A Labor of Love: The Birth Doula
Home-birth midwives and high-risk obstetricians agree: the U.S. cesarean rate is too high, and while there doesn't appear to be any single good explanation for it, a recent study from the University of Minnesota points to a solution already well-known to "natural" birth enthusiasts: the labor doula.
Doulas, who are almost always women, play a role as ancient as childbirth itself: they offer practical comfort and compassionate, continuous support to women in labor. Unlike midwives, they are not trained in medical procedures, and unlike labor and delivery nurses, they don't go off-shift; they'll stay with a woman from the beginning of active labor to about an hour after delivery.
As unlikely as it may seem, in various controlled studies, continuous doula support has been shown to reduce a woman's need for pain medication, forceps, or vacuum suction delivery—and cesarean. After controlling the study for factors associated with high-risk pregnancy (such as gestational diabetes, high blood pressure, and maternal age), researchers found that Medicaid mothers giving birth with the support of a doula were 40 percent less likely to have a c-section.
Why does avoiding an avoidable c-section matter? Some are wary that a preference for vaginal delivery manifests a "selfish" valuation of the mother's "birth experience" over the health of the baby, but it's much more than that. As journalist Jennifer Margulis points out in her new bookThe Business of Baby, while death following childbirth is but a remote possibility for American women, they are still up to four times more likely to die from giving birth via cesarean than vaginally. Plus, babies delivered via cesarean are much more likely to have breathing problems and require a stay in neonatal intensive care units.
While one study demonstrated that even minimally trained "lay" doulas—family or friends of the expectant mother—helped women achieve better birth outcomes, professional doulas often serve middle-class women, who benefit significantly from doula services even if their husbands also support them in labor. Middle-class women are more likely to be aware of the option of doula support, but, more significantly, they're the ones most likely to be able to pay for that support: labor doulas charge anywhere from $300 to $1,500 to accompany a woman in labor, with doulas in cities charging even more. Because most insurance companies do not reimburse consumers for doula care, people nearly always pay out-of-pocket, which means that those who might benefit most from a doula's services—low-income women and women of color, who are disproportionately more likely to have poor health and outcomes in pregnancy and childbirth—are those least likely to receive them.
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