinely bed share for a variety of reasons, including facilitation of breastfeeding, cultural preferences, and a belief that it is better and safer for their infant. However, on the basis of the evidence, the AAP is unable to recommend bed sharing under any circumstances.”

You can read these guidelines in depth in the AAP’s policy statement.

UNICEF UK has similar guidelines as the AAP. They often provide more in-depth information about how to discuss these with parents.

Is Bedsharing Inherently Dangerous?

As a doula, you are likely to navigate these questions. It is important to recognize that statistics show about 50-80% of parents at least occasionally bedshare, varying by region, culture, etc.

A healthy, term infant contact sleeping with their biological, lactating, parent is not inherently dangerous. It is likely a biological norm.

However, modern blankets, modern furniture, pillows, overheated homes, prescription medications, soft mattresses, pacifiers, bottle feeding, etc., are not necessarily natural. None of these things are inherently wrong for parenthood.

However, when we combine contact sleep with comfy mattresses, fluffy pillows, big blankets, prescription medications, bottle feeding, etc., we do create a situation with real risks.

There are typically two different approaches professional organizations make when providing public education regarding bedsharing. One approach, which is what the AAP uses, is to blanketly discourage any bedsharing with infants, especially newborns.

The other approach is to discourage bedsharing while recognizing that statistics show some parents will do so anyway. For that reason, providing some guidelines to reduce risk is also included. This is the approach UNICEF UK seems to take. Per the UNICEF link shared above:

“The authors found that many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. They argue that the data supports policies to counsel parents and caregivers on safe sleep practices, including bed-sharing in non-hazardous circumstances, particularly in the absence of parental smoking, recent parental alcohol consumption, or sleeping next to an adult on a sofa. Further research with appropriate methodology is needed to drill down on actual rates of infant deaths, paying close attention to the definitions of deaths, the circumstances of the deaths, and confounding factors, in order to ensure we have the best information with which to derive public health policy.”

What Should Doulas Tell Clients About Co-Sleeping and Bedsharing?

It is important that you provide current recommendations for your region and only evidenced-based sources. One should never tell a client that it is safe to bedshare and they should do so.

However, if a client is interested in bedsharing, your language is important. One might say something along the lines of, “Well, currently the AAP advises against bedsharing. However, some researchers, such as Dr. James Mckenna, believe bedsharing is safe in some circumstances if both the parent and child meet the criteria. You might find it helpful to look at the AAP website and Dr. James Mckenna’s website to learn more and make the informed decision which works for you.”

Navigating Safe Sleep During Doula Shifts

As a doula, it is important you follow all current sleep guidelines. If parents request you do something which is not in-line with current guidelines you can say something such as, “I’m professionally bound to following current AAP guidelines. It is a liability for me to do anything else. During my shifts, I can only put baby to sleep in a flat bassinet, crib, or pack-n-play. This is not a judgement on any sleeping arrangements you choose during your time caring for baby. I’m simply required to follow current guidelines.”

This means you can only put baby to sleep on approved sleep surfaces without blankets, pillows, etc. If parents continue to ask questions, you can use the opportunity to educate them regarding safe sleep recommendations.

Some doulas have made informed decisions to bedshare with their own children. That is a personal choice which some are comfortable making. However, it is important you do not use that anecdotal experience in place of evidenced-based information. If clients would like information about bed-sharing, be sure to point them to sources such as Dr. James Mckenna.

Pineapple To Induce Labor – What Doulas Need to Know

March 4, 2023

As doulas, we know pregnancy can be a beautiful time. However, we also know the end can be quite challenging, and not feeling like a beautiful time. Our clients may deal with severe heartburn, swollen ankles, and having to constantly pee. They might wonder about pineapple to induce labor.

When our clients do not have a medical complication or risk factor, and they are not beyond their due date, a medical induction is not a great option in most cases. However, even if their midwife or doctor offers an elective induction, some prefer to avoid the potential side effects of medication and interventions.

Yet wanting pregnancy to be over can lead to seeking information about home remedies which might trigger labor. One remedy your clients may hear about is eating pineapple.

Using Pineapple To Induce Labor

As doulas, you likely already know the answer to whether or not pineapple can actually be used to induce labor. However, it is helpful to understand the reason behind that answer so you can best explain it to your clients.

Pineapple contains the enzyme bromelain. The core has the most bromelain. This is an enzyme which can be used as a meat tenderizer as it can break down proteins in tissues. Ever eat a bit (or a lot) of pineapple and your mouth get a bit sore? It is from the bromelain.

The idea of using pineapple to induce labor stems from the thought that this enzyme might ripen the cervix. However, excessive amounts of fruit, especially pineapple, can cause gastric upset. Of course, gastric upset is also sometimes linked to trigger labor (which is why some attempt to use the laxative castor oil).

As doulas, we know that inducing gastric upset tends to do little in terms of labor and simply leaves pregnant people uncomfortable and even dehydrated.

How To Use Pineapple To Induce Labor

As a doula, you know it is not within scope to provide suggestions to induce labor, whether via medication or over the counter remedies. However, you will still be asked about options for triggering labor.

When attempting to induce labor, fresh raw pineapple is typically use. Some will also consume the core as it has the highest level of bromelain.

We do not have any hard and clear evidence showing the effectiveness of consuming pineapple to trigger labor. While one 2016 study found pineapple extract triggered uterotonic activity, that is different than consuming pineapple.

