Verified by 
Coronavirus Disease 2019
COVID-19 Underscored the Necessity of Doulas
Supportive care during birth was always vital. The pandemic highlighted that.
Posted August 16, 2022 Reviewed by Abigail Fagan
Key points
- Hospital visitor restrictions enacted in response to COVID-19 meant that doulas could not provide in-hospital support to most birthing persons.
- Birth doulas play an advocacy role. Removing them from birth spaces increases negative outcomes for Black folks, who already lack needed support.
- The folks that need birth advocates and additional support the most are often people who cannot afford the out-of-pocket cost of hiring a doula.
- Doulas encountered drawbacks associated with the shift to virtual birth support and telehealth reduced the efficacy of doula care in many ways.
We have been following Jodie Lisenbee’s research for several years now. Recently she published an article in Qualitative Health Research: "Birth Doula Care in California During COVID-19: The Impacts of Social Distancing on a High-Touch Helping Profession" which prompted us to interview her about her experiences. She is a doctoral student in Clinical Health Psychology at UNC Charlotte, researching psychosocial factors that influence how labor and delivery experiences play out. She also provides individual and group psychotherapy services to pregnant and postpartum patients. Additionally, she is certified with DONA International as a birth doula and volunteered in the Bay Area for a few years before graduate school supporting births for underserved populations (e.g., people without homes). Her training, socialization, and experiences as a doula strongly influence the lens through which she approaches research and clinical work.
While volunteering with the San Francisco Homeless Prenatal Program, she observed that psycho-emotional stressors could change the way that labor progresses. She also witnessed how blatantly the health care system fails to provide high-quality, person-centered care for birthing persons, especially Black women. She saw an incredible need for research and action that targets the psychosocial aspects of childbirth.
We asked Jodie about some of the takeaways of her research, and this is what we learned.
She recalled, “When I heard hospitals were restricting visitors in labor and delivery units worldwide in response to COVID-19, I immediately thought of the negative impacts this would have on doulas and their clients. In most cases, birth doulas could not provide in-hospital support.”
Birth doulas adapted their services to continue offering psycho-emotional support and evidence-based information to families when these aspects of care were needed more than ever. For most doulas, this was the first time they ever offered virtual birth support, and the doulas in her study noted many challenges with this. They also discussed challenges concerning their fee-for-service contractual arrangements and challenges navigating ever-evolving hospital policies and public health guidance.
The pandemic highlighted the value of doulas’ support for psychological mechanisms that influence the experience of childbirth. For example, doulas help birthing persons set goals and understand what to expect (and help them adapt those goals and expectations when circumstances change!), boost clients’ motivation and belief in their capabilities, provide decision-making support, restructure unhelpful thinking patterns, offer knowledge/ideas, and brainstorm options/alternatives. For her, the results of this study expanded the notion of “emotional support” referenced when we talk about doula care.
A surprising finding was that the overlapping historical context of the Black Lives Matter movement increased awareness of maternal health disparities. Simultaneously, doulas, who often play an advocacy role for Black birthing persons and other vulnerable populations, were excluded from in-hospital births. One doula told Jodie a story of a Black client whose doctor broke her bag of waters without her consent during the pandemic. While the doctor performed a cervical exam, she said, “I’m going to break your water,” and promptly did so, leaving the birthing person exclaiming, “Wait, I didn’t agree to that!” Her doula believed this would never have happened if she had been present.
Jodie imagines that, following the pandemic, we can change doulas’ place within our healthcare system to ensure access to doula care for everyone who wants one and recognize doulas as essential members of perinatal health care teams. She said, “I want to see hospitals and health care providers embrace birth doulas as necessary in labor and delivery environments. Doulas provide complementary care to that provided by medical providers. Birth doulas engage in care that physicians, midwives, and nurses simply are not trained or employed to address sufficiently, such as the emotional and mental struggles that arise within the context of birth.
What needs to change in perinatal health?
Our final question was about the messages that women receive during their reproductive journeys. What is one critique you have of language commonly used in the birth space?
Jodie said: “There are so many awful, outdated terms in the perinatal health world! Geriatric pregnancy, hostile uterus, incompetent cervix… ugh! The term “failure to progress” (to refer to labor dystocia or prolonged, slowly progressing labor) is particularly problematic, however, because of the implications it has for cesarean delivery rates. “Failure to progress” currently accounts for approximately 50-68% of all first-time cesarean deliveries. Even though the time at which a trial of labor has “failed” is pretty arbitrary. This language of failure connotes finality and legitimizes the recommendation for surgical delivery. From a doula worldview, “failure to progress” might be more accurately interpreted as “failure to wait” or “failure to offer appropriate first-line interventions like pain management techniques, position changes, caloric intake, or psychological support to help the birthing person cope with stress.”
We suggest that individuals interested in doula advocacy check out the documentary Aftershock and another great resource that many of the doulas in the study referenced: Evidence Based Birth, and share it with their clients.
