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Reports that Duchess Meghan is working with a doula during the pregnancy of her first child with Prince Harry have left many royal-watchers and media aflutter. Though the palace has confirmed little about the duchess's pregnancy or birthing plan, aside from a "spring" due date, questions about the reports abound: What is a doula? And why would a royal, or anyone, want one?
Doulas, from the Greek term meaning “woman who helps,” are trained assistants who coach women through childbirth. Ravae Sinclair, president of DONA International, says there's a long tradition of women helping other women in childbirth. She sees the recent interest as "a testimony to people wanting to go back to the basics."
"Clients tell me, 'Gosh, that makes so much sense to have someone there, to have that comfort and that connection, who can help me with my personal needs.' "
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And as rates of maternal mortality and harm remain high in the U.S., as USA TODAY has found in a years-long investigation, Sinclair and other experts encourage expectant parents to consider a variety of basic support systems that can work in tandem with traditional medical teams.
Here's how experts recommend expectant parents begin:
It’s not just child rearing that can take a village, says Dr. Gloria Bachmann, professor of obstetrics and gynecology at Rutgers Robert Wood Johnson Medical School.
“Everyone should consider pregnancy a team effort, not one provider,” Bachmann said.
Community accountability is a key part of Rutgers’ Stop, Look, Listen! initiative, Bachmann said, which emphasizes the need to listen to pregnant women’s voices to improve maternal health and safety.
Partners, family members, friends and neighbors all can play significant roles from prenatal through postpartum care, Bachmann said. If a woman is not speaking up or is not being listened to by a medical provider, that community can step in.
“If I don’t say it and you’re on my team, that person coming with me to the visit should say, ‘Gloria isn’t feeling well. She’s starting to complain of a lot of stress in her abdominal area,’ ” Bachmann said.
“The real point here is no question and no symptom is trivial.”
Appointing one or two people from that community to serve as designated patient advocates also can be helpful.
“I personally think anybody going to the hospital, for any reason, or any time, you need to have an advocate with you,” said Lisa Kane Low, associate dean of practice and professional graduate programs at University of Michigan's School of Nursing. “You need to have somebody who is a second set of ears to go out and advocate for you when you can't advocate for yourself.”
An advocate can be the person who is also your life partner or anyone else you feel comfortable with who has time to commit to being present, Bachmann said. Options include friends who have had babies, relatives with a calming presence, or anyone else who understands your childbirth goals.
Further reading:What states aren't doing to save new mothers' lives
An advocate should be prepared to help with a variety of things during pregnancy and delivery, such as:
Accompanying you to prenatal appointments
Helping you develop a birth plan and communicating it to all care providers
Asking tough questions about care options
Keeping a journal of non-pressing questions to ask medical providers during check-ups
Taking notes during appointments about questions asked, as well as recommendations and instructions
Tracking vital signs like blood pressure over the course of your pregnancy to know your typical rate and its fluctuations
Encouraging healthy behavior during pregnancy, following medical professional’s recommendations for diet and exercise
Helping you or your medical providers make decisions if complications arise, and ensuring you know what is happening and all of your options
One example, says Barbara Levy, vice president of health policy at the American College of Obstetricians and Gynecologists, is if someone wants to start an IV or hook up a fetal monitor, advocates should be prepared to ask, “What happens if we don't do this right now?”
Advocates also should review the Association of Women’s Health, Obstetric and Neonatal Nurses list of post-birth warning signs and instructions. They should help you contact medical professionals if they notice any warning signs, during or after pregnancy, such as:
baby less active than usual
“Anything that is not going smoothly should be checked out,” Bachmann said.
The tradition of doulas in the U.S. dates back many years, but their use has grown in popularity in the last decade. In a 2012 survey, 6 percent of women giving birth said they used a doula, up from 3 percent in 2006.
Sinclair, based near Washington, D.C., says that in addition to patients with safety concerns, she sees clients who are single parents or have had traumatic experiences in previous births. But the bulk of her clients are young professionals who met in D.C. and don’t have family nearby.
“They say, ‘We need someone, and I don’t want my partner to be the only one as we are navigating this,’ ” she said.
Doulas can relieve stress by offering familiarity with and reassurance about the maternity and birthing process. Well-established doulas also have good working relationships with medical providers – and know where their role starts and ends.
“We have some boundaries; if I’m not a massage therapist I’m not going to be providing you with a full-on massage,” she said.
Sinclair says the first step in choosing a doula is to look for certification and experience. Then, solicit reviews and references from past clients.
Also look for specialty skills and certifications, which can include:
Certification in childbirth education
Advanced doula training in infant loss
Culturally significant tools like Mexican rebozos (long woven scarves used to wrap a mother’s hips and swaddle baby)
But often it's the emotional support that makes a difference for families.
"To have someone be a guide for them, it's quite relieving," Sinclair said. "There’s a range of emotion and adjustment, and they say, 'Somebody can help us parse this out? That's amazing.' "
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