Doulas as Essential Medical Care


Editor’s Note: This post was updated at 1:06 pm on July 1, 2009 to correct a minor error in the earlier text.

The bond between a parent and child is the primary bond, the foundation for the rest of the child’s life. The presence or absence of this bond determines much about the child’s resiliency and what kind of adult they will grow up to be. For some, being a parent who enables bonding is a natural gift, often learned from one’s own parents. For others it is a real challenge. If our mother was unable to bond with us due, for example, to depression, addiction, narcissism, extreme stress or immaturity, it will be extremely difficult for a bond to develop.



Georgia has the 10th highest teen birth rate in the US and the second highest repeat birth rate among teen mothers. To combat the problem the Georgia Campaign for Adolescent Teen Pregnancy Prevention launched a community-based doula program.

While not impossible, it is especially challenging for teenage parents to develop bonds with their children. A high percent of them were themselves children of teenage parents and have never experienced appropriate parenting. Eighty percent of teen mothers were already living with the stultifying stresses of poverty long before they became pregnant. Without early and on-going interventions, their early parenthood virtually guarantees that they and their children will remain vulnerable and mired in poverty. Children born to teens have less supportive and stimulating environments, poorer health, lower cognitive development, and worse educational outcomes.

If we as a nation are to break the cycle of poverty, crime and the growing underclass of young people ill equipped to be productive citizens, we need to not only implement effective programs to prevent teen pregnancy, but we must also help those who have already given birth so that they become effective, nurturing, bonding parents.

This is why, a number of years ago, I brought the “Community-Based Doula Program” to Georgia where it has been under the wing of the Georgia Campaign for Adolescent Pregnancy Prevention (G-CAPP).

A doula is a birth assistant who provides emotional and physical support to the mother and her family during labor and delivery. Our doulas, however, go beyond the call of the traditional doula. Many times they take on the role of mother, big sister, friend, counselor, social worker, advocate, life coach and more. The doulas make weekly home visits to pregnant teens and their families starting in the third trimester and up to one year after the birth of their baby. They help young mothers (and often times fathers) understand the birth process, and support them during labor and delivery. So many of these young parents don’t know what a real relationship feels like, but through their example, the Doulas model for the mothers and fathers how to be in relationship, how to bond. This is what transforms the young parents forever and gives their babies a better chance in life.

The Community-Base Doula Program has produced some amazing results including c-section rates nearly half the national rate and breastfeeding initiation rates 25% greater than the national average. It’s harder to quantify parental bonding, but we listen to what the young mothers in the program have to say. “I don’t really have a support system anymore,” says one girl, “but I can always call my doula because she still comes around and helps me when I need her.”

Another young mother says, “I had a lot of situations when I just wanted to give up. I wanted to give up on school and I wanted to give up on finding the baby’s daddy. My doula told me to stick in there. You going to get it. Don’t just let it go.”
“Don’t just let it go.”

Profound words from a young woman who, under different circumstances, might have given up. When I see the results of our Community-Based Doula Program I know that if a Doula was a medicine, it would be unethical not to provide it. My great hope is that one day every Women, Infants and Children (WIC) program in the country will include a Doula Program. Funded through the Department of Agriculture, WIC serves the population of poor, often teen mothers but as currently implemented, WIC only address the nutritional needs of disenfranchised parents. The addition of a Doula component isn’t rocket science and it would create jobs for an army of community women who are chronically underemployed, thereby changing their lives along with the lives of the young parents and their children. A Win/Win/Win as I see it. President Obama take heed!

By the way, this isn’t some “charity work” we’re doing for others. This has a direct effect on every one of us whatever our socio-economic status. Think about it: Reducing crime and poverty and ensuring that we have an educated, stable work force has a direct effect on you and me and the future of our country. And we cannot do any of it without reducing teen pregnancy and the dysfunctional parenting that so often accompanies it.

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  • invalid-0

    This sounds like a fantastic program. I would be interested in seeing more outcome statistics from the program. Also, how was the program set up and funded? I am a nurse who works in OB and neonatal intensive care in an inner city hospital. The hospital I work at contracts with a local high school to provide care for their pregnant teens. I would love to introduce a program like this in our community. Where can I get more information?
    http://www.realityrounds.com

  • invalid-0

    You can find out more information about the Community-Based Doula program by calling Kim Nolte, Vice President of Programs and Training at G-CAPP
    404-475-6043, kim@gcapp.org

    We’ve got evaluation data to share with you and have a journal article pending publication.

