Could more low-income women benefit from doulas?

6th October 2014   ·   0 Comments

By Deonna Anderson
Contributing Writer

(Special from VoiceWaves/­New America Media) – It was the spring of 2010 when Long Beach teen Elizabeth Thai gave birth to her first child. She hadn’t taken any birthing classes because she thought she couldn’t afford them, and by the time she learned that her health care plan did cover the cost of classes, it was almost time to go into labor.

“The only things I knew were what I read, and giving birth is kind of hard to fully read up on,” said Thai. Neither did she feel fully supported by the child’s father: “My partner was there but… he wasn’t fully informed about how he could help besides just being there.”

Lacking family support and being young and a first-time mom, Thai felt vulnerable during the birth at the hospital. As she puts it, “I feel like because I was [a teen mom] on Medi-Cal, they treated me like a teen mom on Medi-Cal.”

The experience encouraged Thai, when she became pregnant with her second child at age 19, to seek support outside of the medical establishment and her immediate personal network, ultimately settling on a doula—a decision that would change her life in ways she hadn’t expected: Thai would eventually become a doula herself, providing services to other mothers like her.

The term “doula” is an ancient Greek word that means “a woman who serves.” Today, doulas are people who are trained to provide physical, emotional, and informational support to mothers (and partners) during their pregnancy and the birth of their child.

“I serve the mother by giving her unbiased information, providing her with the pros and cons of her options,” Thai said. “We’re not there to tell [mothers] what to do but if they are confident with their choice then that’s the best thing that we can [provide for] them.” As a doula, Thai said she wants to make sure the mother knows that she has a voice and what the doctor says is not final.

Preschool teacher and newly certified doula Sarah Lavelle agreed with Thai on the role of doulas: “You can’t assume that every doctor will read a mother’s birth plan, so [a doula is] there to be that buffer in case they don’t follow it [during the labor].” A birth plan is a listing of the standards a mother requests for her birth to be ideal for her.

“During the birth, you’re there to be that open book for the mother and partner,” said Thai, whose own doula she said was able to provide her with more options than her assigned nurse, for how to deal with the pain of labor contractions.

According to one study of over 15,000 women published in 2012, “continuous support during labor and birth” such as that afforded by a doula can lead to a more empowering birth experience for mothers. Doulas can also contribute to numerous other improved birth outcomes including: shorter labors, better mother-baby bonding, and less postpartum depression. The research shows that women who received continuous support from a doula during their pregnancy were also more likely to have spontaneous vaginal births and less likely to have used pain medications, epidurals, or to have had negative feelings about their childbirth.

Low-income women less likely to use doulas

Research conducted in 2013 by Katy Kozhimannil at the University of Minnesota School of Public Health found lower cesarean birth rates among Medicaid beneficiaries who had access to a birth doula, compared to all Medicaid patients nationally. Also according to the research, many low-income women have a higher risk of poor birth outcomes, yet are less likely to be able to afford the cost of a doula service. Doula care is usually an out-of-pocket ex­pense, as most insurance providers do not cover the cost.

That being the case, a common perception of doulas held by low-income women is often that they are not an option. “A lot of women who are low-income have a strong belief that doulas are something that they can’t afford at all,” Thai said, even if that isn’t always true.

For example, she said, some doulas are open to bartering for their services. Thai said that she knows a mother who provided graphic design services as a partial payment to the doula service. And several other doulas interviewed by VoiceWaves said the doula community in Long Beach is strong, connected, and willing to find solutions for potential doula clients.

“If I cannot help a mother (personally), I like to help them get to where they need to be,” said birth and postpartum doula Tammy Leeper. “There is a huge disparity between communities who are underserved.”

Lavelle added that there is no one place in Long Beach for women to access birthing resources, which only exacerbates the resource gap in the city. It’s one of the reasons she decided to pursue being a doula.

“Maybe advertising with WIC would increase the visibility of doulas in low-income areas,” Thai suggested. She also cited a program serving low-income mothers in Santa Monica, that she said could be a model for other cities: started in 2011 by The Joy in Birth Foundation and Partnerships for Families, the program allows women to access birth and postpartum doulas, free of charge.

Nydia Aizpuru, another mother who used a doula for her pregnancy but is not low-income, said she was unaware of the support that doulas could provide when she first got pregnant.

She went into labor at roughly 4am and texted her doula, Marisol Garcia. “I was just giving her a heads up.” That morning, she and her husband were keeping track of her contractions but they were “all over the place.” They decided they would head to the hospital that afternoon. Once Aizpuru went into labor, which was over 24 hours long, her doula was there virtually until the end. “We had to almost like kick her out so she could get some rest.”

Looking back, Aizpuru said the support was “priceless,” and would recommend a doula to other expecting mothers, whatever their socioeconomic background. “When the time comes again, we’ll definitely be using a doula.”

Thai encourages women and families considering using a doula to interview candidates before making a commitment. “Don’t be afraid to tell a doula you are not hiring them because you don’t feel a connection or you found somebody else,” Thai said. “Most of the time we won’t take it offensively because we want the mom to feel comfortable to know that she’s choosing the right person.”

Readers can obtain more information about doulas in your area by visiting Doulas of Northern America, doulamatch.net or by doing a web search with the keywords “doula” and “your city.”

This article originally published in the October 6, 2014 print edition of The Louisiana Weekly newspaper.