For her second pregnancy, Erika McBee of Kensington hoped for a vaginal birth instead of the cesarean section she experienced with her first child, as well as a delivery without drugs or other medical interventions. But things weren’t going according to the birth plan she had worked out with her doctor and her doula—a nonmedical provider who supplies physical, emotional and informational support for parents before, during and after delivery. The baby’s head was tilted toward his shoulder, and he was scraping his way down the birth canal slowly and excruciatingly.
After 18 hours of labor, during which McBee, a nurse, experienced blackout pain, she and her husband reluctantly accepted the idea of an epidural. The decision was made easier by the calm presence of her doula, Jenny Corbett, 47, of Silver Spring Doula.
“Jenny really guided us through that difficult moment of reconciling with the change of plan,” McBee, 35, says. “It felt really good having somebody look me in the eye and say, ‘You’re making a good decision.’ ” After another 18 hours of labor, her son was born healthy—and vaginally.
Doulas are often confused with midwives, but there is a clear distinction: Midwives offer medical care, whether it’s assessing blood pressure or delivering babies; doulas do not. Savor It Studios doula Michelle Cohen, who lives in D.C. and also serves clients in Montgomery County, likes to use the word “companion.” “We … are walking alongside someone in their journey, and each person might need a little bit [of] something different through that experience,” says Cohen, 43, who has been a doula for 11 years.
Ursula Sabia Sukinik, 54, of Bethesda has been a doula for 25 years and says she has attended 1,500 births. The founder of Birth You Desire, Sukinik describes doula care this way: “A doula meets with a client prenatally to discuss their goals and birth plan, to develop coping mechanisms and address concerns. At birth, a doula will work with the client’s medical team to have a healthy outcome, and coach the client and their partner in a way that makes them feel comfortable. The postpartum visits are to make sure that the infant is feeding well and to look out for early signs of postpartum anxiety or depression.”
The role of the doula stems from the “natural childbirth” movement of the 1970s, which was a reaction against high rates of interventions, such as inductions, epidurals and C-sections, in hospital deliveries. While doctors initially worried that doulas would interfere with medical decisions, research has shown that doulas improve outcomes for parent and child. That is especially key for the Black community, which has a maternal mortality rate more than three times that of white women.
The American College of Obstetricians and Gynecologists now acknowledges the benefit of doulas, as does the American College of Nurse-Midwives (doulas work with doctors and midwives, and in hospitals, birthing centers and homes). Many mainstream pregnancy-planning checklists now include reminders to hire one.
Local doulas say they see more clients who are older, with a higher risk of complications; more clients without partners; and more clients open to pain medication or other interventions.
“I think people are just realizing the value in having that support,” says Alison Knotek, 39, who works with DC Birth Doulas and teaches childbirth and baby care classes at Adventist HealthCare Shady Grove Medical Center. “And it doesn’t matter the type of birth that they’re going to have.”
The doulas consulted for this story said services start at about $1,500 in the D.C. region. Because doula care is so pricey and is rarely covered by insurance—though costs can be reimbursed through a pretax Flexible Spending Account or Health Savings Account—access has mostly been limited to upper-income white individuals.
This is something advocates for doula care are trying to change. A few insurers provide coverage, and one state, Rhode Island, requires them to, according to Amy Chen, senior attorney with the National Health Law Program, which seeks access to health care for low-income and underserved communities. Meanwhile, Chen says, Medicaid programs in nine states (including Maryland and Virginia) and D.C. offer reimbursement (though doulas say it is far lower than the going rate).
It’s unclear how many pregnant individuals avail themselves of the support. The latest national data is from 2012, when 6% of 2,400 women polled by Childbirth Connection said they had used a doula. Joyce Dykema, a spokeswoman for DONA International, the oldest doula certifying organization, says that, anecdotally, the numbers are growing “mostly from increased awareness of the benefits.” Kim James, a doula and birth and parenting educator in Washington state who owns the fee-for-service DoulaMatch.net, agrees, saying searches for doula care have increased steadily since her company was established in 2008.
