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Maggie McKay: Whether it's your first pregnancy or your fifth, when you're expecting, I think most women would agree, any and all support, both emotional and physical, is a plus and very welcome. That's where a doula can come in, a professional labor assistant who provides support to the mother to be, and her partner during pregnancy childbirth and the postpartum period.

Today, we'll talk about the benefits of having a doula during pregnancy, what their role is, how to find one, what questions to ask when interviewing them and much more.

joining us to share her expertise is Dr. Sheri Livingston from U P M C McGee. Women's in central PA Dr. Livingston specializes in obstetrics and gynecology and is board-certified by the American Board of Obstetrics and Gynecology. She practices at UPMC Obstetrics and Gynecology Specialists-Lititz and is affiliated with UPMC Harrisburg, UPMC, UPMC Community Osteopathic, UPMC Lititz and UPMC West Shore.

This is Healthier You, the podcast from UPMC in Central Pennsylvania. I'm Maggie McKay. Dr. Livingston, thank you so much for making the time to explain the benefits of having a doula and what their role is. It's great to have you here.

Sharee Livingston: Maggie, thanks for having me. I am very happy to be here to discuss a topic that is very near and dear to me.

Maggie McKay: I think so many women and fathers-to-be are going to get a lot out of this, because I'm surprised how many people don't know what a doula is. You know, they're not familiar with it. Like I've asked some pregnant friends, "Are you going to get a doula?" And they're like, "What's that?" So this is very important. What is a doula just to dive right in?

Sharee Livingston: A doula is a non-medical birth assistant and there are many types of doulas. There are birth doulas, postpartum doulas, doulas. Doulas can be used for nearly any and everything that you can think of. A doula is a nonmedical support person key is support. I see doulas as a pie in the sky. They advocate for their patients. They essentially help with physical support, support and educational support and emotional support. So it's so vital to people to have this level of support, so that their significant other can focus on the birth of their child, as opposed to trying to fill in for support person, like what a doula would function as. So it works very well. It creates this comprehensive care model for the doctor, the nurse, the midwife. It really creates a great team.

Maggie McKay: And how does a doula help? What's their role?

Sharee Livingston: So the doula's role is extremely important. They function like a liaison between the patient the healthcare provider. So example, I, as a obstetrician gynecologist, may walk into the room and see that there's something wrong with mom and baby and I may want to move expeditiously. Well, the doula, her role as a support person, will understand that have to move quickly for a medical situation, also that the patient may be fearful at that time. And so they act as this wonderful extension of understanding the importance of maintaining a safe environment for mom and baby and also relaying to me what some of the concerns or wishes and desires of the patient may be. So they act as a great conduit for safe conversation. It's also important to note that doulas spend significantly longer periods of time with the patient than, say, the healthcare provider, because we just aren't afforded those opportunities. And so the doulas get to know patients on a level that we as healthcare providers wish that we could but can't. And so they can study visual cues nonverbal cues and know exactly what the patient is feeling and what their concerns may be and relay that to me as the healthcare provider.

Maggie McKay: Right. Because when you're in it, sometimes it's hard to express yourself, but the doula already knows you, right?

Sharee Livingston: Exactly. They have so many opportunities to a trusting relationship with the patient. And in doula language, they call them clients. So if you hear me refer to a patient as a client, that's because in their language, that's how they refer to them. Our preference in the comprehensive care model is for the doula client relationship to start as soon as possible, as soon as pregnancy is discovered. So that gives the doula and the client the opportunity to build a healthy relationship. so they have all of these months to really work on desires of the family, the desires of the patient, what some of their fears and concerns may be, helping educate them creating this bridge of support.

Maggie McKay: That's so smart. Why should a mom-to-be think about getting doula support at UPMC Magee Women's?

Sharee Livingston: Every person is a birthing person should have a doula. Here at Magee Women's, it's important to extend that opportunity to all of our patients, because having a doula makes the birth experience safer, it makes it warmer and very open to this comprehensive holistic care model that every pregnant person should have, especially pregnant people who are vulnerable. we do see increased morbidity and mortality in pregnant people of color. And so my specific hope is for all women people to have doulas, but specifically vulnerable and people.

Maggie McKay: And what are the benefits?

Sharee Livingston: The benefits of having a doula less likely to end up with a C-section, less likely to suffer with postpartum depression; less likely to have preterm birth and low-birth-weight infants, low-birth-weight being 2,500 grams or less. Having a doula will impart a higher likelihood of breastfeeding, both at time of discharge and eight weeks postpartum. All of these things are just so impactful. Gruber did a study in 2016, looked at improved outcomes doulas were involved. The American College of OB-GYN, as well as Society of Maternal fetal Medicine, all endorsed doulas for improving health outcomes, especially for vulnerable pregnant people.

Maggie McKay: Those are all really significant. What exactly is the role of a doula? What do they do?

