Trained doulas can improve childbirth outcomes — Emotional support ‘inseparable’ from cultural support

By Michelle Lawrence

Contributing Writer

Recent research from the University of Minnesota shows what women like Akhmiri Sekhr-Ra have known for decades: Cultural support during pregnancy has a positive impact on birth outcomes among women of African American heritage.

A birth outcome is defined as the result of a pregnancy and depends on several factors such as whether the infant is born early, survives childbirth, and is born weighing at least 5.7 pounds.

“When we compared birth outcomes among culturally diverse Medicaid recipients who received prenatal education and childbirth support from trained doulas with those from a national population of similar women, we estimated a 40 percent reduction in cesarean rates,” said Katy Backes Kozhimannil, lead researcher on the U of MN study.

“When you look at the potential cost savings associated with a rate reduction of this magnitude, Medicaid reimbursement for birth doulas could be a case where adding coverage on the front end could ultimately result in real dollars saved.”

Currently, taxpayers fund nearly half of all U.S. births through state Medicaid programs, which generally do not cover doula care. A cesarean birth costs almost 50 percent more than a vaginal birth, with average Medicaid payments of $9,131 for a vaginal birth and $13,590 for a cesarean delivery.

A doula provides support in the non-medical aspects of labor and delivery, and according to the study, this kind of support can translate directly into fewer cesarean births, because more mothers may fully understand their birthing options and have the support they need during challenging aspects of labor and delivery.

“I have attended more than 100 births since the early 1990s,” said Sekhr-Ra, “with all kinds of women and all kinds of births. The pattern I’ve noticed is that a cesarean usually becomes an option when a woman does not trust her body or the labor and delivery process.

“I’ve noticed that when a woman begins to listen to the voices around her telling her that she cannot do it without a lot of medical intervention, she loses confidence in her own ability to do what is completely natural. When those voices win, cesarean is the solution.

“In my work as a doula, I talk to and encourage the couple, the mother and father, during the entire pregnancy by reminding them that they don’t have to know everything about birth to do it well — they have natural intelligence,” Sekhr-Ra said.

Numerous clinical studies have found that a doula’s presence at birth tends to result in shorter labors with fewer complications; reduces negative feelings about one’s childbirth experiences; reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction; and reduces the requests for pain medication and epidurals, as well as the incidence of cesareans, according to DONA International.

DONA is an organization that was formed in 1992 among a small group of childbirth experts dedicated to promoting the importance of emotional support for mothers and their partners during birth and the postpartum period. According to Sekhr-Ra, “A doula is support and love.

“Families are not always nearby to lend that support for mothers, and a doula can provide that. A doula is someone who knows what to expect during labor, who can rub your back and tell you it’s gonna be alright. A doula is a sister who has been there,” she says.

Driven by her love of Black people, “her people” as she says, Sekhr-Ra insists that it is an honor and a blessing to be with a woman at her most powerful yet vulnerable time.

“I found out from my father that he was born at home in Georgetown, Georgia. His grandmother was a midwife for the area, and so being a doula is in my blood. Becoming a doula is a calling.”

Though the new research took place among women on Medicaid programs, who are primarily women of African, African American, Latino and Native heritage, Sekhr-Ra recommends that researchers and policymakers focus on the elements of emotional support that are cultural so public health programs grounded in cultural care receive more recognition for their contribution to improved health outcomes for people of African American heritage, and certainly more funding. “Emotional support is cultural,” she said. “The two are inseparable.”

Michelle Lawrence, MA, MPH, specializes in cooking African-based dishes and relationship-enhancing dining experiences for families and couples. She welcomes reader respones to 612-251-9516.