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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.


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Reader Comments (6)

Thank you. I found the NY Times article to be poorly written, and for the tone to be dismissive of doulas. As you say, it overlooks the powerful work that doulas do. It also failed to discuss how the vast majority of doulas are underpaid (if paid at all) and under-valued for the tremendous amount of care we provide our clients - not to mention the vicarious trauma we receive by witnessing birth violence, the crisis intervention we are expected to do with minimal training (if any training at all), the PTSD our clients bring with them from previous birth experiences, the blatant hostility from some care providers that starts the moment they walk into a room with any doula present, and the impact of trying to maintain our own families while remaining at someone else's disposal 24 hours a day, 7 days a week, 365 days of the year. Also notably missing from the article was how doulas dramatically improve birth outcomes for people of colour, those who may not speak English fluently, young parents, incarcerated individuals, single parents, and those expecting babies who may not be retaining custody (either through choice or legal action). Doulas are so much more than a luxury or someone who "replaces" a partner so that they are free to order sushi.

February 12, 2015 | Unregistered CommenterBeth Murch

Thank you for writing this response to the recent NY Times article on doulas. As a doula who has in turn benefitted from doula support during my own labor, I was disappointed to see the doula in the article depicted as a replacement for the woman's partner. My experience has been the exact opposite. In fact, one of my favorite things about being a doula is helping a woman's partner figure out how best to support her. A well-supported birth is empowering not only for the woman giving birth, but for her partner too.

February 12, 2015 | Unregistered CommenterNeile King

Well done. Thank you for saying everything that needed to be said. Did you send this to the NYT?

February 13, 2015 | Unregistered CommenterEmily

Back in 2001, the journal Clinical Obstetrics and Gynecology (Volume 44, Number 4, pp 692-703) published an article entitled " Doulas: An Alternative Yet Complementary Addition to Care During Childbirth". It traces the history of the doula and discusses the science and physiology behind the benefits that doula care confers. So the medical world has known about the positive effects of the presence of a doula during labor and birth, with positive effects that extend "beyond labor and birth to improved post partum and neonatal outcomes". It also uses the famous Marshal Klaus quote:" “. . . if I had told you today about a new medication or a new electronic device that would
reduce problems of fetal asphyxia and the progress of labor by two-thirds, cut labor length by one-half, and enhance mother-infant
interaction after delivery, I expect that there would be a stampede to obtain this new medication or device in every obstetric unit in the
United States, no matter what the cost. Just because the supportive companion makes good sense does not decrease its importance."

There should be nothing but support for doulas as being part of "best-evidence" care in the maternity -care industry, especially since ACOG itself admits that only 30% of its own care protocols are based on "“ good scientific evidence” (Scientific Evidence Underlying the American College of Obstetricians and Gynecologists' Practice Bulletins (Wright, Jason D. MD; Pawar, Neha MD; Gonzalez, Julie S. R. MD., et al) as published in Obstetrics and Gynecology in 2011. Time for some optimal maternity care in this country, supported by well-researched articles in the press, instead of that offering from the NYT.

February 14, 2015 | Unregistered CommenterJacqueline Levine

A great point to think about. I congratulate you on the courage you have to firmly stand for your beliefs and support your causes.

March 11, 2015 | Unregistered CommenterVanessa Ally

I would like to salute you for your motivation and eloquence. Wish you lot of success in your future endeavors!

March 11, 2015 | Unregistered CommenterRosy

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