PORTLAND - An Oregon health agency is recommending the use of doulas as a way to reduce infant mortality among low-income and ethnic minority households.
So what exactly is a doula?
“She stays in the room with the mom until the baby’s born. She doesn’t leave her, so she’s always with her,” says Shafia Monroe, the founder of the International Center for Traditional Childbearing in Portland.
She says doulas aren’t medical professionals. Their role is to support and advocate for a woman before, during and after birth. Monroe says many young mothers no longer have the support networks that were available to their own mothers.
“When it came to that time, those women who had experience from having such large families and breastfeeding, they would come and help and support you,” she says. “And that was just great.”
“But now we see that women’s moms may live across country. Women have to now work themselves. They can’t nurture their daughter like they wish that they could because they’re trying to keep a job.”
Young mother-to-be Khai East was facing just that sort of challenge last fall. She was like a lot of first-time mothers: Nervous. Especially about giving birth.
“I knew it was going to be a time where I was in an incredible amount of pain and might not remember everything,” East says. “I didn’t really know what was going to happen. It’s just this incredible unknown.”
East lives in Portland. Her parents live in New England. And her relationship with her baby’s father was on the rocks. So it was a huge relief to her when a caseworker helped arrange for a doula to work with East through the final weeks of her pregnancy.
“I just felt so much more confident going through the whole rest of the pregnancy and the rest of the labor when I just knew, okay, certain symptoms I’m having, this is completely normal, and this is what to expect.”
East’s doula was a trainee with the Portland-based Mother Tree Birth Services. That meant costs were minimal. But professional doulas charge anywhere from $500 to $1,000. That cost is rarely covered by insurance or public assistance programs.
And Shafia Monroe says unlike when birthing mothers were surrounded by an informal support network, “It is a career, and we want women to stay in the career, to keep doing the work. And they cannot do it without getting paid for it.”
Monroe approached Oregon lawmakers last year to try to come up with a way to make doulas more affordable to low-income women.
As a result of her efforts, the Oregon Health Authority studied the effectiveness of doulas. Its report noted that increased use of doulas among low-income women and women of color has shown to decrease the rate of C-sections and infant deaths.
But while the agency recommends increased use of doulas in Oregon, it’s not as simple as flipping a switch. So Oregon has applied for a federal waiver that would make it the first state to include doulas under the state’s Medicaid program.
Democratic state Representative Lew Frederick says the current state budget crunch makes it a great time to try something different.
“It’s a perfect opportunity to say what really works in preventative medicine, and how do we really incorporate that into our system,” Frederick says.
The state is confident its waiver application will be successful. If it isn’t, doulas would still be considered an out-of-pocket expense and not covered under the Oregon Health Plan.
Doulas aren’t licensed by the state. But most undergo training and obtain certification from one of several national training organizations. In fact, Khai East is undergoing training to become a doula herself.
“I’m really interested especially in first-time moms because you just don’t know,” she says. “You just don’t know what’s going to happen.”
And East figures there’s a nervous new mom out there who could benefit from a doula, just like she did.
On the Web:
International Center for Traditional Childbearing:
Mother Tree Birth Services:
Oregon Health Authority report on doulas:
Copyright 2012 Northwest News Network