Doula Support Improves Maternal and Child Health Outcomes, Patient and Family Engagement

In honor of World Doula Week, celebrated annually March 22-28, The National Institute for Children’s Health Quality (NICHQ) held a conversation with LaToshia Rouse, CD/PCD(DONA), owner of Birth Sisters Doula Services. Rouse currently serves as the Patient and Family Engagement Co-Chair of the National Network for Perinatal Quality Collaboratives Executive Committee and joined NICHQ’s Board of Directors in March 2022. 

A doula is a professional labor coach who provides physical, informational, and emotional support to families during pregnancy, childbirth, and the postpartum period. 

Studies examining the impact of continuous support by doulas report significant reductions in cesarean births, instrumental vaginal births, need for oxytocin augmentation, and shortened durations of labor. Additionally, doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. 

Often, expectant parents receive messages from a variety of sources, Rouse explained. With social media, friends, and family, and even strangers on the street offering advice, it can be difficult for mothers and birthing people to know what information to trust. Working with a birth or postpartum doula offers parents and families an opportunity to connect with a trusted source of knowledge to help them understand critical information and alleviate anxiety they may be feeling. 

There are a variety of doulas who offer different expertise and can improve the birthing experience in numerous ways. Doulas can be helpful in all birthing situations, so Rouse encourages expectant parents to consider working with a doula.  “Whether pregnant patients are having a hospital birth or a home birth, if they need an epidural or a c-section, or if it’s a natural childbirth with no medication, the situation can benefit from a doula,” Rouse said. 

Read more to learn more about Rouse’s experience as a licensed doula and the ways in which incorporating doula support in the birthing process can reduce negative infant and maternal health outcomes and improve patient and family engagement. 

What made you want to become a doula? 

I decided to become a doula after having all of my children and because of the work that I was doing in patient and family engagement. I found that patients were asking clinicians to have more time to be able to communicate with us, for them to be more available to discuss options, and for them to offer more education.  

I love being able to close some of the gaps in care and support families who enter a really stretched healthcare system. Medical staff has so many things now that they have to do. That’s why I’m a doula – that’s the part that I enjoy most is the part where I get to do home visits and meet the other children, and meet the partners, and the best friends, and the grandmas. 

In what ways do doulas support parents and families before the birthing process?  

For me, I spend time in the prenatal period getting to know people. Every single week, if they don’t have a question and nothing comes up to cause a conversation, I’m checking in with them to see how things are going and make observations. Are they super busy? Do they need help with self-care? Are they having struggles with dietary needs? Do they need referrals or resources? Is this an emotional week? What happened? Are they having aches and pains? What are they thinking about? I ask questions to help get to know them in a deeper way. We also talk about marriages and children, in-laws and friends, everything. That context is what’s very helpful for people because they don’t feel as though they are treated like everybody else and they know that they matter. They can trust that this is someone who knows them in the prenatal space.  

I also provide information and help with exercises to prepare for birth. Then, we prepare a birth plan. The birth plan is a wonderful educational tool. It may not go as planned but we also have discussed what you want in those cases as well.   Then in labor we already established trust and built a relationship. 

What are some of the responsibilities of a postpartum doula?  

In the postpartum period, what people really face is feeling like they can’t do things. So, I get to be an encourager and support person who says you can do this. Some parents feel as though they can’t breastfeed because they don’t know anyone who did. They may feel that they don’t know how to take care of a baby because they haven’t been around other babies. They may not be sure if family members offering advice have the most current information, so they don’t know if they’re doing this right. I spend time with people telling them they’re doing it right, and even if there are other ways to do things, I’m able to reassure them and give them options if they so choose to use them. I provide research and referrals for social supports, lactation, and other supports.  

How long does someone work with a doula? 

I do have some clients who do hire me for both birth and postpartum doula support. That could be over a year. 

 Typically, a birth doula works with families prenatally for about 3-6 months. Then, postnatally birth doulas have 1-2 visits typically, but you’re still available for follow-up phone calls.  

For postpartum doulas, we spend a certain number of hours in the home a week and parents negotiate the time they need with the doula. Typically, families pay at an hourly rate over a three-month period. The main job is to be in the home to support families with getting sleep, healing in the postpartum, self-care, family integration, and baby care. Postpartum doulas also help with safe sleep options. And let’s not forget postpartum doulas help share the load of light housework.  

What are some of the benefits of having a doula present during childbirth? 

