S2 E8: Doulas: Finding One and Why You Need One (#43)

Summary

Taylor Rae Roman hosts an episode of On the Outside focused on the vital role of doulas in pregnancy and childbirth, sharing her personal experience and motivation for seeking a doula amid alarming Black maternal health statistics. She explains that doulas are trained professionals who provide emotional, physical, and informational support, and discusses her decision to work with a Black doula and OBGYN, investing over $3,000 for comprehensive care. Taylor breaks down the different types of doulas, their costs, and the availability of free or subsidized programs, and describes her experience finding a doula through NYC Birth Village Doulas who aligned with her hospital birth plan and values.

KEY MOMENTS

Introduction and Black Maternal Health Crisis - 00:00:06: Taylor Rae Roman introduces the episode's focus on doulas and shares statistics about the maternal health crisis, particularly affecting black women.

Definition and Role of Doulas - 00:03:54: Taylor explains what doulas do, their different types, and how they work alongside medical professionals to provide continuous care during pregnancy and childbirth.

Benefits and Importance of Doula Support - 00:07:20: Taylor discusses the research-backed benefits of having a doula, including lower c-section rates, shorter labors, and reduced maternal mortality.

Cost and Accessibility - 00:12:24: Taylor details the cost range for doula services, including her personal investment of $3,000, and discusses various options for making doula care more accessible.

Personal Experience and Selection Process - 00:16:28: Taylor shares her experience finding and working with her doula, emphasizing the importance of finding someone who aligns with personal birth preferences and philosophy.

TRANSCRIPTION

Welcome back. My name is Taylor Rae, and this is another episode of On the Outside. In today's episode, we talk about my experience with my doula, how you might go about finding one and why I think you need to get one.

Today we get into what is a doula and what do they do, why you might want a doula, including why black women and marginalized women might especially want to work with a doula, how to find a doula, including free and subsidized doula programs in the U.S., and the average Now, I read an in-depth New York Times article several years ago, I want to say it was over two years ago at this point, on black maternal health,

and that is truly what made me decide that I wanted to get a doula. Nationally, black women are three to four times more likely to die from pregnancy-related complications than white women, but in New York specifically, black mothers were more than 12 times more likely to die from pregnancy-related complications than white moms.

These disparities are linked to systemic racism, socioeconomic factors, and disparities in access to quality health care, and when I read these numbers, even when you control for things like socioeconomic status and education, the numbers are still staggering.

It's not only about access, it's not only about if you have a good doctor, it's not something that will happen to you. It's something that disproportionately impacts black women and other women of color as well.

have to note but most notably black women are impacted by this disparity and honestly I was so scared. I remember I was reading this article when I was in the car with my husband and I had to put my phone down and I started tearing up and I was thinking about how scared I felt and how out of control I felt because again there wasn't really anything that seemed to mitigate this kind of disparity.

I thought okay well what if I have a really good doctor and that didn't really seem to necessarily make the outcome very different statistically but what I did find is that having a doula can greatly impact this outcome.

I also chose to have a black OBGYN to have a black doula to have these women on my team that I really felt would advocate for me and that they would truly care about my life honestly. I think it is a very scary decision for anyone to decide to become pregnant.

It is not a health neutral decision by any means, but especially as a black woman in the United States, it's a scary thing. So I started to feel a lot more comfortable. Once I found my doula, she has just made me feel so supported.

And I know that she will advocate for me. She will be there for me to support me and Richard. I've learned so much from her and I'm just so excited to talk to you more about doulas today because I don't think a lot of people know what even a doula is, what they do, and how to go about this process.

Before we dive in, I want to remind you that I'm not a doctor. I'm not a medical professional. And everything I share is based on my personal experience and research. Always check in with your doctor or qualified healthcare provider before making any decisions about your health, pregnancy, or preconception journey.

Now let's get into it. First of all, what is a doula and what do they do? A doula is a trained professional who provides emotional, physical, and informational support before, during, and after childbirth.

