Maternity Advocacy

Mamas on Bedrest: DOULAS SHOUL BE PRESENT AT ALL BIRTHS GLOBALLY!

April 6th, 2017

When people ask me what I think about doulas, I simply say,

“Doulas are an invaluable part of the birthing team and I wish I had had not one but two doulas when I was having my children, especially my daughter! We needed one doula for me and one for my husband!”

Doulas are birth attendants, typically women, who stay with a woman providing support, encouragement and non-medical pain relief and comfort measures to childbearing women during labor, delivery and in the early post partum. The World Health Organization has added their endorsement of birth attendants (doulas) by recommending that, “Birth Attendants be present at ALL BIRTHS GLOBALLY,” as part of the WHO Safe Childbirth Checklist Implementation Guide. This is huge, not only for those of us who are doulas and know the invaluable role we play in supporting mothers during pregnancy, labor and delivery and in the immediate post partum period, but also for mothers who may not know about doulas, or who may have been on the fence about getting a doula.

Research on the efficacy of doulas shows that when childbearing women have doulas attend their births they have:

  • Decreased overall cesarean rate (down 50%) and they are less likely to have a cesarean section delivery or other invasive interventions.
  • Shorter labors (decreased 25%)
  • Decreased use of oxytocin by (decreased 40%) a medication used to start or hasten labor.
  • Decreased requests for an epidural or other pain medications by 60%.

Doulas attend to mothers and/or couples primarily during childbirth and in the early post partum period. However, there are ante partum doulas (Mamas on Bedrest & Beyond for example) who attend to mothers who are experiencing complications prenatally and who need additional support. Prenatally doulas offer non-medical supportive care such as helping mothers on bed rest become more comfortable, attending to home duties, offering resources and tips for comfort and support, emotional support, family support, childbirth education, and lactation support and education.

Many people are under the mistaken impression that doulas are only for women having “natural” (vaginal) or home births. Doulas attend all types of births, in all types of settings; home births, hospital births or birthing centers. Additionally, doulas are as beneficial to women having cesarean sections as they are to women having vaginal births. Doulas are particularly under utilized by high risk pregnant women and yet this group stands to benefit the most from the support and emotional care.

Mamas on Bedrest, you can and should consider having a doula present at the delivery of your child-even if the father is present. This well trained, impartial birth professional can act as your advocate and as a bridge to the health care system and to providers when you are unable to advocate for yourself. They can help explain procedures, assist in getting you information on certain proposed procedures and treatments and can help be sure that you are giving informed consent when you sign forms. Doulas are present first and foremost for the mother and the needs of everyone else in the family or on the healthcare team are secondary. Doulas DO NOT MAKE MEDICAL DECISIONS for their clients, but rather hold a space so that a woman and her partner (if present) can determine the best course of treatment for them based on all the available information.

The doula model has been present historically as far back as Biblical times (Exodus 1:15-21) when women of a family or tribe attended to a birthing woman and made sure that her children and husband were fed and cared for. Doulas and Midwives nearly became extinct during the middle and latter part of the 20th century with the advent of hospital labor wards and the specialty of obstetrics. There has been a resurgence in doula use during the latter part of the 20th century and now in to the 21st century. Unfortunately, the use of Doulas has been limited to women of means as they have been the only ones able to pay for a doula as insurance companies have yet to agree to reimbursement.

But there is good news. There are many doula services that offer a sliding scale or are being reimbursed by Medicaid such that ALL women can receive this potentially lifesaving care. In Austin there are the following groups offering low or no cost doula services.

Austin

Giving Austin Labor Support (GALS)– A non-profit organization that supports women with limited or no resources for doula care so that “No woman gives birth alone.”

Mama Sana/Vibrant woman-a grassroots organization of low income women of color serving women in the community with prenatal, birth and post partum reproductive health support.

Outside of Austin, there are several programs around the country serving women from all income backgrounds:

Ancient Song Doula Services– A non-profit organization in Brooklyn New York serving low income women of color.

The Pettaway Pursuit Foundation-Located in Pennsylvania, this non-profit organization specifically attends to high risk pregnant women on prescribed bed rest. A team of contracted doulas provide care and the organization has contracts with several managed care organizations for reimbursement.

Mamatoto Village– This organization also provides very high quality birth assistance and also has its own training program for its staff.

Uzazi Village – This non-profit organization provides doula services to low income women of color in the Greater Kansas City Missouri area, and has another location in St. Louis Missouri. They also provide doula training, childbirth education, reproductive health education and lactation services. They are also now beginning to train midwives.

These are just a few of the organizations that I know of providing doula services. There are others and I am sure many more that I don’t know about. The point I wish to make is that if you would like a doula to attend your birth with you, there is likely a doula organization or solo doula that can help. Mamas, don’t forgo this vital source of support. Doulas really do make births better!

Looking for a doula? e-mail info@mamasonbedrest.com and we’ll do our best to help match you with a doula.

Know of a doula that is excellent at what she does and serves women in need? Share her information here and we’ll start a running list of doulas that are serving low income.

Know of a doula organization that offers services at low or no cost? Let us know so we can share this information.

