As maternal mortality rates persist, especially among women and birthing people of color, doulas are proven to improve birth experiences and outcomes. However, many expectant parents continue to heavily rely on traditional providers and may not be aware of the resources available to them, including the invaluable support doulas provide.
After a “cut and dried” experience during her first two births, Janice Ingram, CD/PCD, CCE, CHW-C, enlisted a doula for her next few pregnancies, eventually deciding to become a doula herself. Throughout both her professional and personal experience, she has seen firsthand how doulas are changing the pregnancy and parenthood journey for the better.
From Mother to Doula
Though Ingram’s first two pregnancies were not necessarily traumatic, the attitude from hospitals and providers was generally, have the baby and go home. “I thought that was what you do,” she said, adding that although neither was a horrible experience, there was certainly room for tweaks.
She was able to bounce ideas back and forth with her care team, not feeling much of a need to speak up as it felt like she was still ultimately in the driver’s seat. However, during her third pregnancy 12 years later, she noticed the whole dynamic had changed.
Her third pregnancy came in 2013, during what she refers to as the Cesarean Age. “I realized that the conversations were different,” she said. “I felt that there was more bias. I felt that it was more like, ‘It’s our decision, and you’re supposed to come along for the ride.’”
Realizing she needed someone to advocate for her, she sought out a doula, whose support she utilized throughout her next few pregnancies. Eventually, she decided to venture into becoming a doula herself, having previously worked with other vulnerable communities including elderly, incarcerated, and disabled people.
While working in the criminal justice field, she heard about mothers and birthing people frequently experiencing complications and high mortality rates. “During all this time, I had had a child myself,” she said. “I realized the pressures that I faced when I had my children and the things that were going on and I was like, I really should share this information because this could help someone else.”
How Doulas Advocate for Parents
As someone who both utilized and served as a doula, Ingram realized how many misconceptions exist surrounding the profession. In her experience, many medical providers assume doulas aim to change the patient’s mind. However, the object of a doula is to support patients and advocate for them to ensure their experience aligns with what they want, regardless of the doula’s personal preferences or bias.
For example, a patient may request to not be medicated during birth, but feel pressure from their doctor, nurse team, or partner to accept pain medication as labor intensifies. The doula’s role is not to say they cannot accept medication, but rather remind them of the reasoning for their decision not to. If the patient understands this, and still decides they’ve changed their mind, the doula then shifts to support the new decision.
As a doula, Ingram also makes patients aware that doctors often do not provide the full scope of information needed to make their own well-informed decision. Rather than operate as a mouthpiece for their patients, doulas provide them with evidence-based resources and encourage patients to form their own understanding, questions, and decisions. Then they can discuss with friends and family, their partner, and their doula before bringing concerns to their provider.
“A lot of times in the medical world, they feel a little threatened, because they’re like, ‘If we give information the doula is going to debunk what we’re saying to her and have [the patient] do something that’s totally not good for their health,’” Ingram said. “That’s not what I am there for.”
One point she especially makes clear to expectant parents is that they are the experts of their body. Medical providers may have significant professional experience, but patients are similarly well-versed in the bodies they’ve lived in for years. Doctors need to listen to and respect patients’ concerns; if they do not, it may be a sign to reassess if the care team is a good fit.
During one birth, Ingram witnessed her patient be told to shut up and listen after speaking up about extreme back pain. The provider rudely dismissed her concerns and continued to explain that this pain was normal and didn’t require extra attention.
“But at that point, no one was listening, because you’ve not only now been rude, you disrespected her and her mother, and you’ve turned the situation more tense and hostile than it needed to be,” she said. “When you bring that kind of energy into the birthing space, it interrupts the flow of what the birth should be.”
Addressing Racial Disparities
For Black women especially, whose maternal mortality rate is three times that of white mothers, Ingram encourages speaking up at the first sign of concern, regardless of whether it could be considered normal. During the postpartum recovery period, when new parents aren’t being constantly monitored or having someone check in, it is imperative to find out for sure if something is a valid concern.
