Updated: Mar 7
(Content warning: Bereavement, pregnancy loss, fertility, and adoption.)
Are you looking for additional support from preconception through the first year of parenting? Maybe you feel anxious or scared about pregnancy, childbirth, or parenting in general? Information overload? Here at Central Coast Childbirth Network, we want you to know that these feelings are normal. CCCN can help support you and your family through this process by offering you resources and support to feel confident and ready for the arrival of your little one.
This month we are highlighting doulas. Not many people know what a doula is, and if they do, there are limited resources to help them choose which one may be best for them. This blog post will discuss: various types of doulas, where doulas work, statistical evidence-based research on the benefits of a doula during pregnancy and postpartum, and community barriers that exist today. We can help you find resources that will help you along this sometimes fearful, overwhelming yet exciting journey!
What is a Doula? What types of Doulas are there?
There is a wide variety of doulas available. It is important to know what type of doula services you are looking for! Each doula's role is unique. The most common types of doulas are fertility, birth, postpartum, adoption, and bereavement.
According to EvidenceBasedBirth and Dr. Christina Morton, a doula is "a companion who supports a birthing person during labor and birth." Birth doulas undergo training and provide informational, physical, emotional, and continuous labor support in various settings, from preconception through parenting for individuals, birthing people, and partners.
Some doulas may receive a certification, while some rely on professional education and intuitive, ancestral practices without a certificate. The most well-known certifying doula organizations are DONA, CAPPA, and StillBirthday offer additional resources on the most common types of doulas.
DONA International is the world's largest doula certifying organization. Their website offers a variety of resources, information, and how to start your journey with a doula. Visit their website here to learn more. Locally, SLO Birth Collective offers a doula certification to anyone interested in becoming a doula. Additional doula collectives that exist on the Central Coast are SMV Doula Collective and SLO Doula Connection.
Now that you know what a doula is, we will share where you can find a doula.
Doulas can practice in various settings, including being employed by doula agencies or volunteering through agencies, organizations, or nonprofits. Some doulas have a private practice and often do not take insurance. However, later we will discuss solutions to financial barriers for families who want doula support.
Additionally, astho.org describes the impact COVID-19 Telehealth flexibilities had on maternity care. "Recent state and federal telehealth flexibilities prompted by COVID-19 have expanded access to doulas and midwives." And… "Doulas are often members of at-risk communities and offer a form of cultural alliance, advocacy, and emotional support for women impacted by racial biases experiences in the healthcare system. By utilizing text messaging and live-video platforms, doulas help clients communicate with their healthcare providers and maintain continuity of care during the postpartum period… Positive outcomes have been reported for home visiting telehealth programs as states partner with Medicaid agencies to redesign home visiting programs and expand access to telehealth services for families and providers."
Let's explore the evidence on doula support.
According to EvidenceBasedBirth, research shows that birthing people who receive continuous support are "more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans."
Interestingly, research shows that birthing people feel less pain when a doula is present. Having a doula present can even lead to an increase in oxytocin levels in the body which promotes labor contractions.
Quick Facts from EvidenceBasedBirth:
With the support of a Doula…
there is a 25% decrease in the risk of Cesarean; the most significant effect was seen with a doula (39% decrease)
Labors are shorter by 41 minutes on average (*there is no data on if the type of person providing continuous support makes a difference)
There is a 10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference.
Numerous scientific studies have noted the positive impacts on the well-being of the entire family with the support of a doula. They can improve both physical and psychological outcomes for the birthing person and baby. Visit EvidenceBasedBirth for more information.
Also, the Cochrane Library is a great resource to learn more about continuous doula support and additional birth choices.
Everymothercounts.org just launched in 2022, a new free easy-to-use, online program called Choices in Childbirth. Learn more about how to access doula support and more topics in childbirth and beyond at Every Mother Counts here.
How do you know you need a doula, and what barriers can one anticipate accessing doula services?
When you first find out you are pregnant, one may consider looking into whether or not they want to hire a doula. Doulas will be able to support you throughout pregnancy. Additionally, if you need support after pregnancy, you can consider a postpartum doula.
