Provider Care

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: “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.

 

 

Final_Doula-Brief-Infographic-Image

Mamas on Bedrest: “Why Wasn’t I Prescribed Bedrest???”

January 26th, 2015

Hello Mamas.

I received the following inquiry from a Mama on Bedrest:

“Hi. I’m 24 weeks along and on my last prenatal visit, my OB noted that my cervix was short. After ultrasound evaluation, he determined that a cerclage was needed. I had the cerclage placed, but my OB has not put me on bed rest. I asked if I should limit my activity and he said only if I felt contractions or otherwise uncomfortable. 

Most other women that I know who have been in this situation were prescribed bed rest. I’m really nervous that something will go wrong and I will lose my baby. What should I do?”

This is an excellent question!! First and foremost, a Mama should always listen to and follow her health care provider’s recommendations. I say this because you have “contracted” with this person to care for you and your unborn child. It only makes sense that you follow their recommendations. Now, if you find that you disagree with your health care provider on many or at least one major decision, I suggest you first talk with your health care provider and ask why they have chosen the treatment plan that they are implementing. Make sure that you understand the ENTIRE rationale behind their decision, and that you understand and are comfortable with the treatment plan going forward, including potential adverse outcomes.

If you are still uncomfortable after speaking candidly with your health care provider, I suggest getting a second opinion. Sometimes having another assessment of your situation will put your concerns to rest. Also, sometimes another person can explain things differently so that they make more sense to you and ease your mind.

Finally, if you have spoken with your health care provider and not gotten the answers that satisfy you, and you have consulted with another provider and gotten a second opinion-regardless of whether they agree or disagree with your original health care provider, you may want/need to change providers. Now I don’t say this lightly. Changing providers mid-pregnancy is most certainly not optimum, however, if you are really feeling uncomfortable with your current provider, it is in your best interest (and that of your baby’s) to work with a provider in whom you implicitly trust, with whom you feel completely comfortable and who will consult with you every step of the way making sure that you are included in treatment decisions, that you understand all treatment decisions and with whom you can speak to freely and as often as you need. If you don’t feel completely comfortable with your health care provider and feel anxious and uncomfortable with his/her treatment plan, then you may need to consider a change. But again, I highly suggest you do all that you can to work with this person who already knows you and your case.

Now, if it isn’t a conflict with your provider and you are just concerned that you should be on bed rest and they haven’t prescribed it, trust your health care provider as they are doing you a HUGE service not placing you on bed rest if it isn’t medically indicated. In our e-book, “From Mamas to Mamas:The Essential Guide to Surviving Bedrest” I spent an entire chapter discussing how bed rest is not an evidence-based treatment and that many, many obstetricians, maternal-fetal medicine specialists and many of the medical societies caring for pregnant women and their babies are urging providers NOT to prescribe bed rest, but to instead treat the pregnancy complication without the activity restriction. It sounds like this obstetrician is doing just that. What our mama should now do is at her next prenatal visit, ask her health care provider to explain to her EXACTLY why s/he did not prescribe bed rest, what s/he expects to happen with cerclage alone, what other treatments they will implement if the cervix continues to shorten to prevent preterm birth and what she can do to improve her pregnancy outcomes. In this way, Mama will have all the information she needs to take exquisite care of herself and her baby-and hopefully have all her fears and anxieties addressed and “laid to rest.”

 

What was your response to being put on bed rest or not being prescribed bed rest? Share your experience below in our comments section.

If you want to learn more about Bedrest not being an evidence based treatment for the prevention of preterm labor and preterm birth, read all about it in our e-book, From Mamas to Mamas: The Essential Guide to Surviving Bedrest” available for immediate download from Amazon.com.