“As Black women, we often tend to think things are smaller than what they are,” she said. As the body recovers, it’s crucial to speak up about things that feel off. Having a doula offers a confidant to provide validation and help advocate to a provider to make sure everything is okay, where they might have otherwise dismissed it as nothing.
To further ensure that women and birthing people of color are validated throughout their childbirth journey, doulas push patient literacy. Over time, Ingram noticed that doctors frequently spoke so quickly or in such complicated medical jargon that the patient did not fully understand what their options were or that they had consented to something they didn’t necessarily want.
To combat this, she empowers patients to challenge their providers if they feel slighted in any way. By asking the tough questions, she believes patients are better able to see their doctors’ “true” side and can make a more informed decision about whether their provider will be a good fit for what they want for their birth.
For example, once a patient receives information from their doctor, she will discuss it with them to learn how they understand what they were told and what they know their options to be. She will then break down any confusing language and offer reputable sources to research so patients can come to their own understanding and identify the questions they still have.
She then encourages them to bring these talking points back to their provider and see how they react. If their doctor cannot honestly answer why they didn’t offer the full scope of information or resources available, or becomes short, defensive, or rude, it may be a sign to seek a new care team. “You need to be comfortable with the person who’s catching your child,” she said.
The racial disparities and high mortality rates that Black women and birthing people face are often the result of dismissive care. In Ingram’s experience, Black parents are often asked about birth control and substance use before they are asked if they are experiencing pain, eating sufficiently, or struggling to nurse.
By recognizing and addressing these disparities, doulas empower parents to trust themselves and their bodies, speak up for their needs, and feel comfortable taking control of their birth experience.
Restoring Balance for New Parents
Doulas not only help facilitate a positive and safe birth but can also help parents overcome stigmas and barriers to care, connect parents to community resources, and provide support for the whole family. Doulas are often mothers themselves who can relate to what new and expectant parents are experiencing and help restore balance in the chaos following childbirth.
“Balance, to me, is not missing a step in life,” Ingram said. Many expectant parents are used to a specific routine at home and don’t realize how much childbirth can affect their normal schedule and environment. When parents just want to rest and recover but return home to a messy house and other children who need attention, things can quickly falter.
In her experience, new mothers especially struggle to let go of household duties and focus on much-needed recovery. “You shouldn’t be putting in housework, cooking meals, jumping back in,” she said. “Even though you feel like you can, you shouldn’t.”
Doulas help provide balance by taking over these responsibilities, sometimes even providing services such as handling laundry, prepping meals, or attending to other children. By taking away some physical and environmental stressors, new parents are better able to focus on adjusting to their new lives, including caring for the new baby and for themselves.
“Self-care is hard to squeeze in without the self-guilt,” she said. “I don’t think it’s fair for people to feel that way. I think they need to be able to adjust and bring in whoever they need to bring in to make everything balanced where it needs to be.”
Changing the Conversation Around Childbirth
Although Ingram has seen more expectant parents age 29 and older choosing to utilize doulas, the trend stems from increased awareness of how common negative birth experiences are. “There’s a lot of women in fear of even entering a hospital at this point just from looking at the statistics, from hearing what other mothers went through,” she said. “It took a lot for us to get verbal about what was really going on behind those closed doors.”
Previously, the stories shared about birth have been fairly cut and dried – people went into the hospital and left with a baby, but there weren’t many details shared about what that visit looked like. Now, as more parents learn about the disparities and disrespect driving maternal mortality rates and health complications, doulas are being sought out more frequently for their support and advocacy.
However, younger parents (in the 25 years and under age group) are trending in the opposite direction. Rather than prioritize a natural birth journey, many young parents are more interested in scheduling their births to get them over with, opting for elective c-sections and inductions.
“I’m hoping that gap closes a little bit more because it’s very concerning when you have babies that are coming out four to five pounds, going to NICU because you wanted to deliver them at 37 weeks, and when doctors and providers are allowing that,” Ingram said.
