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An open letter to the NY Times in response to “Doulas, A Growing Force in Maternity Culture, Seek Greater Acceptance”

As experienced doulas who have attended over 650 births, we were deeply concerned by the characterization of our work in the article, “Doulas, A Growing Force in Maternity Culture, Seek Greater Acceptance.” The author completely ignored more than two decades of medical research that has concluded that with the support of a doula, the rate of vaginal births increases, labors are shorter overall, less pain medications and epidurals are requested, and vacuums or forceps are used less often. Doulas are an evidence-based strategy for improving childbirth for women and infants and this fact was nowhere in Ms. Hartocollis’ article.

Ms. Hartocollis suggests that  doulas are “a backlash against a perceived overmedicalization of birth,” failing to recognize that doula support is a well documented initiative for improving medical care and decreasing unnecessary medical interventions. This is not a perception, as she states, but a fact. Choices in Childbirth, a non-profit organization focused on ensuring that all women have access to maternity care that is safe, healthy, equitable, and empowering, carried out extensive research in 2013 and 2014 and released their findings in Doula Care in New York City: Advancing the Goals of the Affordable Care Act, in 2014. The report aptly evidences the overmedicalization of childbirth. NYC has a cesarean rate (over 30%) that is much higher than the rate recommended by the World Health Organization (between 10-15%), yet no research has demonstrated that these rising rates of cesarean births have improved maternal or infant health. Even though the US spends more money than any other country in the world on maternity care ($111 billion annually), we currently rank 60th in maternal mortality.

One of the best documented tools for reducing unnecessary c-sections and overuse of medical interventions in birth: doulas. In 2012, a Cochrane Review (a not-for-profit organization that collects results from primary researchers on health care interventions), similarly documented less inductions, less pain medications, shorter labors, less cesarean sections, less instrumental vaginal deliveries, and healthier babies with doula support and they concluded that there are no reported adverse effects from having a doula, concluding that "all women should have support throughout labour and birth" (6). Similarly, the American College of Obstetricians & Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) reported in an Obstetric Care Consensus last year that one of their key recommendations for reducing cesarean sections was doula support, which they describe as, "one of the most effective tools to improve labor and delivery outcomes" (ACOG 705).

In Doula Care in New York City, Choices in Childbirth reports that reducing the number of cesareans, and other unnecessary medical interventions, could not only significantly improve women’s health, it could also greatly improve patient satisfaction and reduce the skyrocketing cost of medical care. They estimate that widespread use of doulas would be expected to reduce spending on unnecessary cesareans by over $80 million each year in NYC alone (28). As an evidence-based strategy for improving childbirth for women and infants, the data is clear that all women would benefit from the the support of a doula and that having doulas at all births could vastly decrease unnecessary medical procedures and unnecessary spending.

Further, Choices in Childbirth’s doula report also does an excellent job documenting racial and socioeconomic disparities in pregnancy outcomes in the US and highlights community-based doula programs as an essential tool for improving health care and reducing these disparities. The report states that nationally, African American women at every income level all experienced three times the risk of maternal mortality as similarly situated white women. In New York City, these disparities are far worse. African American women face seven times the risk of maternal death and Hispanic women in New York City also have a maternal mortality ratio that is nearly twice as high as for non-Hispanic white women (3). Ms. Hartocollis does mention the important work of one local community-based doula organization, By My Side, but she fails to look at the context in which they are doing their work and how their doula services might reduce these disproportionately poor outcomes, especially with the changes in hospital policies recommended by Choices in Childbirth.

Doulas are not a luxury item. Doulas do not sideline a woman’s partner or family members, as the author seems to imply. Doulas are an important addition to the birth team and are working to address the healthcare crisis for women in this country. About 80% of US American women will give birth in their lifetime and the issues women face in childbirth are not trivial and should not be trivialized by the New York Times. Rather than documenting the singing and dancing aspirations of two local doulas, Ms. Hartocollis might have used her print space to document the deaths of local women that might have been prevented with better medical care and the education and advocacy that doulas provide.



Stephanie Schiavenato (Poplika), Raising Roots Doula Megan Davidson, PhD, Brooklyn Doula












Works Cited


American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine. “Safe Prevention of the Primary Cesarean Delivery: Obstetric Care Consensus 1.”. American Journal of Obstetrics and Gynecology. (March 2014):693-711.

Choices in Childbirth. Doula Care in NYC: Advancing the Goals of the Affordable Care Act. New York: Choices in Childbirth., 2014. Print.


Hodnett E, Gates S, Hofmeyr G, and Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. 15 July 2013. Web. 12 May 2014.