Community Programs Offer Free Doulas to Women Who Know Where to Look


Doulas, midwives, and natural birth have been hot topics in New York City since recent media coverage of the high cost of birth in the United States, city-wide breastfeeding campaigns, placenta encapsulation, and the release of Ricki Lake’s documentary “The Business of Being Born.” Birth options have expanded, yes, but as these media suggest, it is not without a price.

Expecting parents flock to hire certified doulas – ranging from $700-$2800 and rarely covered under health insurance – for proven benefits including shorter labors, less need for pain medication, better newborn outcomes and higher likelihood of breastfeeding and strong mama-baby bonding. Lactation consultants can run upwards of $300 for a single visit, and quality childbirth education, placenta encapsulation, and other birth-related providers work often in privately paid practices.

For many families short on resources, doulas and other services are often out of reach, yet they still believe they deserve professionals guide them through birth and early parenting on their own terms. So they call us.

I am a birth and postpartum doula with the Northern Manhattan Perinatal Partnership (NMPP), and one of several DONA International-trained doulas provided free of charge to low-income mothers in Central Harlem. In the past year with NMPP and their partner programs, I have worked with families in all five boroughs, in teen foster homes to old historic buildings damaged by Hurricane Sandy and with families ranging from African American and Dominican to Yugoslavian, French, and Fillipina.

Thanks to generous funding from City Council Member Inez Dickens for the NMPP program, as well as other volunteer options such as the By My Side Birth Support Program, Ancient Song Doula Services, and the Bronx Doulas, doulas and an array of birth services are increasingly available for mamas at all ends of the income spectrum. Doulas in particular are often newly trained and willing to donate their services while they work toward formal certification. Many experienced doulas also choose to volunteer for a few births a year as community service, as is encouraged by DONA International and other doula certifying organizations.

However, volunteer doulas are known for burnout and turnover, as each birth requires prenatal and postpartum home visits, 24/7 availability for several weeks at a time, and a high likelihood of being called in during the night for up to 24 continuous hours of work. Doulas also face frustrations from occasional clients who don’t take full advantage of their knowledge and on-call support, referral networks, and those who fail to call them until after the birth entirely.

NMPP’s model is unique in that it provides doulas with a stipend and professional development to ensure high quality services and longer-term commitment. The program also offers doula training to local and multi-lingual case workers, health educators, and fitness instructors whom clients already know and trust. Doulas are provided postpartum and breastfeeding training. “Meet the Doula” sessions, especially in communities that often can’t afford childbirth education classes, help to spread the word about birth options under public health insurance and how a doula can support a family’s unique needs, whether for natural or medicated labor, planned c-sections, or strictly postpartum support, including breastfeeding or safe (for baby) and adequate sleep (for mom).

Doulas are trained to support women in normal childbirth and not to dictate, diagnose, or otherwise perform any clinical tasks. This differentiates us from doctors, midwives, and nurses in that we can create non-judgmental, peer relationships at a deeper level of trust and potentially have an impact on sensitive and persistent health issues such as stress, mental illness, and high-risk lifestyle behaviors that contribute to health disparities around maternal and infant health.

My clients can text or call me anytime – even at 1am when their newborn is crying inconsolably – for advice that may prevent shaken baby syndrome or postpartum depression. Whereas new moms have to make appointments days in advance for a pediatrician and wait 6 weeks after birth to see their own OB-GYN, they may talk to their doula daily and tell her far more than a 15 minute clinic visit allows. They may listen to her suggestions with more openness, knowing that she understands and respects the full context and competing priorities behind her final decision, whatever it may be.

This limited access to trusting and organic communication with health care providers is yet another contributing factor to health disparities in New York City, where the infant death rate among Black women is 2 to 3 times as high as among White, Hispanic, and Asian women, where our lowest income neighborhoods produce the most low birth weight babies, and where teen birth rates run highest in Hispanic families, up to 7 times higher than among Whites (Health Disparities in New York City, 2001).

Doulas certainly aren’t the only solution to health disparities, but we can provide a critical piece of the puzzle, functioning like a specialized social worker and integrating a full package of childbirth education, labor, breastfeeding , nutrition, and fitness support for the most high-risk families. And for many of my clients, the chance to give birth on their own terms, advocating for themselves in hospitals, and persevering for unmedicated labor or breastfeeding against all odds and naysayers, is among the most empowering moments of their lives. Birth can be an opening for a woman to either access her power, or be denied and disconnected from it, in a way that changes her forever.

Being bold enough to ask for help is tough for many moms, and especially those with low income and education who may grow up never believing that they, too, deserve the best. So if they gather the courage to call and ask for a doula, I believe it’s our obligation to offer it, as doulas, community-based organizations, and as a city that cares about what life skills and confidence today’s mothers pass along to our next generation.

Ihotu Jennifer Ali holds a Masters degree in International Public Health from Columbia University and works as a birth doula and women’s health educator with the Northern Manhattan Perinatal Partnership. To learn more, visit her website at www.Creative-Rebirth.comImage





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