Sharee Livingston: Doulas the patient and the earlier they establish this engagement the better. So, in our specific initiative, our Diversifying Doula Initiative, we have a doula navigator will receive a phone call from a patient or receive an intake form online saying, "I am pregnant. I'm interested in having a doula." And what we do then is we will share information about our doulas and the patient then gets to choose her doula based on short biographies about the doula. "Hey, I speak a specific language" or, "Hey, I'm interested in caring for women who have had pregnancy losses" or whatever it may be that creates that bond.

So once they establish this client-doula relationship, then they see each other. Doulas go out to their homes and really just build a healthy relationship outside of the medical environment and get to know the client. And once they do that, they can join them for office visits, which I love since I'm a doctor who loves doulas. I love when doulas are present in the office visits, because it helps to create this learning environment that's focused on the patient. And so doulas join them for their visits. They visit them at their homes. They talk to them on the phone. And in the world of COVID, they have Zoom meetings with them, all of these points of care, if you will, or points of contact.

And then, obviously, when the patients come in in labor, they'll call their doula and say, "Hey, I'm in labor" or, "Hey, I'm getting an induction," and the doulas will come to the hospital and obviously be permitted to stay with them the entire time. At UPMC Magee Women's Hospitals, doulas are welcomed and encouraged to be present with their clients. And during the entire labor process, they're there giving them support, both physical and emotional. They're advocating for their patient. If I walk in the room and I say, you know, something that maybe the patient doesn't understand, the doula will communicate that with me, especially the ones that we have trained where they say, "She didn't quite understand what you said or "Could you say that in a different way?" And patients speak up for themselves, but boy, it feels enlightening and empowering when you have somebody else right there with you, who's advocating for you, making the conversation go that much smoother. And that's the intrapartum experience. Postpartum, they're even more valuable because why do we care about the postpartum experience? Studies show, research show that the vulnerabilities lie in the postpartum period. When you look at maternal morbidity and mortality, most of it occurs postpartum and more than 80% of it is preventable. More than 80% of the morbidity and mortality that's experienced in maternal health is preventable. And so that's why we have this unique focus on the postpartum period. And so having a doula present is even more integral because they're there onsite with them doing home visits, watching interactions with the baby, watching interactions between the support person or significant other who, again, have their own set of situations that makes this a very vulnerable time for a postpartum family.

Maggie McKay: Boy, the doula is busy. Do they have more than one client at a time?

Sharee Livingston: Typically, doulas have about three clients per month. And when we say that, it's three clients who are delivering or potentially delivering. So they average, you know, a good number. But it's a safe number and they understand their limits.

Maggie McKay: Right. We've touched on some of the benefits of having a doula, but I know there are even more. Can you talk about those?

Sharee Livingston: So other values of having a duola are, you have a situation where there is a pregnancy loss. There's a lot happening during that time. So doulas function in a way. To communicate the needs of the patient, what I'm calling patient or what they will call clients the medical provider, to the healthcare provider. people are so on, say, and I'm using the example of a grieving family, they can't gather into words what issues may be or questions they may have. And so the doula acts as a communicative or great communicator between the healthcare provider and the patient.

Maggie McKay: We can't leave out dad. He's got to feel a little bit like, "Oh, what's my role?" What about the partner's role when using a doula?

Sharee Livingston: I think that love doulas just as much as doctors love doulas, because what that does is it takes the weight off of the dad so that he can be just dad or they can be just dad. They can function in that role of the parent as well. So that they're not tending to the mom from a postpartum standpoint from, you know, "She's in pain, so I need to help her with that." Dads want to be there in that role, but maybe they lack understanding of postpartum emotions and things that happen in the postpartum setting. what a doula does is she takes weight off of him, that he too can enjoy the postpartum experience, you know, if they're taking home a baby, as opposed to, say, a grieving family, too can use the support of the doula as well.

Maggie McKay: I bet. I always felt bad, like my husband was left out. He never acted like it or said anything, but I always thought, "Ah, the dad must just feel kind of like pushed aside sometimes during pregnancy." Hopefully not,

Sharee Livingston: Exactly. And good doulas note that, because they have this keen oversight the family and the dynamics. a good doula will also provide support to the other parent based on whatever the needs are for the entire family.

Maggie McKay: That's so useful. Dr. Livingston, what is a doula's role when it comes to someone who wants to have an all natural birth?

Sharee Livingston: All natural births are They're spontaneous. Typically, everything's kind of going in the direction that we as healthcare providers wanted. There are no comorbid conditions. Usually if someone's having just all natural, spontaneous labor, the patient and baby are doing very well. And we too like to take a hands-off approach. And I know that doulas wonderfully advocate for a safe hands-off approach. So I know the doulas that I work with and that we work with here at UPMC Magee really enjoy having the doulas for spontaneous birth, because it's typically associated with lots of pain or can be associated with lots of pain. And it is in those moments that the doulas are most valuable because they can coach patients through their pain process and really build up their confidence that they can get through this. We offer options like nitrous oxide and epidural intravenous medications, but we only like to bring those up if the patient has given us permission to do so. Natural labor is great. We've been birthing babies for 250,000 years. Women and pregnant people know how to have babies if given the confidence to do so and doulas do that very wonderfully.