They're not medical professionals. So they don't replace doctors and they don't replace midwives, but they do work alongside them. So a doula, again, is not something, is not the person that's going to deliver the baby.

Your doula is another trained professional that's going to be there to support you through your labor process. In a big city like New York especially, this is really awesome because it provides a person that's there for continuous care.

When you are at a big office like the one that I'm at, any of the OBs that are on call could deliver my baby. So that means I may not have the specific OB-GYN that I've been seeing over the last nine months.

I might have someone else because this might not be the day or night that she is on call. But my doula will 100% be there because she is that continuous care person. I hire her separately and she provides that support before, during, and after childbirth and is really just you know a little bit more continuity.

Now there are a few types of doulas. There are birth doulas who support you during pregnancy and labor. There are postpartum doulas who help with things like recovery, newborn care, and emotional support.

And there are also full spectrum doulas that may support you through other things like miscarriage, abortion, or any reproductive journey. So there are several different options. My doula is a birth doula, she also is a postpartum doula, and she's also a lactation consultant.

So she does it all. So I have had support before. childbirth of course while I'm pregnant. I've already met with her twice. We've also had some Zoom calls to answer questions. She's there for me to text and ask any questions too.

Then she'll be at my labor and delivery and then she also has a couple appointments with us at our home after baby's here to help with some postpartum support. The goal of Adula is to help you feel empowered, heard and supported throughout your experience.

They're really just there to make sure that you are advocated for, cared for and to also really have that knowledge. I've never given birth before. She has seen tons of births before so she's going to recommend things like positions I should get in.

She's going to be able to tell me what counter pressure we should use. She's going she was saying she's going to bring her tea lights to decorate around the hotel room and her fairy lights to make sure that we have a vibe in the hotel in the not the hotel room in a hospital room to make sure that we have a vibe so that everything is feeling great.

This is really just someone that you can count on to have your back and to also be able to provide information so that if you're getting new shocking information that you don't understand in the moment you have someone that's there that can translate that information to you and give you a moment to kind of take it in and make an informed decision.

Now why might you want a doula? Having a doula is associated with better birth outcomes. Research shows that doulas lead to lower rates of c-sections, less need for pain medication, shorter labors, reduced health insurance costs because you may have less interventions, increased breastfeeding rates and reduced maternal mortality and all of that is going to be linked in the show notes on my website of course that shows where that research directly comes from.

You might also want a doula for emotional and physical support. They can provide according measures, like I mentioned, things like massage, breathing techniques, and encouragement, and it's someone that's done it before.

Advocacy, they help you navigate hospital policies, make informed decisions, and ensure your birth plan is respected. I love this. One example is in my birth plan, we have delayed cord clamping for the baby.

Now, standard is around a minute. I am hoping to go a bit over that. A couple minutes would be amazing. And so my doula is going to be there. So when I'm honestly overwhelmed, because I literally just gave birth, while Richard is like freaking out because he has a son, while we're like hysterically sobbing, my doula will be there.

And if they try to cut the cord or clamp the cord, and there's no medical emergency, and there's no reason why we can't have it go on a little bit longer, my doula will be there to say, hey. Make sure you're respecting her birth plan.

She asked for delayed cord clamping. We need a couple more minutes. She doesn't consent to this in this moment. We need a little more time. She has the ability to advocate for me in that way and to just be another set of eyes and another voice in that room that can support my wishes because we've already discussed them.

And she can't make medical decisions for me. Again, she's not a doctor or a medical staff, but she is able to advocate for me to make sure that I'm looped into the conversation. And I really, really love that.

Lastly, for postpartum care. A doula can assist with breastfeeding, newborn sleep, mental health after birth. And I'm really happy that we do have a couple of postpartum visits with our doula. She is like the sweetest, warmest, like most comforting person.

When I met her, I was like, oh my God, you're so comforting. And I just met you a second ago. So I really think her temperament and disposition was like made for this work. So I know she's gonna be so soothing during that postpartum experience when I'm just becoming a new mom.

