Doula Care Has Gone Virtual

Kanwal Haq, a New York-based doula, was flying home from vacation last September when she received a text from her client: “It’s game day here.”

The baby arrived a week earlier than expected.

“They are keeping me in triage right now because I am only 3cm tall,” wrote his client, Alyssa Coats-Clark. “But boy, do these contractions hurt!”

“Let’s bring BABY BOY EZRA HERE!!!” Ms Haq responded, adding a series of suggestions for what Ms Coats-Clark could ask the nurses to reduce her discomfort.

It was the first birth Ms Haq, 34, had helped with. And, although she hadn’t considered doing it while she was in the air, the plan was always to remotely support Ms. Coats-Clark, who lives in Indiana.

Ms Haq, in a text conversation with her client, as well as Ms Coats-Clark’s husband and mother, was able to assist with the birth remotely, offering advice on labor positions, relief pain and insight into how things would likely play out. progress.

“I was still getting the support I needed from those close to me while Kanwal was giving them the tools and things they needed to provide that support,” Ms Coats-Clark said.

In the United States, about six percent of pregnant women have consulted doulas, who have expertise in pregnancy and childbirth and provide non-medical services. Studies have repeatedly shown that in-person support from a doula during childbirth can improve outcomes for mothers, particularly women of color, including reducing anxiety during labor, length of labor, and risk of premature birth.

In the same way that many therapy appointments and visits to primary care doctors have gone virtual during the pandemic, doula care has also gone virtual. Since then, virtual sessions have become a standard part of many doulas’ care programs. Data is scarce, but experts believe that even when a doula is not physically in the room with a client — but instead provides care and advice over the phone before, during and after labor — mothers may have a reduced risk of unwanted medical interventions during delivery. and be more likely to feel satisfied and supported during and after pregnancy.

The United States is experiencing persistently high rates of maternal complications and deaths, and a growing number of healthcare professionals and lawmakers are embracing virtual doula care as a potential part of the solution. In April, Democratic senators introduced federal legislation to expand Medicaid programs to cover access to doula care, including on telehealth platforms, and already, more than half a dozen health departments have The state has begun to include virtual doula care in their programs.

Although the bulk of a doula’s job is to provide physical and emotional support during labor, they also offer a range of services before and after birth. “They offer breastfeeding support, birth planning, emotional support, helping parents navigate the health care system — a lot of these services really lend themselves to virtual care,” Lori said Uscher-Pines, health policy researcher at the Institute of Health. think tank Rand Corporation and co-authored an editorial on virtual doula care published in a medical journal in January.

By some estimates, more than 6 million women live in areas with limited or no access to maternity care, she noted, and doulas remain a luxury primarily used by high-income white women because many insurance plans do not cover this service. Hiring an in-person doula before, during, and after birth can cost a few thousand dollars out of pocket; virtual support is only a fraction of that, with doulas often charging a few hundred dollars for sessions, including birth support.

Going virtual, Uscher-Pines said, also provides access to more people across the country.

For Janay Hall, who lives in Florida, having a virtual doula during her high-risk pregnancy may have saved her life, she said. She was pregnant with her second child in 2020, at the height of the pandemic, and was diagnosed with pre-eclampsia, a life-threatening form of high blood pressure. One day, three months before her due date, her left arm went numb while she was driving. She stopped and called her doula, Bridgette Jerger, who is also based in Florida and works for a network called GROW Doula.

“She said, ‘You need to call your provider now,'” Hall recalls. “I called my provider and they told me I needed to go to the emergency room immediately. So I went to the hospital, not thinking about anything because I was so early at that time.

Ms. Hall’s blood pressure was so high that she had to be admitted for about a month, and because only one visitor was allowed, her doula provided virtual care. She was monitored to see if her blood pressure would drop, and after each check, Mr. Hall called her a doula to better understand her prognosis. Her doula also offers breathing techniques to reduce stress and logistical advice for her partner, like what to bring to the hospital.

At 34 weeks, when Ms. Hall’s blood pressure was still not falling, she had to be induced. Ms Jerger used FaceTime to demonstrate methods her partner could use, such as specific back massages, to reduce Ms Hall’s pain and soothe her nerves.

In the end, Ms. Jerger also watched the baby give birth via FaceTime.

“A lot of people are like, ‘Oh, I can just use Google.’ But it’s not like Googling, because you can actually have someone walk you through the process,” Ms Hall said.

Anecdotal evidence from doula networks across the country has found that health outcomes for mothers who receive virtual support are better than those who receive no care, and are often comparable to those who receive care in person. A study funded by Maven, a telehealth platform that offers fertility, pregnancy and postpartum care, found that of about 8,900 patients on its platform, women who had at least two virtual doula visits were less likely to more likely to give birth by cesarean section than those who have done so. I don’t have virtual doula visits.

A collaboration between Mount Sinai Hospital, New York City’s public health system, and two doula networks provides care to immigrant, low-income, homeless, and incarcerated women in Queens, New York, often through FaceTime and WhatsApp. This allowed them to reach women living in domestic violence shelters where visiting restrictions are strict, for example, as well as people who live in their cars.

Pregnant women from these populations are often distrustful of formal medical systems, or even excluded. But those who participated in the hybrid doula program saw more doctors, especially postpartum visits, compared to new mothers who did not use the program, said Dr. Sheela Maru, assistant professor of global health , obstetrics, gynecology and reproductive sciences. at the Icahn School of Medicine at Mount Sinai and director of the doula program.

Angelene Love, a Michigan-based doula who works with Mae, a doula network that works with Medicaid in six states to provide in-person and virtual care, said that in September she helped one of her clients through an iPad that a family member set up in the labor and delivery room.

“When she was induced, they zoomed in on me. When they got to the hospital, they zoomed in on me – his mom was just holding the iPad.

When her client went into active labor, Ms. Love got back on the Zoom call and coached her through breathing exercises. It was also important “to just be in the room to hear what the providers were saying to make sure that whatever was happening, my client fully understood it and was able to make informed decisions,” she said. she declared.

Virtual doula care has drawbacks compared to in-person support, Ms. Love said. Chief among them is that it hinders the patient’s ability to establish intimacy with their doula. Ms. Love’s preference, she said, “is that we can meet in person to make sure we have a good connection, good rapport and good trust.” There are also subtle signs of physical and emotional problems that doulas can more easily detect in person than on a video call, she added, such as when a headache may seem severe enough to require treatment. medical or, after delivery, if the baby shows signs. of distress.

But these challenges, she says, are surmountable, especially in situations where virtual care from a doula may be the only option for a patient.

“For some people, being able to get the doula they want is just not feasible in their price range,” she said. “Whatever we can do to break down barriers, we must do. »