The program started out modestly, with about fifteen Hopkins nursing students, many of whom had served in the Peace Corps in Africa as doulas: certified professionals who provide non-medical emotional and physical assistance to women during labor and delivery. They began providing doula services to women at the Hopkins-affiliated Bayview Medical Center as part of the nursing school's Community Outreach Program. Hopkins' School of Nursing added an elective course to train nursing students as certified doulas in 1998; since then, participating students have been practicing their skills at local hospitals, free of charge, under the name Birth Companions.
Returned Peace Corps Volunteers in Hopkins' Nursing Program began providing non-medical emotional and physical assistance to women during labor and delivery
BALTIMORE OBSERVED: TRANSFORMER
Mothers' Helpers
Urbanite #64 October 09
By: Elizabeth Heubeck
Caption: Child care: Through the Birth Companions program, Aisha Raheem received the support of a doula at no charge during the birth of her daughter. | photo by Valerie Paulsgrove
Baltimore's infant mortality rate-the number of infants who die before turning a year old-is 11.3 per 1,000 live births, well over the national rate of 6.3 per 1,000 and higher than in some developing countries. But a local program called Birth Companions has been able to reduce that number for some Baltimore families.
The program started out modestly, with about fifteen Hopkins nursing students, many of whom had served in the Peace Corps in Africa as doulas: certified professionals who provide non-medical emotional and physical assistance to women during labor and delivery. They began providing doula services to women at the Hopkins-affiliated Bayview Medical Center as part of the nursing school's Community Outreach Program. Hopkins' School of Nursing added an elective course to train nursing students as certified doulas in 1998; since then, participating students have been practicing their skills at local hospitals, free of charge, under the name Birth Companions.
The program also formed partnerships with area agencies that serve the most vulnerable: immigrants from war-torn countries, mothers-to-be with substance abuse problems, teens in the detention system. Doulas from Birth Companions now attend about a hundred births annually. "Wherever the mom goes to deliver, we go," says nurse Betty Jordan, Birth Companions' cofounder.
The doula's role is to be a "continuous presence," says Jordan, advocating for and supporting the mother-to-be and family. Historically, their interactions with doctors in the delivery room can be tense, but Robert Atlas, chair of the department of obstetrics and gynecology at Mercy Medical Center, acknowledges the good doulas can do. "It can be incredibly positive to have someone there who's supportive of the patient's needs. The right doula, with the right approach, is incredibly beneficial."
Birth Companions' success rate bears this out. Infants whose mothers are enrolled in the program are far less likely to be born preterm or with a low birth weight-two contributing factors to infant mortality-than others born in Baltimore City. Between 1999 and 2008, on average, just 3.9 percent of the program's babies were born preterm and only 3 percent had low birth weight, compared with 13.7 percent and 12.8 percent, respectively, in Baltimore City in 2007.
The program also saves money. Among women enrolled, the rate of Caesarean sections-more invasive and costly than vaginal deliveries-runs about 5 percent lower than the general community's rate, which hovers around 33 percent. In Maryland hospitals, the average cost of care associated with a C-section ranges from $5,353 to $10,956, compared to $3,893 to $7,676 for a vaginal delivery. That's a significant savings from a program that costs approximately $30,000 to operate annually.
Then there are the aspects of the program that can't be quantified. Doula Missy Mason calls attending births addictive. "The part I love is laboring with the moms. It isn't just going in and checking their blood pressure. It's easing their fears and staying beside them continuously."
One of Mason's recent clients, 25-year-old Aisha Raheem, had hoped to avoid pain medication during the birth of her first child. The difficult sixteen-hour labor prompted her to eventually accept an epidural, but she says the experience was positive overall. "I can take what I learned from the doula and use it next time."