Did you have a doula at your birth? Please share your experience in the comments section below.

Mamas on Bedrest: Vermont is the Best State in Which to Have Your Baby!

February 28th, 2017

According to WalletHub.com “2016 Best and Worst Places to Have a Baby”. Wallethub.com is a virtual financial planning company that helps individuals track their spending and saving, help repair credit and help individuals protect their credit history including protecting identity. Wallethub.com tracks people and money and in their opinion, if you cannot afford to have a baby, you shouldn’t. When the parameters of delivery budget (cost to have a baby, cost of living and cost/availability of health insurance), overall health care ranking (maternal and infant mortality, rates of prematurity, availability of professionals such as midwives and pediatricians, etc.. ) and baby friendliness (i.e. parental leave, available childcare, support for new moms, etc..) were analyzed for the 50 states and the District of Columbia, Vermont ranked number 1 as best place to have a baby by wallethub.com.

It is important to plan for children as unintended pregnancies can cause huge financial strains on families and can have serious health implications for mothers and infants if pregnancies occur too close together. But there are other, equally important issues to consider before becoming pregnant; availability of and access to quality prenatal care, adequate food resources, housing, how will the mama/family fare without mama’s income, childcare and availability and accessibility of resources such as transportation that may pose potential roadblocks to a healthy pregnancy and birth.

The article in question alluded to the fact that if a couple cannot afford a child, they should not have a child. Well, I live in Texas where availability of and access to family planning information and resources is extremely and increasingly limited. So what is a couple to do? Perhaps they cannot afford a child but in Texas, there is not readily available contraception and virtually no access to abortion. Should people simply stop having sex? That won’t happen!

I agree, finances should factor into the decision of whether or not to have a child. The reality is that conception is happening regardless of financial status (or even couple status!!). In my opinion, the best states or more pointedly, the best places to have a baby (because there are little oases within what I will call “maternity deserts”, areas that are fairly void of any sort of maternity support or reproductive health care) are places with the following:

  • obstetricians and midwives, and facilities that allow both to perform deliveries
  • birthing facilities that use the least amount of intervention that is safely possible
  • birthing facilities that allow fathers and doulas to be present to support mama during labor and delivery
  • birthing facilities that allow mama to freely move during labor
  • birthing facilities that believe in immediate skin to skin bonding between mother and baby (even before wiping off the vernix, provided there are no health complications in either mother or baby!)
  • birthing facilities that promote breastfeeding and provide immediate and readily available lactation support to new mothers

These characteristics should define whether or not a provider, a hospital or birthing center, a city or town or a state is “best for mama and baby.” The worst state in which to have a baby according to Wallethub.com is Mississippi and yet I would bet that within that state there are a few hospitals or birthing centers that are supportive of childbearing women and offer quality care and support. In addition to financial considerations, prior to pregnancy (or at least prior to birth) mamas and their partners should research health care providers and the health care facilities available to them in their states, cities and communities. For sure some cities will have more resources than others, and some states will have more resources than others. But that doesn’t mean that having an uncomplicated, normal healthy birth is absolutely impossible. It just means that mamas will have to be savvy, do research about what is available and collect as many resources for themselves as possible.

Mamas, be careful what you read. The headline “Vermont is the best place to have a baby” is misleading alone, may have had many mamas ready to relocate and truly doesn’t give mamas and their families tools and tips to evaluate birthing resources and facilities in their area that may in fact be “Mama and Baby Friendly”. I believe that every woman can have a healthy, uncomplicated pregnancy and birth a healthy full term normal weight infant. This is much easier to do in some areas where resources are more readily available than in others, but it is possible none the less. Use the aforementioned list as a guide to evaluating resources and with a bit of research, you too can make your pregnancy, labor and delivery mama and baby friendly-no matter where you live in the United States!

Mamas on Bedrest & Beyond is committed to helping mamas have safe, healthy pregnancies, labors & deliveries and healthy full term babies. If you need help finding resources in your area, e-mail info@mamasonbedrest.com.

References:

Wallethub.com

The US Centers for Disease Control and Prevention

The Guttmacher Institute

 

Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”

January 14th, 2016

Hello Mamas,

As we roll into 2016 one thing is certain: We are on the brink of change in the maternity world! At no time in history have there been so many groups and so many initiatives determined to improve maternity care and birth outcomes. Below is a press release put out by two leading maternity advocacy groups, Choices in Childbirth and Childbirth Connection (a program of the National Partnership for Women and Families) to raise awareness not only of the cost benefit of doula care, but also the tremendous benefit doulas provide to mamas and infants in improving birth outcomes. A doula is “a trained birth attendant who provides non-medical emotional, physical and informational support before, during and after childbirth.” Here is more from the press release: 

“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”

 “Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”

 The brief provides key recommendations to expand insurance coverage for doula care across the country. They have also provided an informative infographic which also summarized the major points (see below).

  • Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
  • The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
  • State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
  • The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
  • Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
  • State legislatures should mandate private insurance coverage of doula services.

Read the entire Issue Brief Here. For more information, visit Choices in Childbirth or Childbirth Connection.

 

 

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