As a visibly pregnant Stephanie Lewis shopped in a Walmart more than a decade ago, a woman she didn’t know approached her.
“And she was like, ‘Do you have a doula?’ ” Lewis recalled. “And I was thinking, ‘What is that?’ And she explained to me what it was, and from that moment, I was like, ‘I would love to do that.’”
Lewis, now a mother of four, learned on that day that a doula is a professional labor assistant who provides emotional and other support through and after a pregnancy. Having recently completed doula training, the Auburndale resident is now the one approaching pregnant women in stores to ask if they know about the possibility of using a doula.
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Though Lewis had wanted to become a doula for some time, she had been deterred by the cost of training needed to receive certification. A friend told her earlier this year about a free program being offered through the Healthy Start Coalition of Hardee, Highlands and Polk Counties to train doulas, and Lewis eagerly applied.
“I just was intrigued with it,” said Lewis, 39. “I applied for the program, and when they called me and told me that I got accepted, oh my goodness, I told them I felt like I won the lottery — just because, like, when you’re doing something that you’re supposed to do, it’s not a job.”
The Healthy Start Coalition of Hardee, Highlands and Polk Counties, a nonprofit formed in 1992, promotes maternal and child health services in the three counties. Part of a statewide network, it was established by the Florida Legislature to address infant mortality, low birth-weight babies and general childhood health.
The coalition presented the doula training through a collaboration with Simply Healthcare, Indian River Healthy Start Coalition, BEAM Birth Network and The Doula Network, said Amy Beascoechea, a provider liaison. The local nonprofit sought 10 women who would represent and be able to support under-resourced communities in hopes of improving maternal health outcomes for Black residents, she said.
Black women are three times more likely than white women to die from a pregnancy-related cause, according to the Centers for Disease Control and Prevention. The agency attributes the disparity to a range of factors, including variations in the quality of health care, underlying chronic conditions, structural racism and implicit bias.
A doula from the BEAM Birth Network, a Florida nonprofit, led the two-day training, held in Bartow in June. The 10 women finished with doula certifications, allowing them to become contracted providers for an array of health plans reimbursed by Medicaid.
Medicaid plans cover the cost of a doula for two prenatal visits, labor and delivery and two postnatal visits, Beascoechea said.
“So what it’s going to give them the opportunity to do is to create a their own career out of it and to help them better themselves and better their lives and the lives of their families by turning this into their own career,” said Beascoechea, herself a trained doula.
The concept of doulas emerged in the 1970s, with the name adopted from an ancient Greek word for “woman servant.” (It’s pronounced DOO-la.) Doulas, sometimes called “labor companions,” are not medical professionals and do not require state licenses. While doulas are often associated with home births, they are qualified to assist with deliveries in hospitals as well.
During a pregnancy, doulas can help the client develop a set of preferred birth plans, Beascoechea said, so they’ll be prepared to make clear what they want and do not want to happen. During labor, a doula might massage the client’s hands, feed her ice chips or deploy a rebozo, a piece of cloth wrapped around the woman’s abdomen to relieve weight during squatting or help reposition the baby.
Studies have shown that the use of doulas decreases rates of Cesarean sections and reduces the likelihood of having pain-relief medications administered to a pregnant woman, according to the American Pregnancy Association.
Lewis, whose children range in age from 12 to 22, has worked as a certified nursing assistant and describes herself as “a nurturer.” She had previously considered becoming trained as a doula but said she was discouraged by the cost.
Jekera Wilson, another woman selected to receive the free training, said she had been interested in becoming a doula since 2018, following the birth of her fourth child. She, too, said the cost had deterred her.
“With my first child and my last child, they were kind of, like, traumatic experiences,” said Wilson, a Lakeland resident. “So I just felt like women needed another voice in the room, especially Black women, because so many Black women die in childbirth or shortly thereafter. We just need a voice. And I want to be able to provide that.”
Wilson, 28, said she wished she had been supported by a doula during her pregnancies. She followed a doctor’s recommendation of an emergency Cesarean section for the delivery of her last baby.
“I feel like I would have had more options, had I had a doula that would have been able to provide me with a little more — ‘Babies are born on their own time’ kind of thing, versus kind of being rushed for my labor,” she said.
Wilson also cited the experience of her sister. Late in her pregnancy, the woman told a doctor that her fetus didn’t seem to be moving as often as it had been earlier. The doctor told her that everything was normal, Wilson said.
Her sister eventually had a stillbirth. Wilson said she thinks that outcome could have been avoided if the doctor had heeded her sister’s concerns and brought her in sooner to do a C-section or induce labor.
Wilson said many Black women are familiar with the concept of doulas but hesitate to use their services for social reasons.
“A lot of Black people in general are afraid of getting that additional help because it’s someone coming into your home, but they don’t know what the outcomes are going to be,” Wilson said. “So having someone that looks like them is kind of a better option than sending someone that doesn’t.”
Lewis said having a doula in the delivery room helps ensure that the medical staff will be aware of the pregnant person’s wishes for the process.
“If I only knew these things when I had children or when I was going through that stage of my life, just being educated on basic things,” Lewis said. “I’ve learned that we can take control of having children, like we can not give all the power to our physicians and just kind of let them decide what’s best for us. We can kind of take control and say, ‘Hey, I’m not comfortable with that.’ ”
Lewis said she believes visits from doulas can also lessen the severity of post-partum depression by addressing a new mother’s emotional needs. Beascoechea said a doula might notice that a woman is having trouble with breastfeeding and connect her with a lactation expert.
Though the newly trained doulas are not under contract with the Healthy Start Coalition, Beascoechea said she will provide mentorship of the women for the first year.
“We have some workshops coming up, just making sure that they have everything they need to be successful, making sure that they have support for themselves,” she said, “because this can be a very mentally and physically draining profession, as a birth worker.”
Wilson, who now works at a bank, said she hopes to launch a business as a full-time doula.
“I’ve actually been interviewing a few clients, and I’m also credentialed with The Doula Network,” she said. “So they provide us with clients as well.”
Lewis said she is eager to take advantage of her certificate as a doula.
“I’ve been out in my community telling women about it,” she said. “If I see women at Walmart, now I’ll stop and say, ‘Hey, did you know about this program?’ And a lot of them don’t know. And I’ve had people follow up with me, so I think that’s really great, too.”
Gary White can be reached at gary.white@theledger.com or 863-802-7518. Follow on Twitter @garywhite13.
