January 3, 2020

Doula care can improve birth outcomes, say advocates

Although more popular in urban areas, doulas have the potential to improve birth outcomes for rural, low-income women, say advocates.

The role of doula is distinctly different from midwifery because a midwife is a licensed medical professional who is a part of the birth process. A doula, on the other hand, could be thought of more like a professional mom who has a lot of experience in the delivery room and is there to help both parents.

Doulas are able to help new parents understand what is normal through the birthing process and can offer information before, during and after the birth, said Miyoko Inase, an Albuquerque-based doula.

Doulas can be in the birthing room to help mom with her breathing, massage and help with pain management. A doula can take some of the stress off the dad. And if a woman is having a cesarean birth, a doula can be there to help the mother understand what is going on so she doesn’t feel alone during the process.

Inase told NM Political Report that research indicates doula support during the birth reduces the numbers of interventions for both baby and mom.  

“Research shows doula support is tied to a reduction in intervention including Cesarean-section births, drugs, just less intervention for baby and mom,” Inase said.

That means that hiring a doula could help rural, lower-income women, who are at a higher risk for complications, Inase said. She said one reason low-income women are at a higher risk of birth complications could be that it’s sometimes more difficult for women who work lower paying jobs to take time off from work for prenatal care and, in rural areas, they may have to drive long distances to get that care.

“The lack of prenatal care is a big issue in premature birth,” Inase said.

According to the March of Dimes, a nonprofit that tracks premature births nationwide, one in ten babies were born before 37 weeks in New Mexico in 2018.

The rate is highest for black infants, at 12.6 percent, 10.1 percent for indigenous babies and 9.8 percent for both Hispanic and white newborns in the state. 

The cost of a doula in New Mexico ranges from $600 to $900 for the entire package of care, Inase said.

The New Mexico Doula Association is new and in the process of getting off the ground. Inase, who is a member, said one of the goals of the association is to push New Mexico to expand its Medicaid coverage to include doula care.

“It’s happening in a few other states around the country,” Inase said. “We’re feeling that’s a big missing link in helping communities that are at higher risk.”

Doulas often will meet with the soon-to-be parents during the pregnancy, are often there for the birth itself and can offer postpartum care as well. Some doulas specialize in postpartum pregnancy care. They can help with latching and also with home-care, like light housekeeping and keeping an eye on older children so the mom can focus on the new baby.

Doulas can be present for at home births but also for births that happen in a hospital.

Inase said hospitals and medical providers are getting more used to a doula in the birthing room.

“More nurses and providers are happy to have doulas on board because we make their jobs easier,” Inase said. “We’ve been pretty well received here locally in a hospital setting.”

Inase became a doula eight years ago. She said it can be challenging work and there’s high turnover, largely due to the need to be on-call all the time and there are the stresses of running one’s own business.

Inase said there are efforts to create doula collaborations which would enable doulas to take vacations and take turns being on-call for pregnancies.

Anyone can become a doula but there are certifying organizations that provide training and chances to apprentice with an experienced doula. Inase said that to become board certified, a doula has to assist three births. While she was a student, she offered her services at a very low cost for parents who wanted a doula but didn’t have enough money to pay for an experienced one.

She said certification usually costs between $500 to $1,000 and the students work at their own pace. But, she said it’s typical for a student doula to complete her training within a year or two.

Inase said there is a push toward what she called community-based doula care so the mom or parents-to-be receive care from someone who speaks the same language, lives in the same income bracket and is the same ethnicity.

“They’re more like peers,” she said.