Understanding the Role of a Doula

Christina Gebel, MPH, CD Lily Schneider, MPH

APRIL 04, 2023

Pregnant mother being supported by doula and partner

If you’re reading this article, you might be considering having a doula as part of your prenatal, birthing or postpartum care team. Read below for some frequently asked questions and visit the Supportive Birth Collaborative page for more information about doula care at BIDMC.

What Is a Doula?

According to the 2019 Birth Justice report, birth doulas are trained professionals who provide emotional, physical, and informational support for birthing people before, during and after the labor and birth process. While they do not provide clinical support, they can provide one-on-one comfort measures, reassurance, and information useful to weighing decisions about birth interventions.

The goal of the doula is to ensure the birthing person feels safe, empowered, informed, respected, and heard throughout their pregnancy, labor, and delivery experience, regardless of whether they are giving birth in a hospital or at home. Doulas can also improve communication between clinical providers, the birthing person, and their family, by helping to form questions and express the birthing person’s preferences, for example.

Birth doulas usually meet with their clients at least one time (or more!) during pregnancy, and again early in the postpartum period. Doulas may also help with newborn feeding, maternal self-care, and emotional and physical recovery from birth.

What Is the History of Doula Care in the United States?

There is a long history of doulas in the United States in the early 20th century. Black birth workers, known as Granny Midwives, practiced in the South and played both the roles of doulas and midwives as we call them today. As modern medicine became more institutionalized in the early 1900s, public health officials, including mostly male obstetricians, targeted Granny Midwives because they inaccurately believed Granny Midwives were a driver of infant mortality. These factions put up several barriers to either discourage or delegitimize the work of the Granny Midwives; many of these oppressive acts were formalized in 1950 by the Shepard Towner Act.

Figures such as Margaret Charles Smith, Biddy Mason, and Mary Francis Hill Coley served as homeopathic healers of enslaved Black women and rural white women in their communities. Present organizations like Midwifery In Color, the International Center for Traditional Childbearing (ICTC) and Sista Midwife Productions work towards preserving the legacy of midwives of color and their foundational contributions to the midwifery profession.

How Do Doulas Practice Now?

For many years, doulas were accessible largely to affluent or privileged, mostly white patients. Over the past few decades, individual community doulas have built community-based doula practices. Community-based doula programs often include services that are specific to the needs of the community that they serve for free or very little cost.

How Is Doula Care Integrated at BIDMC?

Doula organizations have also grown; one that BIDMC partners with closely is Accompany Doula Care. Accompany Doula Care is a 501c3 that works to increase access to culturally and linguistically tailored birth doula services to individuals and healthcare systems seeking safe and positive birthing experiences in Massachusetts who may otherwise not be able to access it or face barriers like the cost of private doula care.

At BIDMC we welcome many different doula models including community doula organizations, private doulas, and our own South Cove Community Health Center labor coaches.

How Are Doulas Trained and Credentialed?

This is a very common question, but one that is difficult to answer because there is no singular professional organization for doulas nationwide. In fact, there are over 80 different doula training organizations in the country. Additionally, because of the historical structural barriers to practice, like the Shepard Towner Act, many doulas have pushed back on credentialing. However, funders, including Accountable Care Organizations (ACOs), have asked for credentialing to be explored as they consider ways in which to reimburse doulas through MassHealth/Medicaid. At the time of publication, there is an interdisciplinary group meeting regularly with the Department of Public Health in Massachusetts that is currently exploring this question of credentialing.

How Can Doulas Address the US Maternal Health Crisis?

One recent study comparing doula assisted and non-doula assisted births found that assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, a higher newborn Apgar score, and much more likely breastfeed.

The maternal morbidity and mortality crisis disproportionally affects the lives of people of color, and studies have consistently shown that those same patients face higher rates of negative patient experiences, largely due to medical racism. One way to address this crisis is by further integrating maternal support team members, such as doulas, into clinical settings. For women of color, doula support could be one strategy to mitigate the negative effects of racism on maternal and infant health outcomes. Doulas can help address the maternal health crisis by improving birth outcomes, especially among people of color who are most at risk of complications, through continuous support, advocacy, and exceptional care. Doulas can ensure that pregnant people who face the greatest risks have the additional support that they need.

To successfully integrate doulas and other support team members into the hospital setting, we must first improve the relationship between clinicians and doulas. Learn more about this relationship at BIDMC through the Supportive Birth Collaborative.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
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