Maggie McKay: Did you hear the story in the news? Just yesterday I saw it. A woman had to get out of her car with her kids in the car. She was in labor and had to deliver her own baby. And then got back in the car with her kids. Did you hear that story?

Sharee Livingston: I didn't hear that story? But it's not usual, but it's not unusual either. If you have someone who has delivered more than one baby, or they're not having their first baby, labors can be precipitous. And there are times the doulas can't make it to the hospital because of the precipitous nature of labor. But again, that's where education comes in. And if the pregnant person is keen to the happenings of their bodies, most often we're able to catch labor ensuing.

Maggie McKay: What other types of doulas are there?

Sharee Livingston: There are many types of doulas. There are birth doulas. There are postpartum doulas, doulas, doulas, which I think is extremely important when you're dealing with end-of-life issues. even just obstetrically, but just throughout all of medicine, having hospice doulas are very important. So there are all types of doulas, doulas for everything.

Maggie McKay: The big question, how does an expectant mom find a doula?

Sharee Livingston: An expect that mom can find a doula on the internet. But at UPMC Magee Women's, we have our Birth Circles Program where you can log into our website and just search for Birth Circles Doula Program. I started a Diversifying Doula Initiative, which you can find doula on that website. Because I think it's important doulas also look like the communities that they're serving. And so, I created the diversifying doula initiative to increase the number of black and brown doulas, specifically serving black and brown pregnant people.

Maggie McKay: Wow. And that wasn't in place before.

Sharee Livingston: So in our area, we had one black doula. And after I started the Diversifying Doula Initiative, we now have 26

Maggie McKay: Wow.

Sharee Livingston: our area.

Maggie McKay: Wow. That's amazing. Congratulations. That is something to be proud of.

Sharee Livingston: I am very proud.

Maggie McKay: Oh, you should be. My goodness. What questions does a mom-to-be ask a doula when they're interviewing her or him? There are only female doulas, right?

Sharee Livingston: So there are some areas of the country that are promoting male doulas. I have the privilege of talking day with trained doulas, both experienced and those in training. It's interesting. Most doulas believe that it is a profession that should be most populated, if not all populated,, by women. And it just goes to the historical nature of how doulas came to be sitting alongside the pregnant person. I think it is geographic. But for the most part, doulas are women. All of our certified doulas are women and birth circles at UPMC Magee also has all women

Maggie McKay: I would think so. What questions should we ask a person that we're considering having as our doula, when they're interviewing them?

Sharee Livingston: So it's important when a pregnant person is seeking out a doula to ask them about their and their experience. Are they a trained doula? Which means that they've gone through a certified program to learn the details and intricacies of safe doula practices and standard doula practices. That's number one. Number two, they want to learn if their doula is certified. Most doulas are certified, but there are some doulas who do not believe in the certification process, just like there are certified nurse midwives and then there are non-certified midwives. It just depends. But from a hospital perspective, and especially here at UPMC Magee, we allow certified doulas to come into our hospital units, because it's important that certified doulas are recognized because of their commitment to standardization. That's number two. Number three, it's important to understand why -- this is most important, I think -- it's important to understand why they became a doula. Many doulas become doulas because of their own birthing experience, because of something that happened to them that led them down the path of wanting to help another pregnant person. Be it something good that happened or be it something bad that they like to prevent happening to another pregnant person. In addition to that, it's important that they ask about their cultural preferences or spiritual preferences or language. Another thing that's important for the pregnant person to ask their doula is do they have reliable transportation? Because when they need them to hasten to the hospital, they're going to want them to be able to do so obstruction.

Maggie McKay: Those are all important questions definitely. That is such helpful information, all of it, Dr. Livingston. I'm sure expectant women learned a lot today. You know, when you are pregnant, there are so many other things to learn and plan for. So this has been so helpful and I'm sure it will clarify a lot of questions people had about.

Sharee Livingston: It's great to have a discussion about something so important.

Maggie McKay: When it comes to hiring a doula, what can someone expect cost-wise?

Sharee Livingston: Doulas can be expensive. That's why before several years ago, doulas were used by typically affluent white women. And the average cost of a doula is about $800 to a $1000. So that can be cost-prohibitive vulnerable people or socioeconomically-challenged And so, if you're looking for a doula and you can afford one, that's great. But if you can't afford a doula, you still can have one. Many places, specifically UPMC Magee Women's, our Diversifying Doula Initiative programs in place where we can provide doula assistance for free.

Maggie McKay: For free? You're kidding me. I've never heard of that. That is awesome.

Sharee Livingston: Yes. Our Diversifying Doula Initiative provides pregnant people of color with free doula care, we use grant dollars and support fund that.

Maggie McKay: Again, that was Dr. Sharee Livingston who specializes in obstetrics and gynecology and is board-certified by the American Board of Obstetrics and Gynecology.

If you are expecting, have a conversation about a doula with your OB-GYN provider to see if it's the right fit for you. You can also visit upmc.com/centralpaobgyn. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is Healthier You, a podcast from UPMC. I'm Maggie McKay. Thank you so much for listening and be well.