So when I became pregnant with my daughter last year, I was worried about a repeat experience. And sure enough, I again had a retained placenta, in addition to other complications. This time, though, I was able to advocate more forcefully for myself and get the appropriate care sooner.
The difference between the two experiences? I hired a doula the second time around.
It’s no surprise to me that the World Health Organization lists having a birth companion present on its Safe Childbirth Checklist. Pregnancy and childbirth often leave women feeling vulnerable, because medical professionals often focus on the baby, with less emphasis on the mother’s mental and emotional well-being.
One way to shift us closer to better maternal outcomes is to use a doula — a birth professional who ensures mothers feel heard, seen and comfortable — in more pregnancies and deliveries. Having a doula at appointments, to discuss the emotional highs and lows of pregnancy, is invaluable. But it’s an option that is underused in the United States.
Doulas have been shown to improve outcomes during labor, because they are able to remain calm and objective when a laboring individual might be too stressed or overwhelmed to prioritize their own interests. They know what to ask and can help advocate for the mother. Other benefits of a doula or other birth companion, including reduced use of medication during labor and lower rates of Caesarean deliveries, are well documented. And the value of having a support system during childbirth has been known for centuries. In most communal societies older women who have experienced childbirth are present while younger women labor and deliver, to provide guidance and comfort.
The benefits of these support systems are even greater for black women and others who distrust the medical system because of past negative experiences. Research has shown that black women are at an increased risk for complications and discrimination during childbirth. But a birth companion has the potential to empower anyone who has experienced trauma while navigating the medical system.
Unfortunately, few insurance plans cover the services of a doula, though that could change with increased advocacy. New York is one of a few states to introduce Medicaid coverage for birth doulas, and more insurances companies are reviewing the benefits of adding doula care to plans.
My doula fiercely advocated for me and made sure my medical team was including me in decisions and treating me with compassion and understanding. Watching her fight for my right to be heard gave me my voice back. I believe the fact that I am a black woman was one of many reasons medical professionals downplayed my cries for help when I experienced pain shortly after giving birth, with both my son and daughter.
My doula, who is also my friend, also helped advocate for me during my pregnancy. She made sure I was comfortable asking questions when we discovered that my daughter was measuring small. She comforted me a month later, when we found out that my daughter had dropped to the seventh percentile in size and was diagnosed with Intrauterine Growth Restriction. And she made sure I had the chance to process my emotions when we discovered my placenta had decreased functioning and I would be induced at 37 weeks.
My birth companion spoke out when she felt as if I was being monitored unnecessarily, and that allowed me to travel up and down the halls while I was in labor. I learned to have faith in her belief in me, and that strength carried me through those last few pushes without medication.
If I hadn’t watched my doula advocate for me so relentlessly, my birth experience would have gone differently. With her there, I was less concerned about annoying the doctors and nurses and more concerned with making sure that their methods worked for me. Her guidance taught me to trust myself, especially when it related to my health. It enabled me to realize something had gone wrong after my second birth, even though my symptoms were considerably milder than with my first birth. And she reminded me to advocate for myself.
Since then, there have been times I wondered what would have happened if I had responded as defeated as I felt and not pressed send on that last message asking my physician for an ultrasound. I’ll never have that answer, but I know the decision to have a doula was life-changing. Thanks to her, I regained what my first birth had stolen from me: my self-agency. And her help may have saved my life.