Even though evidence supports doula services, there are many barriers to accessing doula support nationally and in the surrounding community. The most common barriers are cost, insurance, availability, lack of awareness, COVID-19 and underrepresented BIPOC and LGBTQ birth workers.
Some states, however, offer covered doula services through insurance. Visit this webpage here to learn more about which states offer Medicaid coverage and implementation of doula coverage laws. According to the Department of Health Care Services (DHCS), a doula will be added to the list of preventative services covered under the MediCal program in California. There are some barriers for doulas, such as low insurance reimbursement and hospital policies surrounding doula support. Check out this research article from Frontiers in Sociology related to how COVID-19 impacted doulas worldwide.
Most recently, TriCare started a pilot program for Military Families this year in the United States. California will also be starting a new program in the summer of 2022. Today, Tricare families receive covered doula services with a Tricare Doula Provider. If you are under insurance, check with your insurance provider to see if part or all of your doula services are covered. It is good to ask doulas if they are insurance providers and what financial plans they accept.
Zabrina Cox, the current CCCN President, is also the Owner of Zabrina Cox LLC, a local doula, Registered Nurse, Childbirth Educator, and CCCN Member. Zabrina discusses how she and other doulas can offer solutions for families experiencing financial hardships. Zabrina says, "Cost can be a barrier for some families who want doula support. I believe everyone deserves access to childbirth education and doula services. As a doula, I am more than happy to work together with parents and families to discover what works best for them. Here are some ways doula services can be financially attainable: Payment Plans, Sliding Scales, Barter, Request donations from family and friends, request a gift certificate from family and friends, HSA/FSA Cards, add these services to your baby registry."
So, from preconception through postpartum, we can imagine that expecting families may want additional physical, emotional, and informational support along the journey. Evidence suggests clear benefits of doula support.
Additional research from Listening to Mothers California notes that out of 2,500 women in 2016, only 9% used a labor doula. Eighteen percent wanted one for future use, and another 39% would consider it. Visit the California Health Care Foundation to learn more. We continue to connect with local doulas on the Central Coast to raise awareness about doulas and the benefits of doula support.
"If you want to look at the health of a community, look at how the M(others) are cared for. This is the primary motivator for why I'm focusing attention on postpartum planning, education, and care of the M(other). Connecting with a doula before birth to go over lactation education and facilitating postpartum planning and resource sharing is so important. Also, hiring a postpartum doula for care in the recovery period is often known as "the fourth trimester". It is generally expected that time and energy on preparing for labor and childbirth education happens. Also, for preparation of the baby's room and showering the family with gifts. What a baby needs most is a well supported care provider that is focused on nurturing and nourishment while also healing themselves. What about your perineum? Who is cooking for you? What type of bodywork can you plan into your recovery? I've worked with folks who are working through physical and emotional healing from an abortion, to mothers to be and educating the family on keys to postpartum wellness, to doing light house work, to sitting with a hot pack on mama and doing deep listening and guided mindfulness visualization of birth story and trauma. I believe womxn are the indicator species for our planet. There is a huge gap for maternal wellness and awareness of and care of the womb space.
With Covid being a stressor on families to figure out how to connect best with care providers, I think the silver lining is that we have become more aware of simple steps we can take to reduce spreading sickness and ways to do more outdoors. I've been meeting with my clients virtually, in-person with a mask, taking tests for virus presence, and outdoors with safe distancing. My favorite is getting to meet on a blanket outdoors with warm sun, tea, and a notebook. A few weeks ago, I hosted a postpartum planning workshop outdoors and had heat lamps and blankets overlooking the creek under the oak trees. We gathered safely and comfortably.
It's important for people to interview and connect with a few doulas to get to know their style, background, and overall how well they gel with them and their family. After all, it is a pretty intimate time being shared, and it's important that the client feels safe and exalted by the person caring and working with them. Most doulas I know offer a free consultation to meet for free and see if it's a good fit." - Victoria Carranza
Authored in collaboration with:
Morgan Jamati, CCCN Intern
Zabrina Cox, CtP Program Director