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 MamaGlow, which provides doula services and other support to moms-to-be and write the book Own Your Glow. But what do doulas do, exactly? And what are the benefits of a doula? In this interview, Thomas answers all these questions and more, and we delve into some astounding research around the effectiveness of doulas.
Discovering Firsthand the Need for Doula Services
When Thomas was pregnant with her first son, she began calling doctors offices to get an appointment, and was shocked at how challenging it was. It was October when she made her calls, and the first appointment she could get was at the end of May. “That’s when I realized that something is flawed here,” Thomas says. “I needed to help people navigate this process.”
For her part, she took herself out of the mainstream hospital birth complex and opted to work with midwives instead. When she did deliver her son, it was, as she describes, “the most beautiful, gratifying experience.”
In fact, the experience was so profound for her that she decided to devote her career to helping women reclaim the birth process. She founded MamaGlow to use all of the knowledge, education, and resources she’d acquired to help more women have positive birthing experiences. “I see my work as not just being there to celebrate the beautiful, glorious moments, but also the challenging moments where we have to make decisions,” Thomas says. Her aim is “for moms and families to feel most informed so that they can make these decisions, and always have the best outcome possible for that person.”
MamaGlow provides multiple services, including prenatal yoga, mindfulness practices, and self-care guidance, but one of the most important ways in which it supports moms-to-be is with doulas. But what is a doula, and what do doulas do? The answer may not be what you think.
What Do Doulas Do?
A doula, Thomas explained, is a maternity healthcare practitioner who works with couples and mothers to support them throughout pregnancy and the birthing process. They provide the mom-to-be and her partner with hands-on support during labor, and act as a liaison between them and the hospital and doctors, both during labor itself and in the weeks and months before, if necessary.
They also provide education on various aspects of the birth experience, helping mothers and their partners understand all the decision points ahead of them and craft a birth plan that will be their blueprint during labor. This includes things like pain management options, who should be in the room during labor, whether to cut the umbilical cord immediately or after a delay, and more. Once the birth plan has been established, the doula will act as the mother’s advocate, ensuring that it is followed to her specifications whenever possible
On top of providing these practical services, doulas are also a source of emotional and psychological support for mothers. They’re there to answer questions, provide a listening ear, and check in with the mother’s emotional well-being. This is especially true of postpartum doulas who work with mothers in the weeks and months after birth to help with the transition to new motherhood.
Doulas are completely different from midwives, who deliver babies just like obstetricians do. Doulas are not involved with the medical or physical parts of labor at all, providing a different kind of support. And, as it turns out, that type of support is incredibly effective.
The Research-Backed Benefits of A Doula
So we’ve answered the question of what do doulas do — but are doula services worth it? What are the benefits of a doula? According to the research, there are quite a few.
For one thing, there are the financial benefits: a 2016 study in the journal Birth found that Medicaid and private insurers could save nearly $1,000 per birth by offering women the support of a certified doula. This is because using doula services has been shown to reduce cesarean and preterm births: women who use a doula have a 25% decreased risk of getting a C-section, and their risk of having a preterm baby drops from 6.3% to 4.7%. This is a big deal, given that C-section births account for almost a third of all U.S births and cost about twice as much as vaginal births, while 1 in 10 U.S. infants are born preterm and these babies incur 10 times more medical costs than those that are full-term because they have to remain in the neonatal intensive care unit (NICU) post-birth for days, weeks, or sometimes months.
The benefits of a doula also include a better, less medicated labor and delivery experience for the mother. Using doula services has been associated with a 10% decrease in pain medication use, and can shorten labor by 41 minutes on average. Doula services also improve outcomes for the baby, improving Apgar scores — a measure of a baby’s health at birth.
When it comes to the benefits of a doula, the authors of a study published in the Journal of Perinatal Education put it simply, writing that their research “reinforces the case that doula involvement is a cost-effective method to improve outcomes for mothers and infants.”
How Doulas Can Reduce Racial Disparities in Birth Outcomes
One distressing reality about childbirth is that there are huge racial inequalities in birth outcomes, with women of color and their babies much more likely to die or experience complications during childbirth.