  • invalid-0

    What a great program! Keep it up and hope it will spread to the other states.
    I wish this had been there when I was a first time mom.

  • invalid-0

    As a reproductive justice activist who supports affordable and widespread doula care for pregnant women, I was startled and disappointed by the poorly researched and stigmatizing article you’ve written in support of it. You have packaged together inflammatory and racially coded language to describe young mothers and linked doula care to “reducing crime and poverty and ensuring we have an educated, stable workforce.”

    First, doula care for pregnant women is good for the health and well-being of pregnant women and that is enough of reason to ensure it is affordable and available to all women.

    Secondly, you link “break[ing] the cycle of poverty, crime and the growing underclass of young people ill equipped to be productive citizens” to reducing “teen pregnancy” (an age range you never define) and the creation of the Community-Based Doula Program. You provide no research to support such a link and that’s because there isn’t any. Furthermore, the words “poverty,” “crime,” and “underclass” together represent tired, racially-coded language meant to invoke the worst racist imagery of Black people (Please see the book “Myth of the Welfare Queen,” which takes on such Reagan-era imagery even in its title).

    Finally, you’ve written that: “[W]e cannot do any of it without reducing teen pregnancy and the dysfunctional parenting that so often accompanies it.” Young mothers need the support you’ve identified, but that focuses on their strengths and destroys myths about their supposed collective responsibility for “crime and poverty.”

    Please do not contribute to this stigmatization of your mothers in support of affordable and accessible doula care for all women.

  • invalid-0

    I agree with the reproductive justice activist. Support doulas because it reduces crime? That’s a thinly veiled attempt to invoke 80’s style crack baby sensationalism. If Jane Fonda is a crime reduction advocate she should take it to the police department.

  • invalid-0

    preach it, sista!

  • liza-fuentes

    Ms. Fonda cites the best reasons why doula programs should be accessible to adolescents and all women: they help mothers gain confidence and skills that contribute to positive outcomes for them and their babies. Doulas can also connect women to resources and information to make their own best decisions, which is a big part of lowering c-section rates and increasing breastfeeding rates. However, at NLIRH we find that framing support for doula care in terms of crime and poverty reduction, and implying that doula care will stem a tide of a growing "underclass" as stigmatizing to women of color and low-income women as it is inaccurate and ineffective. As Ms. Fonda notes,a vast majority of adolescent mothers were living in poverty-income families before they got pregnant, which correlates with a lack of health insurance, lack of ability to pay for and attend college, and poor public high schools where mentorship for college or futher training is inaccessible.Highly segregated, marginalized communities that have been subject to racist policies of social and economic exclusion for decades is what causes "cycles" of poverty. Motherhood at any age could never achieve the tremendous race and class based inequities that have been foisted up women of color.

  • invalid-0

    Ms. Fonda’s article really speaks on behalf of people who have consistent interaction with the identified population in a professionally SUPPORTIVE/advocacy role on a consistent, and intimate basis. Otherwise, terms like

    crime (various forms of domestic violence and child abuse),

    underclass (limited literacy & comprehension, marketable skills, or socially unaccaptable behaviors, incapability to plan –even for short-term future)and

    poverty (the result of the myriad of factors that increases the probability of women receiving Doula services, racial and sex descrimination, the general “underclass syndrome”, legacy or teen pregnancy, etc) very easily understood by most people who know nothing of Doulas.

    I imagine that Doulas have to start where the mother/client IS, not where ‘theoretically’ she’s capable of aspiring to move toward. So for any shock, startle, or disappointment the language causes, challange yourself to have meaningful, consistent dialogues with the women and their support systmes (in THEIR environments) who use these services.

    And let’s face it, the welfare queen (or other social stigma), is a sort of whipping boy, and she’ll become less so in light of the Channel 46 expo on previously solid middle class families who are now slinking to the welfare office for foodstams and whatever else they can get, in a depressed economy.

    I am very proud of the G-CAPP/Families First Doulas program. Surely everyone agrees the work is very, very important and has enormous benefits for the expecting mothers, babies and family systems.

    I intend to support their work by telling mothers of teen girls that I work with out their program!