Now black women and marginalized women may especially want a doula. The maternal mortality crisis in America, as I mentioned at the beginning of this episode is absolutely horrific. Black women are more likely to die from pregnancy related causes than white women.

And we have so much evidence of that. There's systemic racism in healthcare. Many black and marginalized women report feeling unheard or dismissed by medical providers. So having doulas as advocates can help ensure that your concerns are taken seriously, that your birth experience is centered on your needs.

Also finding a doula can really help with cultural competence, making sure that you find someone who understands your lived experience can make a huge difference in feeling safe and supported. So especially if maybe you don't speak the native language of those that might be at your hospital.

Maybe you don't necessarily share the same culture as those that might be delivering your baby. Having a doula that aligns with your background and understands your story is also a great reason to have a doula.

Like if English is your second language and your hospital is mainly going to be speaking in English, having a doula that might be able to speak in both English and your native language would be amazing.

In these situations, I think it's really important to consider having a doula if you are part of any sort of marginalized group and feel like your needs might not be taking it into full consideration.

Now how to find a doula? There are so many online directories and databases. There is D-O-N-A International, the National Black Doulas Association. the birth rights bar association, and there may be many more based in your specific local area.

So you can definitely look up doulas in your specific city or town. Hospitals and birth centers may also have partnerships with doulas or might be able to provide referrals. I did ask my OBGYN, are there any doulas that you've worked with recently that any of your patients have had that you would recommend?

That is not how I ultimately found my doula, but that is definitely a good starting point. So getting those referrals is also a good way to go about finding a doula. I'll share a little bit more about how I found mine later in the episode.

Now, the average cost of a duel in the United States, of course, it's gonna vary so much based on where you are. A birth doula can go anywhere from 800 to over $2,500. This might cover things like prenatal visits, labor support, postpartum follow-up, and then for a postpartum doula, you might be looking at some hourly charges, 25 to $75 per hour.

For us, we did an all-inclusive package that included support before the baby comes, being with us at the hospital, and also visits after baby's here, and we are paying a little bit over 3,000 for all of that for our doula.

This is not covered by insurance, so it absolutely is a luxury if you are looking for a specific kind of doula, and if you want to have the ability to interview multiple doulas, ask for specific things, and of course, I feel super grateful that we have that ability.

But there's also some good news here. There are ways to offset the cost of your doula. First of all, experience and certifications are going to cost a lot more. More experienced doulas or those with specialized training, like a lactation consultant, is going to be able to charge higher rates.

Also, doulas that have additional services, such as our doula is able to do a little training, a private at-home training with us for infant CPR and first aid. That's a specialized service. So things like that are also going to cost more.

So if you have a doula that might be a little bit newer, that might have some less bells and whistles for some of these other things that aren't truly necessary when it comes to your actual birth experience, are they nice to have?

Yeah, absolutely. But you might not need these things, right? You might not need someone that can help with, for example, being a lactation consultant. You might not need someone that can help with that CPR certification, all those kinds of things.

That could definitely impact the cost of your doula. There's also, in some states, the opportunity for your doula to be covered by Medicaid. So in New York, New Jersey, Oregon, a couple other states, a doula can be covered under Medicaid.

Some private insurers may also reimburse doula services. Many doulas offer income-based pricing or work with organizations that provide subsidized services. So looking for sliding scale and community programs where they have doulas is also great to do.

The doula project is a nationwide organization that helps provide free or low-cost doulas for underserved communities. And I know in New York specifically, there's an initiative to try and get free and low-cost doulas to as many people as possible.

So definitely look up your specific state. There may be a program to help you get a doula. Hospitals and birth centers may also offer subsidized doula care. So that's something you can ask about in your prenatal visits.

Lastly, there are of course nonprofits and mutual aid groups, grassroots organizations that provide doula support for free or on a sliding scale. Now, while my doula was at a pretty steep price point, that doesn't necessarily mean that all doulas are at that price point.

There are so many different free and subsidized doula programs in the U.S. And you can also find a doula that might be a little bit newer so that you can still get that guidance and that expertise from someone that does have more experience than you, especially with your first birth.

