Historically, pregnant women have generally been supported by secular women during labor and delivery. This custom was particularly prevalent among black women in Mississippi, who relied on midwifery grannies and women in their communities, especially during the days of segregation when black women were denied care in clinics and clinics. hospitals.

Today, women who provide non-medical support to women in labor are called doulas.

Getty Israel

A doula is a trained childbirth professional who provides emotional, physical and social support during pregnancy, labor and delivery, and immediately after the baby is born. Typically, doulas develop a relationship with pregnant women in the third trimester.

The effectiveness of doulas in reducing medical interventions, especially cesarean deliveries, which are often medically unnecessary, and improving birth outcomes is well studied.

Doula support during labor and delivery is associated with lower cesarean section rates and fewer obstetric interventions, lower rates of intrapartum analgesia, instrumental vaginal delivery, periods of labor shorter and higher rates of spontaneous births and infant APGAR scores.

Mothers who received a doula during childbirth were four times less likely to deliver a low birth weight baby, half as likely to have a complication during childbirth, and more likely to initiate the birth. feeding with milk.

A University of Minnesota study reported that the cesarean section rate was 22% among doula-assisted births and 31.5% among Medicaid recipients nationally. The odds of a cesarean delivery were 41% lower for Medicaid-funded births with a doula than for Medicaid-funded births receiving usual standard care.

In addition, a regional study composed of 65,000 Medicaid recipients reported that women who received the support of a doula had rates of preterm birth (4.7% vs. 6.3%, respectively) and cesarean section (20.4% vs. 34 , 2%) lower births among Medicaid beneficiaries at the regional level. Doula-assisted births were associated with a 22% lower probability of preterm birth. In addition, the rates of hypertension and diabetes were lower in deliveries supported by doula than in women in the regional group.

A recipient of a federally funded Healthy Start Grant Serving a Medicaid population has integrated doula support services into their program. Program participants had rates of preterm births and low birth weight that were almost 50% less than women who did not receive doula support.

However, only a few states, Minnesota, Oregon, and Illinois, reimburse this highly valuable, evidence-based service, which could potentially save millions of dollars in medical bills for states with high Medicaid registrations, such as the Mississippi which covers about 70% of births. and is known for its high rates of premature births, low birth weight babies, cesarean sections, infant mortality and very low rates of breastfeeding.

It is time for doulas to be integrated into health care and payroll systems as the demand for the service continues to rise among pregnant women in Mississippi.

My clinic in Jackson receives inquiries every day from Medicaid members who cannot afford the cost. Therefore, service is beyond the reach of most women in the state. In Mississippi, the cost of having a doula can range from around $ 400 to $ 1,000 or more depending on the doula and the level of service received.

The only lasting solution to ensure that all pregnant women have access to doulas is to establish national standards and regulations and to provide reimbursement for service charges.

Getty Israel is Founder and Executive Director of Birth Sisters Inc. to Jackson.


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