The maternal mortality crisis has cast a long shadow over the United States. “Pregnancy-associated deaths”—which the Centers for Disease Control and Prevention (CDC) defines as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy”—are on the rise, with Indigenous and Black people two to three times more likely to die from pregnancy-related causes than white people. The National Center for Health Statistics (NCHS) reported an 18 percent increase in U.S. maternal mortality between 2019 and 2020, with a higher relative increase in Hispanic women and non-Hispanic Black women. At the same time, national rates of postpartum depression (PPD) almost tripled during the early days of the pandemic, with one in three new parents experiencing intense sadness, anxiety, or despair that interfere with daily living.
To combat this striking loss of life and to support the mental well-being of new parents, a suite of holistic birthing practices is empowering people to take control of their birth and postpartum experiences. These efforts are making a dent in these grim statistics and are reintroducing the joy of childbirth, particularly to underserved communities.
$25b
Doulas offer culturally minded, holistic care for birthing people that emphasizes education, counseling techniques, and advocacy tools, says Trends Advisor Latham Thomas, the founder of Mama Glow, a maternity brand dedicated to empowering folks on the “childbirth continuum.” There is strong evidence that doula care increases maternal satisfaction and leads to better health outcomes for the newborn child, and that potential is drawing more people to holistically-minded birthing care. The search term “doula” has gained traction on Google over the last five years, and the global doulas and birth coaching market is expected to increase from $13.5 billion in 2022 to $24.6 billion by 2032. “[These services] are really meeting some of the structural, cultural gaps that exist to ensure that people come on the other side of their pregnancy into the birth and early postpartum journey feeling whole, capable, competent, and supported, but also feeling empowered and transformed,” Thomas says.
A swell of new doulas means more holistic birthing practices are popping up as existing services expand. For example, Sésé, a New York-based cooperative providing doula services and other maternity care, plans to offer four times more doula services in 2023 as compared to its 2016 beginnings. “This is critical when it comes to helping birthing people," says Nicole JeanBaptiste, founder of Sésé. "Extensive research proves that the continuous support of a doula significantly lowers the chances of risky interventions such as epidurals and c-sections, and shortens the length of labor.” (Note that interventions such as these are considered safe and may be life-saving, but all medical procedures come with inherent risk to the patient.)
While there are currently no uniform requirements for becoming a doula, the increased interest in holistic birthing services necessitates more opportunities for education. Mama Glow—which has trained 3,000 doulas since its launch in 2018 and currently has training hubs in New York City, Los Angeles, Miami, Paris, and online—is set to expand its online educational offerings in 2023. Meanwhile, Thomas is also making an effort to integrate doula training into the American medical system. Mama Glow has already introduced the first-ever Ivy League doula club at Brown University. Students there can participate in a work-study program that involves taking a gap year to learn doula services before heading off to medical school. Thomas herself will teach a class at Brown in 2023. “So we will have a bunch of students coming through the program headed into medical school, and who will take these skills that they're learning into the training [with them] to help transform the medical system,” she says.
All of these efforts boil down to one essential goal: To make birthing people, particularly those from underserved communities, feel supported and understood during and after birth.
Beyond the possibility of a safer birth, many people seek doulas to care for their physical and mental health post-birth—a considerable focus for nurse practitioner Nikki Greenway, founder of Bloom Maternal Health, a company that provides community-based pregnancy and postpartum support in Louisiana and Texas. “Bloom Maternal Health provides virtual and in-home postpartum care two days, two weeks, and two months [after birth]—and then we extend care up to one year,” says Greenway. “Clients receive daily check-ins, video chats, and comprehensive live support from myself, a nurse practitioner, or a perinatal nurse.” Because postpartum cardiovascular and mental health issues are among the top reasons for maternal deaths, Greenway also provides clients with automatic blood pressure cuffs and a curated list of vetted mental health providers. And in 2023, Greenway plans to continue growing her network of doula organizations, home birth midwives, and local agencies so that every new parent can have a team of people fighting for their physical and mental well-being.
