When Tiana Taylor read a book with a chapter on birthing babies in college, she was hooked; two years later she started work as a certified doula.
“I love being a doula,” Ms. Taylor said. “I love going to birth.”
Doulas, different from obstetric nurses or midwives, are trained professionals who provide emotional, physical, and informational support to pregnant people and their partners during pregnancy, childbirth, and postpartum. They work in conjunction with medical professionals to ensure women have positive birth experiences.
“Doulas are advocates, doulas are teachers, doulas are educators. Doulas are there to care,” Ms. Taylor said.
Physically, doulas can assist with breathing techniques, position changes, and relaxation strategies during labor. Emotionally, doulas provide continuous support to empower and relax the pregnant person.
Doulas also help future parents navigate the healthcare system, which can often be overwhelming. They can manage communication with healthcare providers and help pregnant people understand their options when developing a birth plan.
“It’s empowering for ladies,” said Irma Cobian, Midwife at Mercy Health, Spring Valley Obstetrics and Gynecology. “They have a voice. They are heard. If they feel like a provider isn’t listening to them, they know at least the doula will be there for them, and the doula gives them that strength – that power – to get through a pretty significant time in a woman’s life.”
Long history
Doulas have roots deep in history, stretching all the way back to ancient Greece, where women offered emotional support and guiding wisdom to one another during childbirth.
While the tradition of female support during childbirth existed in many cultures for hundreds of years, the modern emphasis on hospital births put medical intervention, rather than emotional support, at the forefront of pregnancy.
It was not until the 1970s that the contemporary doula movement was born.
In recent years, there has been a boom in doulas at the national level, said Sarah Rainey-Smithback, co-president of the Board for Solace Health and Wellness, and the director of the Women’s, Gender, and Sexuality Studies Program at Bowling Green State University.
Ms. Taylor also notes an uptick in local pregnant people requesting doulas, which she credits to a national informational campaign that has taken place on Instagram and TikTok.
Currently, according to a list compiled by local midwife Shelly Varelli, there are over 20 independent doulas in Northwest Ohio.
“We have seen an interest in the use of doulas in our area, as we have nationwide,” Ms. Rainey-Smithback said. “As information about the infant and maternal health crisis spreads, more people are turning to proven strategies, like using doulas, to improve outcomes for pregnant people and babies.”
According to the American Pregnancy Association, studies have demonstrated that having a doula can lead to shorter labor and a lower likelihood of a C-section. Having a doula can also decrease anxiety during labor.
Patients sometimes confuse the roles of doulas and midwives, Ms. Cobian said. While midwives are registered nurses that deliver babies and provide medical care, doulas exclusively provide support for patients. Doulas and obstetric nurses must work closely to foster a comfortable birthing environment. It’s an intimate collaboration, Ms. Cobian said.
Even though Ms. Cobian’s midwife group “labor-sits” patients – meaning they are present through the entirety of the labor process – she still sees the benefit of a doula. The more support the patient receives, the better,
“When our patients will say, ‘Well I’m going to get a doula,’ we’ll say, ‘That’s up to you. We’re there for you, but two heads are better than one,’ ” Ms. Cobian said.
Social advocacy
In addition to providing general support, doulas can provide missing support and advocacy for minority populations that have been marginalized within the healthcare system, Ms. Rainey-Smithback said.
The infant health crisis is particularly significant in Lucas County. According to the 2019 CDC report, the infant mortality rate is 5.4 deaths per 1,000 live births nationwide, but in Lucas County, it is 9.5 per 1,000 live births. For African Americans in Lucas County, the infant mortality rate is 15.9 for every 1,000 live births.
“Minority populations face many barriers to receiving care in our current medical system, including racial bias, lack of private insurance – which often comes with better and more comprehensive care – access to clinics, and so forth. Doulas provide pre- and post-natal education and resources, emotional support, and serve as a consistent advocate for the pregnant person, helping them navigate the system,” the educator said.
Depending on a doula’s experience, the cost of services can range from a few hundred to thousands of dollars. Currently, in an initiative to improve the health of pregnant people, the Ohio Department of Medicaid has been offering doula services through a grant opportunity in specific counties and additional pilot programs.
Starting this fall, Medicaid will cover up to 48 15-minute sessions with a doula from the first prenatal visit to a year postpartum at a rate of $12.50 per unit. Medicaid will also offer a $600 reimbursement for a doula’s birth services, separate from prenatal and postpartum visits.
The Ohio Department of Medicaid requires doulas to receive a special certification from the Board of Nursing to enroll as doula. However, there is no universal certification for doulas.
Medicaid covering doula services is especially significant, Ms. Rainey-Smithback said, because when a patient on Medicaid goes for prenatal care, they are likely to get a different provider each visit. Hiring a doula provides consistency within their care regimen.
For Ms. Taylor, however, Medicaid covering doula services does not come without concern. If healthcare providers begin building doula programs due to the fact they can now bill Medicare, Ms. Taylor says, who the doula’s true client is – the hospital or the pregnant patient – will become convoluted.
What is so special about doulas is that they are outside of the healthcare system, Ms. Taylor said.
Contact Elena Unger at eunger@theblade.com
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