After Latham Thomas’s birth experience brought to light the lack of holistic pregnancy options in the traditional healthcare system, she was driven to found Mama Glow, which provides doula services and other support for moms-to-be. Doulas, Thomas explained, work with mothers and couples throughout the pregnancy, including hands-on-support during labor, and act as a liaison between them and the hospital and doctors. While midwives deliver babies, doulas act as emotional and psychological support — and as it turns out this is incredibly important, and effective.
The Effectiveness of Doula Services
A 2016 study in the journal Birth suggested that using a certified doula could save Medicaid, and perhaps private insurers, nearly $1,000 a birth by reducing cesarean and preterm births, NPR reported. Expectant mothers who use doulas also had better birth outcomes, and their babies had higher Apgar scores (a measure of a newborn’s health after birth). A study published in the Journal of Perinatal Education put it simply: “This study reinforces the case that doula involvement is a cost-effective method to improve outcomes for mothers and infants.”
Doula Services Go Underutilized
Yet many women don’t even know about doulas, let alone use them. Of those mothers who are eligible for Medicaid-covered doula services, only 15% use them, and as of 2017, only 6% of expectant mothers overall use doula services (up from 3% in 2006, but still!). In January 2017, The American Congress of Obstetricians and Gynecologists said that doulas are “probably underutilized” when it comes to improving patient satisfaction and reducing cesarean rates.
So if doulas can improve mother and infant experience, lead to better health outcomes, and cut costs, why do so few women use them? “There are real impediments to infiltrating a system that is designed to put money first,” Thomas says. As she explains, hospitals like the idea of doulas in theory, but in reality, they threaten doctors’ livelihoods. A 2017 study of physician compensation found that approximately 52 percent of doctor compensation that had a production bonus based that bonus on relative value units (RVU’s), aka the amount of money that doctor brought in for the hospital. Physicians without bonuses are generally paid based on services performed. Since caesareans cost much more than vaginal births, a particular doctor reducing the number of caesareans he or she performs each month, for instance, would reduce the amount of revenue brought in for the hospital, and could significantly impact the hospital’s revenue and his or her overall take home pay.
There’s also a power imbalance that Thomas points out: “There’s still this idea that ‘you’re the layperson, we’re the expert, we’re the doctor, it’s our show.’” And because of this dynamic, and the lack of patient empowerment in our country across the board, many women don’t push back against what the doctor says.
The Future of Holistic Pregnancy and Doula Services
Still, there are reasons to be hopeful. “So many more women are using doulas,” Thomas says. She also notes that social media platforms like Instagram have given more visibility to doulas, which has allowed women to “see a different side of how birth has been presented to us.” More people are becoming interested in doula services, and there are also many more trained doulas now than before.
The challenge now, as Thomas sees it, is to create an infrastructure within hospitals and insurance providers that supports doulas and their skill sets. “I would love to see more doulas inside the hospital,” she says, describing her ideal scenario of hospitals pairing every expectant mother with an on-staff doula. “That,” she says, “would be amazing.”
Watch our full interview with Thomas, where she shares her own birth story and discusses wide-ranging topics related to holistic pregnancy, including fertility, birth control, prenatal yoga, and challenges within the healthcare system.