In these situations, she believes a doula is especially important to have to explain exactly what patients are signing themselves up for. Without a doula, patients and their partners are responsible for keeping track of what’s happening with their care, which can be daunting while trying to simultaneously navigate the emotional and physical toll of labor.
For example, a provider may suggest a medication that the patient consents to without fully understanding. If this medication then makes them sick or leads to a complication, there exists a gray area in who is liable, and it can be difficult for parents to keep track of previous conversations or agreements on treatment. The result could potentially mean a negative health outcome during birth that they may not be able to prove was caused by the provider.
Having the support of a doula who understands the birth journey, the inner workings of the body, the hormones and emotions surrounding birth, and can also keep track of the medical care provided, can alleviate parents of this burden. Then, parents can focus solely on the transformative experience of birth and keeping the mother or birthing parent and baby safe and at peace.
Get Connected to Support
In addition to doulas, there exist a variety of resources that work to empower expectant parents throughout the childbirth journey and improve health outcomes. Count the Kicks, a public health campaign proven to reduce stillborn births, teaches parents to be in tune with their baby’s movements and recognize early signs of problems. The education is supported by many providers and doulas, including Ingram, and showed immense success in its first decade.
Kimberly Isburg, communications specialist for Healthy Birth Day, Inc. and their Count the Kicks initiative, utilized the kick counting method in her own pregnancies. Similar to Ingram, her personal experience as a mother drove her passion to educate and support other expectant parents.
Within the first ten years, the Count the Kicks campaign realized their goal of a 32% reduction in the national stillbirth rate, with a reduction of 39% among Black mothers specifically. The campaign continues to work with providers – including OB=GYNs and nurses as well as doulas, midwives, and other birthing support persons – to educate patients about counting kicks and continue improving maternal and infant health outcomes.
In the campaign’s early years, providers expressed concern that asking parents to track fetal movements may increase anxiety and cause them to constantly obsess over whether their baby was moving enough or not. However, according to Isburg, 77% of Count the Kicks app users reported the method actually reduced their anxiety about their child’s well-being.
While there are printable record sheets as well as a web-based app, majority of Count the Kicks users utilize the free phone app. Parents are encouraged to use the app once daily to count how many times their baby kicks, tallying how many movements occur within a certain time span.
After each session, this data is stored, and over time parents can see visual trends in their baby’s movement as well as share this information with their care team. This allows both parents and providers to recognize when their baby’s movements change and can potentially signal a complication that may have not been caught otherwise.
“Babies are just like us,” Isburg said. “If we’re sick, we’re going to lay down and move less.” Recognizing a baby’s normal movements, as well as changes to these movements, can raise a red flag that the baby or birthing parent may be in distress. A recent report includes stories from eight women sharing how addressing a change in their baby’s movement, using the Count the Kicks method, led to the discovery of a problem that could’ve put their own life at risk.
In addition to potentially saving lives, the practice also empowers parents to be more in tune with their bodies and helps partners bond with the baby prior to birth. For women and birthing parents of color, this practice can especially help with speaking up to providers by offering evidence-based, measured data that supports their concerns.
The Count the Kicks app is free, easy to use, and available in 14 languages. The Count the Kicks website also offers a Parent Academy that houses videos, tools, resources, and more information regarding the importance of kick counting and notifying providers of any changes.
Get Connected to Support
The Maternal and Infant Health (MaIH) Project, offered by Altruism Media, Inc., connects pregnant women and birthing people to a continuum of health and social care from pregnancy through one year postpartum. This support includes access to: a community health worker and doula; education about counting kicks, breastfeeding, and other ways to improve health outcomes; support for the partner and family; and assistance addressing unmet needs like housing, food insecurity, transportation, and more.
To learn more about how The MaIH Project can help you and your family, call or text 844.860.011 or visit https://altruism-media.org/the-maih-project/.