To reach the levels of enzyme which might cause some uterine activity would likely create significant oral and gastric discomfort. Some sources suggest one would need to consume upwards of seven raw pineapples.

If one looks hard enough, they are likely to find anecdotal stories of pineapple triggering labor. However, those consuming pineapple in an attempt to trigger labor are already full term. This means their body was likely going into labor regardless of consuming pineapple or not.

If one browses the internet, they might find a few pineapple smoothie recipes for inducing labor. However, most of those articles still say there’s no real evidence consuming pineapple will trigger labor. Of course, if your client enjoys pineapple, it can be part of a healthy diet. There is no real risk to consuming normal, culinary amounts of pineapple.

Well, no major risks. They can still experience heartburn, gastric discomfort, and oral pain. Remind clients that without major evidence, they are best off sticking to eating whatever amount they enjoy and not going overboard.

Inserting Pineapple To Induce Labor

I’m going to be honest; I was surprised to search and see some people attempting to insert pineapple vaginally. I mean, it makes sense if their goal is to ripen the cervix. However, the amount of potential pain, risk of infection, abrasions and sores from bromelain, and complete lack of evidence of potential support makes this a very, very bad idea.

Of course, as doulas, we know how desperate the end of pregnancy can seem. It is not shocking that some would attempt nearly anything to get labor going.

In my non-clinical mind, I was certain inserting pineapple was a really unsafe idea. However, I wanted to confirm with a clinical provider to be certain.

Jennifer Timbs, CPM based in Texas, stated, “Yes fruit inserted into the vagina would be bad. That is just asking for a yeast infection. The vaginal flora could definitely be impacted by inserting fruit.”

Considering the lack of concrete evidence showing pineapple triggers labor, the risk of an unpleasant infection at the end of pregnancy just is not worth it. If a client asks about this, it is within your scope to say this is not recommended but that they can and should confirm with their midwife or doctor before attempting to insert anything to trigger labor.

Is Pineapple Safe To Induce Labor?

In the absence of an allergy, there’s not likely any dangerous side effects from consuming pineapple in hopes of triggering labor.

The study mentioned above did find uterine tissue responded to pineapple extract, but direct application does not translate to an effect via the digestive system. Bromelain is likely to be impacted by stomach acid before much if any is absorbed into the system.

In short, there is not a major risk to attempting to consume a typical amount of pineapple hoping labor is near. However, consuming mass quantities has no evidence to support the risk of significant discomfort.

The 5 Rules of Being a Great Doula

March 3, 2023

When we become doulas, we want to make sure we are the best doula we can be. Sometimes, this leads to comparing. However, there are many types of amazing doulas. You can be uniquely you while still following these x rules for being a great doula.

Being a doula is not about fitting into a cookie cutter. It is about being able to support clients in a way which feels holistic and judgement free. Following these basic rules can help you be a great doula.

#1: Follow Evidence to be a Great Doula

Doulas are professionals. As such, it is vital we remain a true professional source for evidenced-based care and support. When you train and certify with the International Doula Institute, you can know for sure you have a foundation in evidence.

As you continue to provide support to your clients, make sure you are referencing evidenced-based sources. Keeping up to date with evidence is also important. Attending pregnancy, birth, postpartum, and lactation specific workshops, conferences, etc., are great ways to continue your education as a doula.

You can also keep up to date by reading newly published medical journals, reading evidenced-based blogs (citing sources), and reading books published by professionals in our field.

#2: Be Comfortable Simply Holding Space

We learn all the comfort techniques, evidence, etc., and we want to put them all into practice. When clients hire us, we want to make sure they see our service as valuable. This can make it tempting to be very hands on, to try lots of physical comfort techniques, etc.

While there are clients and times where lots of hands on is needed, there are also plenty of times you simply need to hold space. The ability to be present holding space is just as valuable as a double hip squeeze.

What is holding space? It is a conscious act of being present, open, allowing, and protective of what your clients need in each moment. It means no judgement about any decisions they make either. Sometimes you will be hands on and holding space, other times you are simply present holding space.

#3: Include The Partner and Support System to be a Great Doula

Yes, the one in labor is the one who is front and center. They need all the support and care. However, when you are a great doula, you are able to include the entire birthing family.

You can coach their support person or partner in providing physical comfort techniques. Providing encouraging words, practical support, and reassurance to partners is a huge component of caring for the whole family.

Welcoming a baby is a big moment for the whole birthing family. It is important the whole family feel included in the experience.

#4: A Great Doula is Reliable

Pregnancy and birth are unpredictable. However, your support should not be. To be a great doula, you need to be reliable.

Make sure your contract clearly lays out when you begin being on-call, how long until you will arrive when called, and how long you stay. Then, make sure you are always available to meet those agreed upon obligations.

That said, life can be unpredictable. Obviously, if you have the flu, you cannot safely expose a new family. This is why it is vital to always have a backup doula in the event of an emergency. It is also important your clients be aware of what constitutes an emergency and who will be there in that case.

#5: Be Confident and Humble

It takes wisdom to balance confidence and humility. As a doula, it is important you be confident in your understanding of birth and evidence. However, it is also important to be humble in your interactions with clients and medical professionals.

While doulas are well trained and educated in birth, we are still non-clinical. It is important we do not act outside our scope nor advise clients to not follow medical advice. We can be confident in sharing general, evidenced-based information so clients can make informed decisions. However, we must never tell a client what they should do.

And of course, be yourself! Your clients have chosen to work with you for a reason. Trust you’re the right doula for them.