More and more women want a doula at their side before, during and after they give birth.
More women are hiring doula care to have a secondary voice and body of support in their birthing spaces.Laura Cofino hasn’t always considered the hospital to be her safe place. She has an autoimmune disease that requires her to spend too much time inside sterile, white linoleum walls. So, when she thought about having a child; she knew immediately that if her birth was in one, she would need to have a doula – someone there to support her wishes – by her side.
Not all doulas maintain these boundaries, and those that do not, contribute to a slight stigma in the medical world against doulas, Hull said. Careful scrutiny before engaging a doula is warranted, she and other medical professionals said. Dr. Sarah A. Hoopes, an obstetrician and gynecologist at Houston Methodist and St. Joseph’s Medical Center said that the lack of government insurance coverage makes it more difficult for patients like those at St. Joseph’s – a hospital that treats primarily people from lower socioeconomic backgrounds – to hire a doula as they may not have the financial means to pay for this care out of pocket.
Cofino said thanks to Hull, her entire birthing process, both before, during and after delivery went better than she had expected. She said Hull asked her questions and made sure she felt comfortable about the little things that hadn’t crossed her mind – like choosing whether or not she wanted to wear a gown from the hospital or get an IV.
Parker had wanted Hull as her doula, but she was unavailable at the time of Parker’s due date and the expectant mother engaged another doula. She quickly learned that just because a doula is meant to help, doesn’t mean all will assist their clients to smooth-sailing birthing waters. Parker says she got the exact opposite when it came to the birth itself. Although the doula had helped with labor pain coping mechanisms and other tips in advance of the birth – she did little else.
Although Parker ended the day with a healthy baby boy, the obstetrician who delivered Parker’s baby gave her an episiotomy and ruptured her membranes without her consent, she said. With Hull’s guidance and the early processing preparation work, Parker accomplished what she had wanted all along: a safe home-water birth.
“I am really working with two different people with two different experiences, there is a difference between being in labor and being at a labor and both of these people need to be supported and prepared,” Hull said. “Each of them is complementary, but each of them are different so as a doula, you want to be prepared to work with both partners because they are both going to have a baby.”
As a childbirth educator too, Debbie Hull suggests that her couple clients take birthing classes to better prepare themselves for what is to come and support each other before, during and after the birth.And if expecting mothers are wanting to explore this option – male doulas do exist.
Hoopes said that this does not appear to be the feeling toward doulas by a vast majority of physicians. Especially as there is research that having doulas involved in the birth process statistically leads to better outcomes, she said. “The most common thing I see – especially when a homebirth is transported to a hospital – is at a point there may be a situation where the mother already has to compromise on something that she didn’t want that had to happen,” Hull said.
Increasing access specifically to those who are on Medicaid would increase the chance of better birth outcomes for the populations that already have substantially higher rates of severe maternal morbidity and mortalityCurrently in the Texas Legislature, efforts are being made toward the potential expansion of Medicaid coverage to include doula and other perinatal services under House Bill 465.
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