You have no experience and they have a couple births under their belt. That might also provide the opportunity to find a doula that is a little bit less expensive. Now, I found my doula from NYC Birth Village Doulas, which is a database here in New York.

I really wanted a doula that was experienced and I was looking for a doula that had just a background that I felt would align with me. What I was really looking for is sometimes... I've seen doulas, especially on social media, which of course we can't believe everything we see on social media, but I've seen a lot of doulas that kind of give me the vibe of being very hippy dippy, very much about home births,

very much about using herbs versus medication, keeping everything super quote unquote natural, and just giving me that very much, you know, hippy dippy vibe that I love. if you love it, love for some people, but just doesn't necessarily align with me or what my vision was for childbirth.

I knew that I wanted to give birth at a hospital, not at home, not at a birthing center. And honestly, that's just because a little bit of my own anxiety and also my ignorance coming into pregnancy. I didn't really know anything about birthing centers.

I didn't really know anything about home births. Perhaps if I was having several more children, this is something that I would have the experience to think more about. But especially for my first pregnancy, I was like, I really wanna do this in a hospital.

That's the only place I can imagine feeling actually safe and not anxious. And that's different for everyone. So if you feel confident and comfortable doing a home birth, doing a birth at a birthing center, then that's amazing.

But for me, it wasn't something I had ever thought about before, and I didn't really have any information about it. So knowing how quickly I got pregnant, I didn't really get much time to also think those questions through any more deeply.

And pretty soon I found myself really committed to the fact of giving birth in a hospital, which so many women do. That being said, I wanted to work with a doula that was cool with that decision, that would be fine with any medical interventions that might come up, and that wouldn't make me feel guilty for not being natural enough, right?

That wouldn't make me feel shame or embarrassment or make me feel pressure to have a certain kind of birth. And I'm so, so happy that I found the doula that I'm working with. Finding a doula that really finds that balance between a little bit of that romanticized, magical way of thinking that I really just get energized with, and especially my background being an actor, I did experimental theater for many years.

I love a visualization, I love a relaxation technique, I love a breathing exercise. These are things I grew up doing and spent so much of my life doing as an actor, honestly. So having a little bit of that, but also having the grounded reality of her truly understanding so much about hospitals and the medical system and what I can expect.

She's already had several, many births at the hospital where I'm delivering at. Knowing that she also comes with that knowledge was something that I really wanted. To speak a little bit more tangibly in our sessions, we've covered things like our first session was really just getting to know each other.

I found her when I was only a couple weeks pregnant. I think I was like under 10 weeks pregnant. She was like, wow, you are very early. and very ready for a doula. And she learned that I was an anxious girl that was over-prepared.

And so getting to know each other in that first conversation, getting to know more about her background, really feeling if we were a good fit, that was kind of our first session together. Our next session, which we had at our home, we talked a bit more things like using the birthing ball and getting my body prepared for labor.

We talked about our upcoming meetings and what I was looking for, what kind of support I was wanting. We talked about my birth plan, how to write one and what it was included. And we talked about a lot of just random questions that were on my mind, everything from breastfeeding to different types of products and if she thought I should buy them.

In our most recent meeting, we went over my birth plan and talked about it more in depth, especially because I finally had it completely figured out. We talked about the birthing classes that I've been taking both online and in person so that I could share with her my thoughts.

We talked about things like circumcision and me using nitrous oxide as a potential pain reliever because I didn't even know my hospital had it until recently. So I wanted her thoughts on that. And we talked about tons of other postpartum questions like do I wanna use a belly binder, what she thinks of them, which ones might look good and so much more.

Really having a doula is like having a personal one-on-one consultant to ask any questions to and to get feedback from. I couldn't recommend it more. Overall, for me personally, I don't think that I would be nearly as comfortable or confident in this process or experience without having a doula.

I feel so happy that I don't need to go into the hospital with stress on my mind about advocating for myself. But instead, I know that I have someone there that's got my back. Of course I have my husband, but I know that that was also a lot of additional pressure for him.

