Could Low-Income Women Benefit More From Doulas?

Sep. 24, 2014 / By

It was spring of 2010 when Long Beach resident Elizabeth Thai gave birth to her first born. She was a teen and had not taken any birthing classes because she didn’t think she could afford them. By the time she learned that her health care plan did cover the cost of classes, it was almost time to go into labor.

“The only things I knew were what I read, and giving birth is kind of hard to fully read up on,” said Thai.

For her second birth, Thai knew she wasn’t comfortable with the idea of relying solely on the medical support of hospital staff. As she puts it, “I feel like because I was 19 and on Medi-Cal (at the time of my second birth), they treated me like a teen mom on Medi-Cal.”

It didn’t help that when she was in labor with her first child, Thai didn’t feel fully supported by the father. “My partner was there but it was the typical partner – he wasn’t fully informed about how he could help besides just being there.”

Her experiences during that first birth encouraged her to seek out a doula for her second pregnancy, a decision that would change her life in ways she never expected: Thai would eventually become a doula herself, providing services to other mothers like her.

The term “doula” is an ancient Greek word that means “a woman who serves.” Today, doulas are people who are trained to provide physical, emotional, and informational support to mothers (and partners) during their pregnancy and the birth of their child.

“I serve the mother by giving her unbiased information, providing her with the pros and cons of her options,” Thai said. “We’re not there to tell [mothers] what to do but if they are confident with their choice then that’s the best thing that we can [provide for] them.”

As a doula, Thai said she wants to make sure the mother knows that she has a voice and what the doctor says is not final.

Another doula agrees. Preschool teacher and newly certified doula Sarah Lavelle said, “You can’t assume that every doctor will read a mother’s birth plan, so [a doula is] there to be that buffer in case they don’t follow it [during the labor].” A birth plan is a listing of the standards a mother requests for her birth to be ideal for her.

“During the birth, you’re there to be that open book for the mother and partner,” said Thai, whose own doula she said was able to provide her with more options than her assigned nurse, for how to deal with the pain of labor contractions.

According to some studies, the use of doulas can lead to a more empowering birth experience for mothers. Doulas can also contribute to numerous other improved birth outcomes including: shorter labors, better mother-baby bonding, and less postpartum depression. Studies also show that women who received continuous support from a doula during their pregnancy were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, or negative feelings about childbirth.

Despite growing awareness around the relative lack of doula services in low-income communities, not much has been done to bridge the access divide.

Research conducted in 2013 by Katy Kozhimannil at the University of Minnesota School of Public Health found lower cesarean birth rates among Medicaid beneficiaries who had access to a birth doula, compared to all Medicaid patients nationally. Also according to the research, many low-income women have a higher risk of poor birth outcomes, yet are less likely to be able to afford the cost of a doula service. Doula care is usually an out-of-pocket expense, as most insurance providers do not cover the cost.

That being the case, a common perception of doulas held by low-income women is often that they are not an option.

“A lot of women who are low-income have a strong belief that doulas are something that they can’t afford at all,” Thai said, but there are ways.

For example, she said, some doulas are open to bartering for their services. Thai said that she knows a mother who provided graphic design services as a partial payment to the doula service. And several other doulas interviewed mentioned that the birth community in Long Beach is strong, connected, and willing to find solutions for potential doula clients.

“If I cannot help a mother (personally), I like to help them get to where they need to be,” said birth and postpartum doula Tammy Leeper. “There is a huge disparity between communities who are underserved.”

Lavelle added that there is no cohesive place in Long Beach for birth resources, crediting this as a reason some communities in the city have less exposure to them. She also credits this and the lack of workers as reasons she wanted to pursue being a doula.

“Maybe advertising with WIC would increase the visibility of doulas in low-income areas,” Thai suggested.

“There is a program in Santa Monica that is helping out mothers who are high risk. And now I believe they are working more with low-income mothers,” Thai said. The organization, called The Joy in Birth Foundation and the Partnerships for Families, started in 2011 to provide birth and postpartum doulas free of charge to the program’s clients. They are currently collaborating with organizations in Los Angeles County to expand.

Marketing specialist Nydia Aizpuru, another mother who used a doula for her pregnancy but is not low-income, said she was unaware of the support that doulas could provide when she first got pregnant. “[My partner and I] started taking a Bradley [Method] class and that’s what started the whole thing,” Aizpuru said. The Bradley Method is a system of techniques that are sometimes used to help mothers give birth naturally. Aizpuru’s instructor for the class was Lia Berquist-Fletcher, who is a doula herself and connected her with a fellow doula to provide services.

Aizpuru went into labor at roughly around 4am and texted her doula, Marisol Garcia. “I was just giving her a heads up.” That morning, she and her husband were keeping track of her contractions but they were “all over the place.” They decided they would head to the hospital that afternoon. Once Aizpuru went into labor, which was over 24 hours long, her doula was there virtually until the end. “We had to almost like kick her out so she could get some rest.”

Families considering using a doula for their birth can obtain information by visiting the Doulas of Northern America (DONA) website at, visiting or doing a web search with the keywords “doula” and “your city.” Mothers and doulas alike suggested expecting mothers interview doulas before committing to any one.

“Don’t be afraid to tell a doula you are not hiring them because you don’t feel a connection or you found somebody else,” Thai said. “Most of the time we won’t take it offensively because we want the mom to feel comfortable to know that she’s choosing the right person.”

“Using a doula is priceless,” said Aizpuru, who encourages mothers, of all socioeconomic backgrounds, to use a doula. “When the time comes again, we’ll definitely be using a doula.”

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Deonna Anderson

Deonna N. Anderson is an alumnus of UC Davis, where she received her bachelors in communication, with minors in professional writing and sociology. She is a freelance writer, creator, and self-proclaimed foodie. As she continues her writing career, she plans to cover culture, education, and race. Another one of her goals is to see fifty countries by the time she’s 50. So far, she’s seen four—Canada, Spain, France and Japan. Since her first time stepping foot on other soil, she’s been committed to seeing as much of the world as humanly possible. When she’s not working, blogging, or plotting travel, Deonna likes trying out new recipes, going hiking, or reading a good book.