There are a lot of misconceptions about doulas, according to Latona Giwa and Dana Keren, co-founders of Birthmark Doula Collective (www.birthmarkdoulas.com). Many people wrongly believe doulas only assist with natural births, for example. Others just don't understand exactly what a doula does.
A doula is a trained health advocate who helps women through pregnancy, labor and birth. "We are health advocates, educators, labor support, labor coaches. ... A lot of what we do is help with decision making," Giwa says. "A doula is the only professional that is with the family for the entire labor and birth process, from start to finish."
Doula services improve birth outcomes, Giwa says. Women who use doulas are 50 percent less likely to have cesarean sections and unnecessary medical intervention. Postpartum depression is decreased, family bonding is improved, fathers are more involved and mothers are more satisfied, Giwa says.
"Doula services are really an essential part of maternal health care and an effective response to the poor birth outcomes in this region," says Giwa, who adds that Louisiana has the second highest cesarian section rate and the lowest breastfeeding rate in the country.
The state lags behind the rest of the nation in other birth outcome indicators, too: "Louisiana performs worse than nearly every other state in the nation on measures of infant mortality, preterm birth, low birth weight, and cesarian sections," according to a 2013 report for The Commonwealth Fund. This is one reason Keren, who is studying to be a nurse midwife, and Giwa, an MBA student at Tulane University, decided to open Birthmark Doula Collective. They saw a need doulas could fill. "The impact of doula services is so beneficial on birth outcomes, it is something all women deserve," Giwa says.
Since opening three years ago, the collective has served more than 300 families through labor coaching, classes and support groups — all by word of mouth. There are 10 doulas with the collective, and at the time of this interview, every one was on call, and two were attending births. The collective also offers a student doula training program led by nurse midwife Nicole Deggins,
"The demand [for training] is higher than we can fill," Keren says.
"The interest in doula services is definitely growing," Giwa says. "But for women to have more access to doulas, there have to be more doulas."
Doulas at Birthmark Doula Collective do everything from explaining womens' childbirth options to breastfeeding support to checking in with families during the weeks after childbirth, often a sensitive and sometimes turbulent time. There are also other providers who offer perinatal services, such as chiropractors, lactation consultants and massage therapists who do prenatal massage with fees based on income. Birth packages range from $700 to $1,500. The fee is not covered by major insurance plans, but Birthmark Doula Collective offers a "one-to-one" program: For every full-paying client the collective receives, it offers services to a client who cannot afford to pay.
"[Every provider we partner with] shares our collective mission of supporting women regardless of income," Giwa says.
Giwa and Keren are working to open New Orleans' first freestanding birth center. Birth centers are homelike environments where women with low-risk pregnancies can give birth outside of the hospital setting. There are 250 birthing centers in the U.S., which are staffed by midwives and accredited using national standards.
"We call it high-touch, low-tech care," Keren says. "There's a kitchen, large birthing suites, each with a tub. You can bring your kids, grandparents, eat when you want, wear what you want."
They aim to open the center at a location in the Irish Channel, near Touro Infirmary, by the end of 2014.
"We are excited to complete the spectrum of birthing options," Keren says.