I feel like a lot of times we don't necessarily think about the support person, the partner to the person giving birth. And honestly, how stressful the situation is for them as well. Like my husband's gonna be watching me go through probably the toughest day of my life.

A lot of physical pain and mental endurance. And it's not gonna be super easy for him. We're really close. And I feel like Richard's gonna be very impacted by seeing me in that state and by being strong for me and supporting me with everything from counting breaths and counting contractions to that physical presence, giving me counter pressure, massage.

Like he's gonna be busy. He has like a whole checklist of tasks that he's also doing to get me through our labor and delivery. And then also having the added pressure of, but make sure that they do delayed cord clamping.

Make sure I get the golden hour. Make sure that they don't offer me an epidural. Make sure that this happens. That's a lot for him to take on. So having the luxury of a doula, because unfortunately it is a luxury.

I wish everyone could have a doula. I wish it was something that was covered by every insurance. I wish it was something that was easy to obtain. I wish it was something that was talked about more. But to have the luxury of having a doula is something that I'm very, very grateful for.

The outcomes are really amazing. The impact of having a doula is really awesome. And I'm just very grateful that I get to have one. So if you are in a position to hire a doula, or if you're able to check out some of the resources that I named, that will also be in the show notes, definitely do so.

Now on next week's episode, I'll be discussing the ultimate pregnancy checklist and how to get organized for baby's arrival. I shared my giant checklist on Instagram a couple months ago and people were like, what does that even say?

That looks so long. That looks crazy. What is that checklist? And it has truly helped me keep my brain together. So I'm gonna share so much more about that next week. You can follow me at @taylorraeroman.

As always, a full transcription of the episode along with citations can be found on my website. All those links are available in the show notes. See you out there.

REFERENCES

Raising New York. "Maternal Health." https://raisingnewyork.org/maternalhealth/.

New York Times. "Childbirth Deaths: Why Black Women Are More at Risk." New York Times, January 7, 2024. https://www.nytimes.com/2024/01/07/nyregion/childbirth-maternal-mortality-black-women.html.

Bui, Quoctrung, and Claire Cain Miller. "Rich or Poor, Childbirth Is Deadlier in the U.S. Than in Other Countries." New York Times, February 12, 2023. https://www.nytimes.com/interactive/2023/02/12/upshot/child-maternal-mortality-rich-poor.html.

Parents. "How Much Do Doulas Cost?" https://www.parents.com/pregnancy/giving-birth/doula/how-much-do-doulas-cost/.

National Academy for State Health Policy. "Doulas and Midwives Are Key Partners in Improving Maternal and Infant Health Outcomes." https://nashp.org/doulas-and-midwives-are-key-partners-in-improving-maternal-and-infant-health-outcomes/.

March of Dimes. "Doulas and Birth Outcomes Position Statement." https://www.marchofdimes.org/sites/default/files/2023-04/Doulas-and-birth-outcomes-position-statement-final-January-30.pdf.

Gruber, Kenneth J., and Susan H. Edwards. "Doula Care, Birth Outcomes, and Cost Effectiveness: A Review." Frontiers in Public Health (2023). https://pmc.ncbi.nlm.nih.gov/articles/PMC10510774/.

Hardeman, Rachel R., and Katy B. Kozhimannil. "Improving Maternal Health in the United States — A Review." New England Journal of Medicine 390 (2024): 561–564. https://www.nejm.org/doi/full/10.1056/NEJMp2308601.

Tully, Kristin P., et al. "Doula Care in the United States: Research Evidence and Policy Implications." Women's Health Issues 34, no. 2 (2024): 89–97. https://www.sciencedirect.com/science/article/pii/S1049386724000215.

Disclaimer: The information shared on On the Outside is for informational and educational purposes only. I am not a doctor, medical professional, or licensed healthcare provider. The content of this podcast is based on my personal experiences and research, but it should not be taken as medical advice. Always consult with your doctor or a qualified healthcare professional before making any decisions related to your pregnancy, health, or well-being. Every pregnancy is unique, and what works for one person may not be right for another.