Ms Kanwal Haq, a doula, demonstrates virtually how her client could use a scarf to relieve pressure in the hips during pregnancy, at her home in New York. NEW YORK – Ms Kanwal Haq, a New York-based doula, was on a plane home from a vacation when she received a text from her client: “It’s game day here.” The baby was arriving a week earlier than planned.
“They are keeping me in triage right now, though, because I’m only 3cm,” her client, Ms Alyssa Coats-Clark, wrote. “But, boy, do these contractions hurt.” “Let’s get baby boy Ezra here,” Ms Haq wrote back, adding a series of suggestions on what Ms Coats-Clark could ask the nurses for to reduce her discomfort.
It was the first birth Ms Haq, 34, had helped with. And, although she had not envisioned doing so while in the air, the plan was always to support Ms Coats-Clark, who lives in Indiana, remotely. Ms Haq, in conversation over text with her client, as well as her husband and mother, was able to support the delivery from afar, offering guidance about labour positions, pain relief and insights into how things would probably progress.
“I was still getting the support I needed from the people closest to me, while Kanwal was giving them the tools and the things they needed to be that support,” Ms Coats-Clark said. Roughly 6 per cent of pregnant mothers in the United States have sought the care of doulas, who have expertise in pregnancy and childbirth and offer non-medical services. Studies have found that in-person doula support during birth can improve circumstances for mothers, including by reducing anxiety during labour, the length of labour and the chances of a premature birth.
In the same way that many therapy appointments and visits with primary-care physicians went virtual during the pandemic, so did doula care. Since then, virtual sessions have become a standard part of many doulas’ care packages. Data is scarce, but experts believe that even when a doula is not physically in the room with a client – instead providing care and advice over the phone before, during and after labour – mothers may have a reduced risk of unwanted medical interventions during birth, and be more likely to feel satisfied and supported during and after pregnancy.
The US has persistently high rates of maternal health complications and deaths, and a growing number of medical professionals and lawmakers are embracing virtual doula care as a potential part of the solution. Although the bulk of a doula’s job is to provide physical and emotional support during labour, they also offer a range of services before and after birth. “They offer breastfeeding support, they offer birth planning, they provide emotional support, they help parents navigate the health care system – a lot of those services really lend themselves to virtual care,” said Ms Lori Uscher-Pines, a health policy researcher at the think-tank Rand Corp and co-author of an editorial about virtual doula care that was published in a medical journal in January.
According to some estimates, more than six million women live in areas with limited or no access to maternal care, she noted, and doulas are still a luxury predominantly used by high-income white women because many insurance plans do not cover the service. Hiring an in-person doula before, during and after birth can cost a few thousand dollars. Virtual support is a fraction of that amount, with doulas often charging a few hundred dollars for sessions, including support during birth.
Ms Angelene Love, who works with Mae, a doula network that works with Medicaid in six states to provide in-person and virtual care, conducts a consult in her office in Belleville, Michgan. PHOTO: NYTIMES Ms Angelene Love, a Michigan-based doula who works with Mae, a doula network that works in six states to provide in-person and virtual care, said she helped one of her clients via an iPad that a family member set up in the labour and delivery room. “When she got induced, they Zoomed me.
When they got to the hospital, they Zoomed me – her mum was just, like, holding up the iPad.” When her client went into active labour, Ms Love got back on the Zoom call and coached her through breathing exercises. It was also important “just to be in the room to hear what the providers were saying to ensure that, whatever was going on, my client completely understood it and was able to make informed decisions”, she said.
There are drawbacks to virtual doula care compared with in-person support, Ms Love said. Key among them is that it hinders patients’ ability to build intimacy with their doulas. Ms Love’s preference, she said, “is that we’re able to meet each other in person to make sure that we have a great connection and rapport and trust”.
There are also subtle signs of physical and emotional concerns that doulas can more easily pick up on in person than on a video call, she added, such as when a headache might seem serious enough for medical attention or, postpartum, if the baby is showing signs of distress. But those challenges, she said, are surmountable, particularly in situations where virtual doula care might be a patient’s only option. “For some folks, being able to get a doula that they want is just not feasible in their price range,” she said.
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