According to data from the CDC, African-American infants are more than twice as likely than white infants to die in their first year of life, and are much more likely to be born preterm and with a low birth weight (both of which are associated with higher risk of health issues or death later on). Meanwhile, African-American and Native American women have three times the risk of death from pregnancy complications as their white counterparts.
While these race disparities will take great efforts to dismantle, doula services can be an effective way to close the gap and improve birth outcomes for women of color. Because doulas can help to improve birth outcomes for both mother and baby, it makes sense that engaging doula services would be especially important for non-white women.
One study actually tested this theory specifically, looking at two groups of women who were at-risk for adverse birth outcomes (due to race or social factors). In one group, the women worked with doulas, and in the other, the women elected not to. The results clearly showed that the women who worked with the doula had better outcomes — in other words, outcomes that were closer to those of non-Hispanic white women. Various organizations, including the Center for American Progress and Black Mamas Matter, have called for doula services to be more widely available to black women, as well as covered by Medicaid, in an effort to end the staggering racial disparity in birth outcomes. In 2018, Governor Cuomo announced a large initiative aimed at addressing poor black maternal health in New York, and part of this initiative included a Medicaid pilot program to cover doula services. Minnesota and Oregon have already taken similar measures, and we hope that more states and cities will get on board.
Doula Services Go Underutilized
Despite all the benefits of a doula, 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 Jan 2017, The American Congress of Obstetricians and Gynecologists (ACOG) said that doulas are “probably underutilized” when it comes to improving patient satisfaction and reducing cesarean rates. And remember, that’s a group that has a vested interest in keeping it’s members (doctors) employed and well paid! If the ACOG is saying “probably,” we think it’s safe to assume doula services are “definitely” underutilized.
So if doulas can improve the 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’ income. “If we know that you could save money, you can reduce cesareans, all these things, it sounds amazing,” says Thomas. “but when it’s [time to] roll out a program, now you’re talking about people’s livelihoods.”
A 2017 study of physician compensation found that approximately 52 percent of doctor compensation had a production bonus, which was based on relative value units (RVUs) i.e. 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 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 the infrastructure within hospitals and insurance providers that supports doulas and their skill sets and information. To allow them to be a liaison between the doctor/hospital and the client. “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.”
Conclusion: What Doulas Do and Why to Use Them
Giving birth has become its own industry, and it can be a confusing and intimidating one for mothers-to-be to navigate on their own. Doula services help make it easier. Here are the primary things to know remember about doulas:
Doulas are not midwives. They do not deliver babies, but rather provide emotional and psychological support for mothers and couples.
Doula services include various modes of support, including hands-on assistance during labor, patient education, serving as a liaison and advocate between the mother and the hospital, and support postpartum.
Studies have shown that doulas can save expecting mothers and insurers a lot of money, by significantly reducing the number of C-section and preterm births.
Studies also show that using doula services improves the birth experience for the mother by reducing reliance on pain medications and shortening labor, and also improves the health of the baby, resulting in higher Apgar scores (a measure of newborn health).
Doula services go largely underutilized, likely because hospitals are disincentivized to reduce medical procedures that bring in large sums of money.
There is reason to hope that doula services will become used more widely, as social media and the burgeoning wellness movement increases awareness of what doulas do and their benefits.
Have you or someone you love worked with a doula? Share your experience in the comments below!
Watch our full interview with Thomas to learn how society’s age biases influence the way doctors approach fertility treatment, why a holistic approach to fertility often beats drugs or other treatments, how stress hormones impact a woman’s ability to conceive, what birth control does in the long-term to a woman’s period, her thoughts on pads vs tampons, how mindfulness meditation and yoga improve pregnancy and labor, and much more.
1. Kozhimannil, K. et al. Modeling the Cost‐Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery. Birth. 14 January 2016
2. Gruber, K. et al. Impact of Doulas on Healthy Birth Outcomes. J Perinat Educ. 2013 Winter; 22(1): 49–58.
3. Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;68:423–429.