Moms turning to doulas for pregnancy aid
Demand said rising amid state’s health care struggles
Doulas, professionals who assist pregnant mothers before, during and after a birth, are rare nationwide and rarer still in Arkansas.
But those in the industry say demand is growing and that their work of caring and advocating for expecting and new parents could be a benefit in a state struggling with maternal and neonatal health care.
The service can be expensive, and doulas are not always covered by health insurance. Some employers pay for doulas as part of a benefits package; other families can afford to hire them by themselves. A handful of states are reimbursing doula services in Medicaid or are considering it, but not Arkansas.
The cost can be prohibitive for lower-income families. Some doulas, like Dillon Harvey-Williams of Jonesboro, apply a pay-what-you-can sliding scale, $400 to $1,000. In Little Rock, Sondra Rodocker, who owns Arkansas Family Doulas, said some lower-income families find a way to come up with the money.
“They will save. They will pay $20 a week on their invoice. They have family that contribute to their birth fund,” she said. “I would like everyone to have support. But these doulas deserve to [be] paid, just because they are there. They’re their person, and sometimes they endure and see a lot of things that you wouldn’t see on a regular basis.”
Rodocker thinks that perceptions of pain tolerance are poorly calibrated in Arkansas, whether that of Black people, women who have already given birth or even men.
“But when we’re talking about these specific things and complications that women can have versus those men may have, it can be a little stickier,” she said. “Especially when we’re talking about the uterus and all of these different things, most of the people treating us don’t know what it’s like to be us.”
Arkansas does not license doulas to operate; all those interviewed were certified by a professional school, which typically includes some in-person training.
Rodocker stressed the primacy of her clients in the
delivery room over medical professionals. She said doulas sometimes act as coaches during delivery but that prenatal plans include set roles for partners and spouses during childbirth.
“We kind of act as the gap between the medical side and the peer side,” she said. “Since we do have a little bit more education than just your friend who may have been to the births, we can really help provide a lot of those resources. Sometimes your [health care] providers may not have extra time to go over those little things with you.”
Most clients reach out to Arkansas Family Doulas around the 12th week of pregnancy, Rodocker said. Much of the care comes in the form of emotional and family support in addition to discussing what birth is like and how to self-advocate during the process. Much of it is about instilling confidence in clients about their parental abilities.
Harvey-Williams, 27, is one of a few doulas in northeast Arkansas and is in training to be a midwife. It’s part-time work for her, with one child at home and another on the way, and she takes around a client or two every other month. (Arkansas Family Doulas, soon to change its name to Arkansas Doulas, employs independently contracted doulas, handling administrative work and paying the doulas 70% of their contracts with clients.)
While Harvey-Williams said demand for her services is light, it has increased, especially after the pandemic. During that time, she offered services virtually and additional prenatal and postpartum visits; one client even chose Harvey-Williams to come into the delivery room with her over her partner. Clients have found her through Google or by referrals; most of them are first-time parents.
“A lot of them are more on the crunchy side, more geared towards wanting to do a home birth, but they don’t have the finances,” Harvey-Williams said. “They already have the mindset that they need help advocating and navigating the hospital system. They know that there’re some issues there, and that’s why they’re hiring a doula.”
Harvey-Williams begins the relationship with an interview, after which she encourages potential clients to examine the impressions. “It’s such an intimate role that you really want [the] person who’s best for you. You don’t want to just go with whoever’s cheaper or the first person you find,” she said.
Once the two make a match, Harvey-Williams does two to four prenatal visits at home, during which they formulate a birthing plan. She stays two hours after the birth and meets twice after the birth.
Dr. Sam Greenfield, a professor in the University of Arkansas for Medical Sci- ences’ Department of Obstetrics and Gynecology, said the medical conversation about doulas has progressed from what they are and what they do to discussions about their roles in medical and birthing spaces.
Greenfield said support and advocacy through the birthing process “intuitively makes a lot of sense.” Studies have found benefits for mothers having low-risk births: Doula-assisted mothers were less likely to have low-birthweight babies and birth complications, and those with doulas had fewer cesarean sections.
“One of the things I think the role can be is shepherding patients through a challenging time and through a challenging conversation,” Greenfield said. “But they’re not medical providers in the traditional sense. I think that’s where there’s an opportunity for good — and if not understood, some areas of concern.
“This is a welcome conversation in the birth space in terms of things that can potentially have an impact on improving outcomes,” he said. “Because we don’t have a lot of them in Arkansas, our contact overall has been somewhat limited. But certainly there’ve been a lot of groups that have called for them, in terms of having an increased presence.”
Arkansas has high levels of maternal mortality. Greenfield noted the further disparity in Black maternal health.
“One thing that is positive in this setting is that we are paying attention to it in a way that I cannot recall the state has ever paid attention to in the past 20 years,” he said.
The UAMS department has educated medical professionals about the issue. The state has formed the Arkansas Maternal Mortality Review Committee to review every maternal death, identify if it was pregnancy-related and see if recommendations could be made from them. (Cardiovascular disease, cardiomyopathy and heart disease more broadly are some of the top causes.) Other professional organizations are being formed to study the issue, as well as maternal morbidity. Greenfield noted that traumas associated with childbirth can reverberate into the future.
“For many families, having a child may be a once-ina-lifetime episode,” he said. “Having someone who can assist with understanding the process and to help patients ask difficult questions to understand what the experience may be like — all these things have the potential for benefit.”
Rodocker and one of her contractors, Alexis Jackson, both entered the profession after experiencing severe health issues when they gave birth.
“Everything was OK until it wasn’t,” Jackson said. “I woke up one morning, and I was swelling, waist-down. It was almost like water retention.”
Female family members she sought advice from played down the issue, which turned out to be preeclampsia. Her blood pressure was skyrocketing. She had a C-section, after which she had a series of seizures and was put into a medically induced coma, followed by another week of hospital care. After being discharged, she experienced a pulmonary embolism caused by a preponderance of blood clots, which resulted in additional weeks of hospitalization.
“After going through that and also being a doula, I’ve noticed that there were definitely some things that could have happened that could have caught it,” Jackson said. “One is education. If anyone around me had known signs of preeclampsia, I could have gone to the doctor right then and there instead of waiting for things to get worse. If I had a doula, I definitely would have picked up the phone and called my doula.”
Dr. Sam Greenfield, a professor in the University of Arkansas Department of Obstetrics and Gynecology, said the medical conversation about doulas has progressed from what they are and what they do to discussions about their roles in medical and birthing spaces.