In the past few years, the term “doula” has popped up everywhere, when we talk about birth and maternal health care. However, a doula is not a new role in the care of pregnant, birthing, and new mothers/parents, rather it is an old one that is being reclaimed and refashioned to address the most urgent needs in maternal health care today. In most traditional and indigenous cultures throughout the world, the care of people has always happened in families and communities. Pregnancy and the time after birth is one of those life events that draws in elder women and girls in the family to help in the care of the new mother and her baby, so they are not alone. The new mother and her baby are held in community, while being nourished, healed, and cared for the first few weeks of the new baby’s life.
In many West African, such as in Ghana, this care is often organized by the mother or mother-in-law of the birthing person.I grew up in a big Ghanaian family in the US and I joined my mom in the rotation of care that included my grandma, my mom, and other aunties after each of my aunt’s or other women in our community gave birth. Many cultures have traditions and rituals of care and support carried out by women and other chosen kin to hold space and love, center, celebrate, and care for women and birthing people during the most sacred transitions of pregnancy, birth, and postpartum.
Although the term “doula” was coined in the 1960s, “doulas” have always existed in our communities. Doulas or the women and people who care and support, were so embedded that we honestly didn’t have the need to name them as such. Dr. Dana Raphael, a Medical Anthropologist studying cross-cultural patterns and practices of breast-feeding, noticed that in many of the cultures where she studied, there were always female caregivers around the mother who “mothered the mother” during and after childbirth. During a study in Greece in 1969, she learned the word “doula” which means “female servant” and started using it in her writing and the work she was doing around improving lactation in the US. Doulas, particularly black and brown doulas are intentionally reclaiming and amplifying the caring role that the mothers, grandmas, aunties, cousins, friends, and chosen kin have held for generations.
Why do you need a doula?
The difficult reality of growing a baby and giving birth in a busy society today, means that you might live far from family, family might only be able to come and help for a short time, or you just might not have people you can call on. There’s a multitude of advice, books, magazines, shows, vlogs, blogs, marketing of products, apps, platforms, and many things that speak to women and birthing people, but not enough of it is individualized, inclusive, affordable, or accessible for all pregnant, birthing and postpartum people.
Over the past few decades the steep disparities in health care, health care access, and health outcomes across the US continue to grow. This is especially true in reproductive and maternal health care for black and other people of color. This means there is a need to reimagine and reclaim more traditional and communal ways of caring for each other to improve health outcomes.
In the US, there is not much talk about the Sustainable Development Goals (or SDGs), but there are 17 globally developed goals to transform the world and create a better and more sustainable future for all.There’s an important SDG goal that aligns with improving maternal health, Goal 3, which aims for Good Health and Well-Being and “ensuring healthy lives and promoting well-being at all ages is essential to sustainable development”. Goal 3 has 13 targets related to improving health and wellbeing and Target 3.1 is to reduce unnecessary maternal deaths by 2030. Improving maternal health and preventing unnecessary maternal morbidity, mortality, disrespect, and other harms is a global imperative.
Doulas, part of your perinatal care team/village
Assembling a perinatal care team is one way we can begin to comprehensively and holistically improve maternal health experiences and outcomes. A doula is an essential member of your perinatal care team.
A doula helps to fill the care and health information gap that exists in the US healthcare system, while offering not only women, but all people experiencing life on the reproductive health spectrum (from fertility, pregnancy, birth, postpartum, abortion, or loss) educational, emotional, and physical support. Doulas are not meant to replace partners, family members, or other chosen kin, rather they can help to complement and fill in gaps, when family and friends are not able to be present. Doulas are more than an important public health intervention, they are essential for rebuilding a more equitable and accessible maternal health care.
Many black doulas and other doulas of color, like myself, are committed to reclaiming and honoring our traditional ways of supporting and caring for pregnant, birthing, postpartum women and people having experiences on the reproductive health spectrum. The Black Maternal Health response is a growing village of birthworkers, reproductive and maternal health care providers, researchers, policy makers, and community members committed to improving our reproductive, birth and postpartum experiences and outcomes while building a more comprehensive, inclusive, and accessible maternal healthcare system in the US.Using a range of community engagement, reproductive justice, birth justice, birth equity, and postpartum justice approaches, strategies, and frameworks, we are focused on centering the needs and goals of black birthing people, honoring and trusting the strength and ability of black birthing bodies, honoring and upholding the dignity of black birthing bodies, listening to and believing in the needs and desires of black birthing bodies. Black and brown birthworkers are a catalyst for change in their communities and in the healthcare ecosystem.
Doula or a Birthworker?
