Doulas Look for Greater Acceptance in Maternal Healthcare System

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Marisa Pizarro’s birth, as described by Anemona Hartocollis of the New York Times, starts out on a busy day in her apartment in Lower Manhattan’s financial district. As Marisa labored alongside her doula, her contractions 10 minutes apart, her husband (a music producer) was able to work on an upcoming release, tend to their young daughter, and catch up on the news on his iPad. With the presence of their doula, Marisa labored until it was time to go to the hospital.

The story of Marisa’s birth highlights the role of doulas in the United States:

Doulas are a growing force in the ever-changing culture of maternity, at once a manifestation of the growing demand for personal service (the doorman, the yoga teacher, Amazon Prime) and a backlash against the perceived overmedicalization of birth, with its high rates of cesarean sections.

Medical professionals can express resistance to doulas, and there is no insurance reimbursement for birth doula services. Despite the growing demand of doulas, they are a small part of the system of maternal healthcare. A recent report estimated that “there are as many as 400 doulas working in New York City who attend about 5,600 births a year, or about 5 percent of all births.”

doula (an antiquated Greek word for a female servant) offers support that complements the support from other birth partners (if others are involved). For many women, the support from their doula is

less-fraught emotional support than do sisters, mothers or husbands. They offer tactics to help women manage the pain of labor, as Lamaze breathing classes did to a previous generation. They are familiar faces and patient advocates in a situation where the patient may be meeting the nurses or the obstetrician on call for the first time during the birth. They also consult on prenatal subjects like nutrition and postpartum challenges like breast-feeding.

“We’re not there to change what the parents get,” said Adele Loux-Turner, a doula based in Brooklyn. “We’re there to help get what they want. If there’s a conversation to be had, we do and can let it be known that we’re there to kind of eliminate the hidden menu items.”

Some providers recognize how doulas support mothers in an otherwise impersonal hospital setting. They may recommend doulas, or – at the very least – feel obliged to allow them to honor their presence at the labor. Other providers work closely alongside doulas, and some hospital programs offer volunteer doula services.

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Doulas continue to seek out more recognition from insurance companies, but “insurance coverage is still rare, according to Choices in Childbirth, a maternal advocacy group that released a report promoting doula care last year.”

“Having a baby in New York City is a very lonely thing,” Dr. Jacques Moritz, an obstetrician at Mount Sinai Roosevelt hospital in Manhattan, said.

Yet the benefits of doula care are significant.

In New York, the By My Side Birth Support Program, which has provided free doula services to more than 400 low-income women in Brooklyn, has found that doulas led to a “definite improvement” in breast-feeding, but only a slight reduction in C-sections, perhaps because doulas could not influence hospital policy, said Mary-Powel Thomas, director of the program, a federal and city partnership.

According to Dr. Jacques Moritz, an obstetrician at Mount Sinai Roosevelt hospital in Manhattan, “a doula is like a personal trainer. Not that you can’t do it yourself; it’s just nicer if you have a personal coach for it.” 


For more information about the role of a birth doula, the growing interest in having doula support in labor, and the current state of recognition of doula care, you can read the entire article here, or check out an earlier post discussing the role of a doula.

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