There are no official databases of doulas in the U.S. James says there are 5,000 active doulas in her database, and she estimates the number of doulas nationally at 12,000. There also are no formal licensing requirements to become a doula; instead, doulas are voluntarily certified through independent organizations—of which there are now about 100, according to the National Health Law Program. These organizations typically require taking a childbirth education class, completing a two- or three-day doula workshop and attending several births. The cost to become certified ranges from a few hundred dollars to a couple thousand.
While the certification process is unregulated, one aspect of doula care that seems clear-cut is the benefit to parent and child. A 2017 review by the Cochrane research organization of 26 medical trials concluded that doulas reduce C-section rates and the need for epidural anesthesia, while improving the birthing experience and newborns’ vital signs. A 2022 analysis from the University of Maryland found that doulas increased the odds of respectful care, meaning there was good communication and the person giving birth felt supported and heard.
A 2016 study involving Medicaid recipients found that women who were supported by doulas throughout their pregnancies had lower C-section and preterm birth rates. A 2013 study of socially disadvantaged mothers found that those with doulas had higher rates of initiating breastfeeding, while their babies had higher birth weights.
The benefits are especially important for African American women. The maternal mortality rate of Black women in the U.S. is 3.3 times that of white women, and income makes no difference: A 2022 study of California mothers published by the National Bureau of Economic Research found that the wealthiest Black mothers and their babies had “markedly worse” outcomes than the poorest white families. According to the National Bureau of Economic Research, a doula pilot program aimed at Black women in marginalized areas in California is showing that the women served have more full-term births, fewer C-sections and lower rates of postpartum depression than the state and national averages.
Local doulas say many Black women in Montgomery County are aware of the statistics and arrange for doula care. Silver Spring’s Giny Acea, 33, who has been a doula for 10 years and whose heritage is Cuban, says the client base has become more diverse in the past five years, and that Spanish-speaking and Black women sometimes seek her out. “They just want someone that they can connect with,” says Acea, who is studying to be a midwife and was inspired to become involved in pregnancy care when she delivered a baby on the side of the road in Cuba at age 17.
Jade Floyd, 41, of Silver Spring says that once she was aware of the dangers to Black mothers such as herself, “I did everything in my power and with the resources I had to change that.”
When she became pregnant in 2019, among the steps taken by Floyd, a senior vice president for the public affairs firm Global Strategy Group, was hiring Sukinik to be her doula.
That delivery, in April 2020, was in the early days of the pandemic, a time when doulas were barred from most delivery rooms because they weren’t considered essential workers. Sukinik coached Floyd and her husband via laptop during a challenging labor as the baby’s heart rate dropped. She then talked them through the difficult decision to have a C-section, and, post-delivery, found Floyd an acupuncturist and a lactation consultant.
“I’m really just thankful for having her as part of my care team,” Floyd says.
Floyd hired Sukinik again before she delivered a second baby, via planned C-section, in February 2022. Sukinik, along with Floyd’s OB-GYN father-in-law, insisted that Floyd take her high blood pressure readings afterward seriously, an intervention that Floyd believes saved her life and demonstrates how important post-delivery doula care can be.
Besides age and race, the reasons women seek the extra support include preexisting health conditions, family history, anxiety, not having a partner, having a nervous partner, wanting backup for the partner, having a previous miscarriage or traumatic birth experience, wanting to avoid a C-section, and wanting an unmedicated birth, doulas say.
But the element of doula practice that doulas mention over and over is the constant and continuous care. “I think the biggest surprise that first-time parents have is how much time they are just by themselves in the hospital room with nobody around,” says Corbett, who has been a doula for 10 years.
Giving birth, McBee says, can be “the most beautiful and the most terrifying day of your life. And it’s nice to have someone there to…hold your hand through the scary moments.”
Interested in hiring a doula? Here are some things you should consider:
- Is your obstetrician, midwife or hospital open to doulas? One indication is if the hospital has a midwifery program. Midwives tend to be more welcoming of doulas.
- Where has the doula been certified? There are so many programs that it can be difficult to judge the quality. Check if your state accepts that certification for its Medicaid or community doula programs.
- How many births has the doula attended? This is a more reliable indicator of experience than years.
- Does the doula’s birth philosophy match yours? You don’t want someone to be pushing a natural birth on you if you are open to an epidural.
- Are you comfortable with them? The doula will see you in your most raw and vulnerable state.
This story appears in the September/October issue of Bethesda Magazine.