In the years to come, it will become increasingly crucial for doulas to become affordable and locally accessible. As of now, doula services cost up to a couple of thousand dollars and are rarely covered by insurance. “As a nurse practitioner, I can bill insurance, but it is often a logistical nightmare when providing the type of comprehensive care families truly need,” says Greenway. “With that in mind, we are exploring private funding so my work is less regulated by insurance companies and my clients don’t worry about costs.”
A handful of states allow Medicaid to cover doula services, with more making progress in this realm. That's why public advocacy pursued by organizations such as The National Health Law Program’s Doula Medicaid Project, The National Birth Equity Collaborative, and The Black Maternal Health Caucus will also be key for doula organizations in the coming years to ensure that anyone who desires doula-guided birth, abortion, or post-partum care can afford it. Eight states and Washington, D.C., already offer Medicaid doula reimbursements, and in 2022, Blue Shield of California launched a maternal and infant health initiative in collaboration with community-based organizations and doulas. Still, there’s a long way to go before everyone, everywhere, can opt into holistic birthing services if they so desire.
Medical clinics are also embracing a more holistic approach to maternity care and are looking to increase the accessibility of their services. Maven Clinic, a virtual health-care platform focused on women and families that was founded in 2014 with the aim of providing “whole-person care that covers the entire family journey,” closed a $90 million Series E round in 2022 in order to expand Medicaid coverage for its services in 2023. “Particularly in the aftermath of Roe, the need [for access to women’s health services] has never been greater,” Maven founder and CEO Kate Ryder wrote in the brand’s fundraising announcement. “We’re committed to serving Medicaid patients with the same quality and attention to their experience that we have brought to every other market in which we’ve operated.” In September, Maven also announced a partnership with the non-profit March for Moms to launch a new program that will invest in community-based organizations focused on improving maternal health outcomes in the new year.
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Meanwhile, Oula, a modern maternity center that combines obstetrics and midwifery care, currently has two New York City locations and plans to launch in six new markets over the next three years. “Since launch in 2021, we've been focused on raising the standard for pregnancy, childbirth, and postpartum care, one patient at a time," says Elaine Purcell, the co-founder and COO of Oula. "But we want the care we provide to be available and accessible to everyone, no matter where you live or how much money you make." (Oula performs better than average at the national, state, and city levels on several key maternal health metrics, including a lower rate of preterm deliveries and cesarean births, according to data collected by the brand.)
Workplace well-being in the weeks and months after giving birth will also be pivotal to the health of parental well-being in future years, points out Arianna Huffington, founder and CEO of Thrive Global—a well-being platform that combats workplace burnout. Generally speaking, postpartum physical recovery can last anywhere from six to eight weeks, but some research suggests that it can take even longer for both the mind and the body to recuperate. A 2000 Australian study found that women still have high levels of exhaustion, back pain, and more up to seven months following birth—and there’s evidence to suggest that these health problems can lead to postpartum depression (making both physical and mental care vitally important). “Of course, parenthood can be an incredible time of wonder, joy, and connection," Huffington says. "That’s why companies have a responsibility to give new parents the time they need to enter into this new stage in their lives, especially since study after study shows that mothers (and babies) fare much better when they have sufficient paid time off after giving birth.” She adds that generous parental leave is and will remain a huge draw for job candidates.
There’s been positive momentum in the parental leave space. In May, Millennial women’s media brand The Skimm launched a public database that aggregates the leave policies of over 480 companies. As part of its #ShowUsYourLeave campaign, The Skimm also offers a toolkit for advocating for better paid family leave policies at your company.
All of these efforts boil down to one essential goal: To make birthing people, particularly those from underserved communities, feel supported and understood during and after birth. And it's a movement that's growing quickly. Mama Glow drew 400 people to its first Doula Expo in 2021—the “first and only festival for birth workers, families, and caregivers.” In 2022, attendance grew to 1,000, and Thomas expects 2023’s event in May to be the best and largest one to date. “Our focus is to empower people through tools and information, and to shore up support for them throughout the process of preparing for a transcendent birth experience,” says Thomas. ✙
Latham Thomas
Founder Mama Glow
"The maternal health crisis is couched from a lens of a fear of gloom, of doom, of sadness—and I think that also impacts how people move through pregnancy if they think that they could die. Our focus is to empower people through tools and information, and to shore up support for them throughout the process of preparing for a transcendent birth experience."
Photo Credit: Oula
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