BirthRoot Doulas Expanding Access to Care

Jessica Hunter

Doulas may seem like the latest wellness trend for expectant mothers, but for many women, having a trained professional who provides support before, during, and after childbirth -- is a return to the past -- and a potentially life-saving move.

Maternal mortality in the United States is at an all-time high, with Black women being disproportionately affected, regardless of age or education level. The Center for Disease Control data shows American Indian/Alaska Native and Black women are two to three times more likely to die from a pregnancy-related cause than white women— with 60 percent of these deaths classified as preventable.

Enter the doula, an advocate who could possibly bridge that gap by providing educational, emotional, and physical support before, during, and after pregnancy in capacities that midwives and doctors cannot. Doulas do not replace medical professionals or a mother's initial support person but serve as non-medical support in partnership with a birthing person, maternity care provider, and other resources. In the Erie community, BirthRoot is a growing group of doulas providing their clients with a professionally trained, representational, accessible woman who is not only familiar with maternal wellness but also knowledgeable about navigating Erie's system of maternity care.

"Our moms have our phone numbers; we talk and Zoom often to discuss their pregnancy progress and expectations, '' said Tica Nickson, director of prevention at Emma's Footprints/BirthRoot Community Doula Alliance. "Also as community-based doulas, we are further involved with our moms because we work to connect our clients to resources that bridge real life gaps for our moms.  BirthRoot develops connections and partnerships with other professionals and community organizations so that when our moms need assistance beyond their pregnancy, we can link them." One of those partnerships is with a group called Erie City Moms. Their volunteers have found ways to edify new BirthRoot moms with prepared meals and drive-thru baby showers. UPMC Hamot has also secured a grant that is currently being used in training some BirthRoot Doulas to become certified lactation counselors.  "Doulas build relationships with their mommas so they feel empowered in all stages of their maternity.  We help to elevate the engagement of the relationships necessary to ensure positive birth outcomes — relationships including those with their midwives or doctors," said Nickson.

Collaboration within the community by the community is a return to a model that was effective centuries ago. The incorporation of a doula adds a skilled, compassionate companion to help women comprehend their pregnant body and advocate effectively for themselves and their baby.  A doula will meet to discuss options and birth preferences to help a woman effectively communicate them to their provider before labor. Currently, our local hospitals permit mothers to have a doula as a second support person. "I think moms and their families see worth in having another helper in that space to make sure all moms' needs are met.  I often joke that doulas 'doula' dads and grandmas through their loved one's birth," said Nickson. "Having someone who is comfortable and experienced in the laboring process can be priceless to those families.  I also think doctors and facilities are truly trying to improve birth outcomes in all women but especially Black women and recognize the benefits for the mother in having the constant, calming presence of a trained doula in the room. I have one patient and I am there specifically to ensure the physical and emotional comfort of my momma," said Nickson.

During delivery, Nickson explains that the care a woman receives with a doula is constant.  Nurses and providers come and go as they have many patients but, the difference in having a doula is they tend to the emotional and physical needs of one mother, one birth at a time. "Our practice at BirthRoot (and probably with most doulas) is to block off one two-week span before a woman's estimated due date and one two-week span after the date and we won't take another birth in that time frame," said Nickson. It's also common practice to have a backup doula in case it is necessary. The client will get to know them as well. After delivery, doulas stay with moms typically two to three hours postpartum, especially if they have decided to breastfeed. Doulas generally do two to three home visits postpartum and those can be in person or virtual. The role of a community-based doula postpartum varies greatly from mother to mother.

Currently, there are no federal regulations for doulas. If you are looking for a doula, Nickson suggests finding someone who has been through a reputable training program and also participates in continuing education. "I think a valid question when you are interviewing doulas is to ask how they have kept their practice current.  Doula certification, though not required,  provides, I think, an extra level of professionalism that will be recognizable by medical professionals," Nickson said. "It's important to pick someone who is professional but also comfortable.  If you're not comfortable with them before you go into labor, chances are you won't be comfortable with them when you're in labor. I truly believe that some of us are just built for it and that will come through no matter how much or how little training someone has, so do your homework but also trust your instincts."

In the past, because of the lack of access and coverage by health insurance, doulas seemed to be a luxury only for those that could afford the out-of-pocket expense. Private insurance reimbursing members for doula care is relatively new and still requires upfront payment by the family, and Medicaid insurances do not cover doulas. There is funding available that allows doula care and support for Black moms and babies through BirthRoot thanks to a recent grant from the Erie Community Foundation. "BirthRoot is working to realign with our cultural heritage in providing funded doulas for women that probably wouldn't have access otherwise.  Our goal is to continuously provide some equitable competencies in spaces where Black women and other BIPOC are underrepresented but disproportionately affected. The pandemic has heightened everyone's awareness of the issues but these issues are not new," Nickson said. Women interested in learning more can call 814-449-6200. BirthRoot is being grown and funded by Emma's Footprints.

Amy VanScoter is a certified yoga instructor at SchoolHouse Yoga in Erie with a passion for wellness, and a marketing and communications professional. She can be reached at avanscoter@gmail.com.