Access to Doula Care is a Public Health Issue For All

Choices, Doulas, Postpartum Health

Michele Giordano
Executive Director, Choices in Childbirth

This week is World Doula Week, and Choices in Childbirth is thrilled that doula care is gaining more traction and visibility across the country, even receiving recent national media attention in The New York Times article Doulas, A Growing Force in Maternity Culture, Seek Greater Acceptance. But, it is also an ideal time to advocate for every woman to receive this critical benefit in her maternity care. We hope to pick up the conversation where the Times left off: why access to doula care remains low, even when it is more necessary than ever. As highlighted in our report, Doula Care in NYC: Advancing the Goals of the Affordable Care Act, evidence shows that widespread access to doula care has the potential to significantly improve health outcomes and the experience of childbirth for women and infants.

A model maternity care system is one that respects a woman’s choices and supports her care from a doula.   Doulas serve a vital role in maternity care—continuous physical and emotional support throughout a woman’s labor and birth increases the likelihood of safer, healthier, and more satisfying birth experiences. Specific benefits include reduced Cesarean section rates, shorter labors, fewer medical interventions, and greater likelihood and longevity of breastfeeding. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine agreed, releasing a joint statement in February 2014 that continuous labor support is among “the most effective tools to improve labor and delivery outcomes,” and is likely underutilized. Why, then, have hospitals not caught up with these findings, given that only 5% of all births in New York City are supported by a doula? Viewed in context with the city’s high rates of maternal deaths and complications and the skyrocketing cost of birth, an immediate need for system-wide improvements in maternity care practices is imperative.

Increasing access to doulas would also provide a significant public health benefit. Like community health workers in other fields, doulas support women’s access to health and social services, educate women on healthy behaviors in postpartum and newborn care, and can help women navigate their particular emotional and medical care needs after birth.  Universally investing in doulas for pregnant teens and for low-income women of color would drastically improve disparate public health gaps in intrapartum care. For many, having a doula would be an integral layer of support in the birth experience, holding as vital and equally important of a role on the birth team alongside the L&D nurse, midwife, social worker, and doctor.

For many, having a doula in the room affirms a central belief we all hold: that a woman should be supported in the choices she makes about how she will birth her baby. After all, birth should not be regarded as something that passively happens to a laboring mother, and it should be supported by the right resources, encouragement, and options that respect a mother’s decisions about her care.  Doulas are trained and equipped to give that support to mothers and families and can provide comfort during an unpredictable time.  Dr. Jacques Moritz, Director of Gynecology at Mount Sinai Roosevelt, noted “Having a baby in New York City is a very lonely thing.”  We know it doesn’t have to be– especially if there’s a doula around.

Maternity care in NYC must improve. If families and women are choosing doulas, then it is time we value and empower this choice.