Doula. Birthworker. Birthkeeper. Birth or Labor Companion. Healer. Wombkeeper
There are so many terms to describe the work we do to make care more accessible to black and brown women and birthing people in our communities, so which one is right?
They all are! You may notice that your doula also identifies as or prefers to be called a birthworker or healer. I identify both as a doula and birthworker.
Benefits of having a doula
The benefits of having a doula are numerous and the evidence is well documented in a wide variety of research studies. The research evidence shows that having a doula often leads to more positive reproductive, maternal health, and overall perinatal experiences. Doula support has several emotional, physical, and clinical benefits. Among the myriad of benefits, having a doula leads to improvements in birth and postpartum outcomes.
For more information and evidence on Doula Care:
Evidence on: Doulas(Evidence Based Birth) - https://evidencebasedbirth.com/the-evidence-for-doulas/#:~:text=Christine
Impact of Doulas on Healthy Birth Outcomes - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/
https://choicesinchildbirth.org/storage/2014/10/Infographic-10.28.14.pdf
Community-Based Doulas - https://healthconnectone.org/our-work/community-based-doulas/ (HealthConnect One)
Advancing Birth Justice Community-Based Doula Models as a Standard of Care for Ending Racial Disparities (Ancient Song Doula Services + Every Mother Counts)
The World Health Organization (WHO) recommends a companion of choice which can be a doula and/or spouse/partner, family, community member in four sets of WHO guidelines on improving maternal and newborn health.
What does a doula do?
Most doulas will tailor their services and offerings to meet your needs and goals. A doulas should meet with you several times during your pregnancy to connect, develop a relationship, and learn more about you and your goals. There are several ways a doula can support you on your journey, here are few (this list is by no means exhaustive, every doula has their own approach, doula care services and offerings):
Offer support as you navigate a complex, broken, and racist maternal health system in the US and communities all over the world
Support a woman/birthing person to listen to and trust their body, their body sovereignty
Work in partnership with your partner, family and family structure, community, and chosen kin
Listen, believe, and honor your needs and desires by trusting your body’s ability to grow, birth your baby and heal your body
Offer Cultural humility and culturally affirming care and support
Create space for you to explore your desires, understand your needs around birth and postpartum for you, your baby, and your family
Bears witness and advocates for your needs, desires, and goals
Offer information and education, so you can make informed choices around your pregnancy, birth, and postpartum needs and care
Planning for and establishing your birth goals
Providing continuous physical and emotional support to you and your partner during labor
Expanding your knowledge of the maternal health provider landscape and connection to additional holistic and supportive community (support groups, childbirth education, etc) and provider resources (pelvic floor, lactation consultants, etc) that can support your birth and postpartum experience and support your intersecting needs through community referrals
Strategies to help you find the right provider for your birth and providers for your perinatal care team
Offer strategies and resources to address the social and life issues that intersect with pregnancy, birth, and postpartum ( housing, food, immigration status, etc.)
Strategies for comfort and guiding your labor experience
Support you in making a plan for your postpartum healing and wellness journey
Supporting your postpartum healing and wellness journey
Supporting you on your breast/chestfeeding goals
Supporting you and your family’s transition into motherhood/parenthood
Offering sibling care to the other children in your home
Meal planning for nourishing postpartum foods
Navigating grief and loss
And much much more
What a doula is NOT/CANNOT DO:
A doula cannot give medical advice, cannot replace your midwife or other health providers.
A doula can not promise or guarantee how your birthing experience may flow.
Doula or a Midwife?
Finally, a doula is not a midwife. A midwife is a medically trained health care provider who provides medical, mental, cultural, and emotional support and medical care. You should explore having a midwife as an essential member of your perinatal care team or village, particularly if you have a low-risk pregnancy. Midwives can catch your baby. Midwives use a physiological, person-centered model of midwifery care. They are wonderful providers, not only for pregnancy, and postpartum, but also for well-woman care across the reproductive health spectrum.
We were not meant to do this alone!
You are not meant to journey through life transitions alone, especially not reproductive and maternal health life transitions.
Every woman and birthing person deserves support and someone who can advocate for their reproductive and birthing needs and goals, AND someone at their home who can support their transition into parenthood, nourish, and support the body’s healing. Everyone deserves a doula, so choose one that you feel is aligned and is the right one for you.
We are reclaiming our ways of educating, caring for, and celebrating women, birthing and postpartum people, so that we can improve our reproductive, birth and postpartum experiences and outcomes.
Still have questions about Doulas?
Reach out and schedule a free 20-minute consultation, right now I’m serving postpartum clients, but I can connect you with resources to find the right doula for you! I’d love to hear from you, if you think I might be the right postpartum doula for you!
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