Mommie Dearest: Doulas Should Be A Birth Option For Everyone, Not A Status Symbol

The New York Times, once again, is on it. Much like their report on midwives as a status symbol that appeared in their style section a couple of years ago, they’ve again turned their focus on the birth world. And this time, in a piece from last week, they’re zeroing in on doulas.

For those not tapped into the birthing world, you may be asking yourself exactly what a doula is. A doula — which the Times informed me is antiquated Greek for “female servant” — is an assistant that you can hire to help support and advocate for you during labor and birth. Many doulas also offer postpartum services like breastfeeding support. The practice harkens back to a time when we lived in closer quarters and women gathered together to help each other with labor and birth, passing along time-tested advice and support. Doulas can offer a more personalized touch and a familiar feel in what can be an otherwise sterile and medicalized hospital setting, where you may even be meeting the OBGYN delivering your baby for the first time.

Doulas do not take the place of your partner or other support people. A good doula is there to supplement those folks. They also do not deliver babies, so they should not take the place or step on the toes of your provider. (But of course, like any occupation, there are stories of doulas gone bad). The benefits of doulas are myriad, from helping ease birthing women’s pains using a variety of techniques to helping cut down on unnecessary interventions, to just overall making the birth experience a smoother one.

It’s at this point that I should note that I had a doula for the birth of my son, so in general I’m pro-doula. We had recently moved, my family wasn’t close by, and I wanted all the support I could get in the delivery room. And to be honest, my doula made a difference. She was the one that advocated for me in between midwife shifts at the hospital, where a nurse started getting agitated because my son’s heart rate was slow. My doula suggested I change positions (something I nor my husband would have had the presence of mind to consider) and my son’s heart rate ended up being just fine. She also swapped on and off with my husband so he didn’t tire out during my labor when I needed constant pressure on my back to counteract the intense contractions I was experiencing. She was also invaluable in those first few days postpartum when I was trying to figure out breastfeeding. She didn’t come cheaply, but it was an investment that ended up being worth it for me. And it’s one I wish more women had access to if they wanted.

The article in the Times takes a look at doulas and how ones in New York City are attempting to create a more formal network, attempting to get covered by insurance, which would be huge. One thing about doulas — you pay for them out of pocket, and depending on where you live, they can be expensive, sometimes nearing thousands of dollars. So, much like the previous Times article on midwives as status symbols, doulas too are among those ranks. While many doulas have sliding scales and some even provide pro-bono care for low-income patients, the majority charge for their services, and rightly so.

But this is also why many doulas are pushing to be recognized by insurance companies. While it’s tricky to quantify, as there aren’t a plethora of studies detailing the benefits of doulas, the anecdata from those who have used doulas is powerful. Stories of women whose labors could have taken a different turn but didn’t because of a doula. Even stories of women who ended up with C-Sections, but still had the support and care of their doulas, making it a less fraught and difficult procedure. And, in a country that boasts one of the highest rates of C-sections and overmedicalization when it comes to birth, having an extra person who is there just to support you can be a game changer.

But, like many trends, it’s important to see who has access to doula care and who could benefit the most, because honestly the two are not mutually exclusive. The Times article profiles a wealthy couple living in Lower Manhattan who hired a doula for their second birth. Odds are, this couple also had access to high quality prenatal care, and did everything they could to ensure a healthy, low-stress pregnancy, already setting them up for an easier birth. Was the doula helpful for their birth? Yes, and they could obviously afford the $2,000 price tag. But what about mothers living in other parts of the city? The ones who might not have access to regular, quality prenatal care. Those who don’t have access to the same nutrition or time for physical activity. Basically, those who could truly benefit from an extra support person in the delivery room.

According to the Times piece, the state of Oregon’s Medicaid program covers doula, which is fairly revolutionary and something many doulas across the country would like to see take place at a more widespread level. There’s a lot of talk about ensuring better, healthier, and safer births in this country. If insurance companies were truly invested in better outcomes, they may want to seriously consider covering doulas for all women who would like one, so they stop being a style trend accessible to only a certain segment of the population, and become a real and viable birth option for all.