It is important to have a birth doula because birth doulas encourage strategic movement. The birthing person’s movement helps the baby move, and that has been proven to shorten labor. It also helps to avoid cesareans, and movement aids in pain management as well.  

Doulas also help with creating a peaceful atmosphere. There are times when I use humor. There are times when we pray together. There are times when I’m just looking them in the eye and telling them I understand because I’ve been there. Those pieces can be overlooked because the noises and speed of a hospital can be unsettling. I bring a “calm” when I enter a room, even before I do anything. They can relax knowing I am only there for them as a guide. Upon entering we are working through the birth plan. The birthing family doesn’t have to remember it all and know when to use it. If the birth plan includes hydrotherapy, doulas are there to ensure we’re using water for pain relief.  We’re helping with counterpressure for pain management. We’re helping regulate their temperature and emotions. We’re massaging them. We also help make sure people understand the information they’re getting. If a doctor or nurse comes in and makes an observation, we clarify what they mean in plain language to help parents understand how that may change their birth plan. I also engage the partners by telling them here’s where you ask a question. Then there are times I’m just there to create space for families to process the information they receive. Sometimes people have heard a lot, and they need a minute. Just to name a few things.  

Studies show so many benefits beyond my examples. We are busy in a birth. 

You mentioned partner support. What does that look like in terms of a doula being engaged with the partner and the family support system? 

Prenatally, partners are unsure of why they need a doula. They’re not sure how we will together work. This is what I learned, and this is how I operate: Think of sports….  Mom has the ball. The doula is the coach, and dad is offense and defense if we need it. We are in constant communication focused on preserving mom’s wishes as much as possible. It’s never a great thing for partners NOT to be involved, so I make sure they know how to do a hip squeeze, how to gather pertinent information and how they can help during labor.  

Some watch me and I say they can take the next one. Sometimes I’ll text people and say, “Tell her how well she’s doing” or “Go get her some water.” That way moms can see partners doing it without being instructed, because that’s important. Moms may want them to know, and sometimes they don’t. I also sometimes just give them the break they may need. They may need to walk out of that room and go eat, and just let it go for a minute and come back. They know I have her covered so they can do that. Dads and partners become fans of doulas really quickly seeing the support they get. Doulas support the family.  

How can incorporating doulas in the birthing process improve outcomes for infants and mothers and birthing people? 

There are so many benefits. Reduced need for Pitocin, reduced need for intervention, reduced need for epidurals, increased breastfeeding rates and reduced anxiety/ depression in parents are some of my favorites. These are some of the things that my clients care most about. They don’t want interventions, they want to breastfeed, and they have significant support to do so. It helps with anxiety and depression. Sometimes people have anxiety and/or depression going into birth, and sometimes it happens after, and we don’t pay enough attention to how this transition impacts their mental health. Not being a part of the decisions during your appointments and in labor really can create birth trauma. Having doula support does impact people in labor, before labor, and after labor.

People need people. One of the key needs that people have is connection, so the connection with their doula means a lot.

If a pregnant person is interested in working with a doula, how do they find the right doula for them? 

Some clinicians have lists of doulas they’ve worked with that they can provide. Some people search the internet, for “doulas near me.” You can also do that search on social media. You can use hashtags to find doulas as well. But I find that word of mouth is really where people tend to find me. Friends referring friends.  

Do a consultation to find out if the person is a good fit. You have to find a doula that matches up with your needs.  

Here are some questions to ask:   

• Why are they a doula? 
• When are you needing a doula?  
• Where will you give birth?  
• Do they have a back up if they can not make it for some reason?  
• What is the cost?  
• Where did they train to be a doula?  
• Can they support a natural birth?  
• Do they have experience with the birth you would like to pursue?  
• How will they incorporate your partner?  
• Are they familiar with any pre-existing conditions you have?  

NICHQ has several projects dedicated to improving infant and maternal health outcomes.  

The National Network of Perinatal Quality Collaboratives provides resources and expertise to nationwide state-based perinatal quality collaboratives (PQCs) with the goal of deepening and accelerating improvement efforts for maternal and infant health outcomes. 

As the coordinating center for the NNPQC, NICHQ enhances the coordination and communication of PQCs across the nation, advises state PQCs that are in early stages of developing their collaboratives, and give technical assistance focused on quality improvement (QI) methods that improve health outcomes for mothers and newborns, particularly within populations disproportionately affected by adverse perinatal outcomes. 

 Learn more about NICHQ’s National Network of Perinatal Quality Collaboratives initiative.