The doula community may be growing, but it is still struggling with mainstream understanding and acceptance. That means representations of us that miss the mark—like the one published in the New York Times last week—have the potential to devastatingly minimize the impact doulas can have, particularly on the birth experiences of people who need support the most.
As I read the series of responses to the Times piece from across the doula community, I felt a strong sense of déjà vu. It only took a quick Google search to remember that the paper got it wrong about doulas only a few years ago. In a 2008 story about a woman who didn’t like her doula, a Times writer characterized the doula as combative; the anecdote ended with the doula leaving the birth altogether, supposedly because an epidural was employed, without getting the chance to tell her side of the story.
This time around, reporter Anemona Hartocollis portrays the doula in her piece as a helpful, comforting presence to the mother. However, she also depicts doula services as the newest luxury for the very wealthy: “a manifestation of the growing demand for personal service (the doorman, the yoga teacher, Amazon Prime).”
As Hartocollis recounts the story of one client’s experience giving birth with a doula present, she continues to include telling details about the client’s personal life, such as her lower Manhattan loft apartment, her partner’s post-delivery sushi order, and repeated references to private car services. She includes this gem, from the client’s music-producer husband: “I’m ready! … Would you like the finest that Uber has to offer, babe? V.I.P. S.U.V.? What’s the name of this hospital?’”
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By portraying doula services as an extravagance, Hartocollis dismisses both doulas’ availability and potential significance. Doula care is not always expensive. There are many organizations in New York and elsewhere that provide accessible options, such as Ancient Song Doula Services (ASDS), a Brooklyn-based group that centers the experiences of women of color. They provide doula training and services at low to no cost. If I were writing that Times article, I would have followed ASDS Founder and Executive Director Chanel L. Porchia-Albert to one of her births, and seen the ways her support changes the experience of the women she’s working with—very few of whom live in lofts in the Financial District.
A doula’s effect is shaped by the people she supports. If a doula works with a relatively privileged woman, like the one depicted in Hartocollis’ article, that woman will see the emotional benefits of the tailored attention; for that client, it can be an indulgence. But doula care is not going to have the same effect on her as it will on someone who is already facing a challenging and potentially negative experience.
The chances of facing such troubles can be high, especially for women of color. What the Times article fails to discuss is that the United States has really bad birth outcomes: We rank below dozens of other countries when it comes to maternal mortality, infant mortality, and premature birth. Experiences of labor in U.S. hospitals aren’t just “lonely,” as one obstetrician quoted in the article calls them—they can be downright dangerous. This is particularly true for Black women, who face much higher rates of all of the above problems compared to white women. Race is a major determinant of whether you’ll have a healthy pregnancy and healthy baby in this country. In New York City alone, according to ASDS, Black women are nearly eight times more likely to die during childbirth than white women. These disparities exist throughout the country (although at varying levels based on geography), and for Native and Latina women too. For example, nationally, Native American and Latina women have higher risks of premature birth than white women, but still lower than the rates for Black women.
So doulas serving women of color can make a difference that is far more lasting than, as that same obstetrician put it, someone equivalent to a personal trainer. We’re talking about the difference between premature birth and getting to full term, the difference between a cesarean section (major abdominal surgery with serious risks) and a vaginal birth. We’re talking about the difference between life and death. Ninety percent of the women ASDS provides doula support to are Black; among the 200 women for whom they cared between 2010 and 2012, they saw significant beneficial outcomes as compared to city averages. The c-section rate among this group was only 12 percent, compared to more than 32 percent citywide. Only 2 percent had preterm births (compared to 9.3 percent citywide), and only 3.25 percent had low-birth weight babies (compared to 8.6 percent citywide).
ASDS isn’t the only group reporting improved outcomes with doula care. A University of Minnesota study looking at 1,000 doula-supported births also showed significantly lower c-section rates than the national average. The study looked at Medicaid-funded births, meaning the sample was predominantly low-income women.
All that said, there is one thing the Times article may have gotten right: The future of the doula movement will likely be determined by money. I wrote about this for Rewire in 2013, and the questions I raised then—about what it will take to bring doula support to everyone who needs it—endure.
ASDS, for its part, survives off modest grant funding (they received their largest grant ever at the end of last year from Every Mother Counts, a foundation founded by former supermodel Christy Turlington Burns); women who can afford to pay the full fee for their births; and the fees from the doula trainings and workshops they offer. But volunteers drive a lot of their programs, which Porchia-Albert acknowledges isn’t sustainable. In December, Porchia-Albert told me that her vision for the doula movement would be “to educate and create jobs for the doulas and the moms who come through the door [of ASDS]. Money shouldn’t limit us to anything we want to do. We can’t have access to things if we can’t pay for it. That shouldn’t stop you from getting the care that you need.”
In order for doulas to have the greatest impact possible, we must ensure doula care doesn’t turn into exactly what the Times suggests: a frill only the wealthiest can afford. There are many out there working to ensure this, in addition to Porchia-Albert and ASDS. There are doulas who offer sliding scale or barter services for low-income clients, doulas who start organizations that apply for grant funding to serve low-income people, and, as briefly mentioned in Hartocollis’ article, doulas who are advocating for Medicaid and insurance reimbursements. The doula movement I’m a part of is not about creating a new luxury service for the wealthy; it’s about making sure those who need it the most have support.