As evidence of her participation in and enthusiasm for her doula training program, Anastacia Karabatsos, a third-year at OSU studying biology, carries a visual aid made by a fellow doula in the program that she believed to be particularly powerful and helpful for new mothers learning to breastfeed: two wooden beads sit, hanging together on a keychain, one slightly larger than the other. The larger bead represents the size of a newborn’s stomach; the smaller bead represents the quantity of breastmilk that a newborn needs to be fed every few hours. 

The doula training program began in January 2018 and is funded by a grant from the Intercommunity Health Network, the medicaid provider for Benton, Linn and Lincoln counties. The grant proposal was submitted by Heart of the Valley Birth and Beyond, a local nonprofit organization that also serves as the fiscal agent for the grant. 

Karabatsos said that what sets doulas apart from midwives is that midwives provide medical care while doulas tend to the more social and psychological needs associated with pregnancy, birth and motherhood. To do this, doulas can help their clients make birth plans, establish their needs and serve as an advocate for them throughout the process when interacting with other services or medical practitioners. 

The program is part of the Reproductive Health Lab in the OSU anthropology department. This lab, according to Melissa Cheyney, associate professor and program champion, is a space devoted to investigating questions related to birth or reproductive justice. The perspective taken in this space, according to Cheyney, is largely focused on the medical anthropology portion of the human side of healthcare. 

“It kind of stems from the idea that we can’t all be created equal if we don’t get an equal start in life,” Cheyney said. 

According to Cheyney, the United States is currently the only high-income country struggling with rising maternal mortality rates. Among the factors contributing to this unsettling trend, is the United States abnormally high rate of Cesarean sections, commonly known as C-sections. A C-section is a surgical birth procedure that directly removes the baby through the mother’s abdomen. Sometimes these procedures are planned, but they can also be done when an unexpected issue takes place during birth.  The World Health Organization says the rate of birth via C-section should not exceed 10-15 percent, the United States’ rate of birth via C-section is over 30 percent. This, according to Cheyney, plays into a “too much too soon,” approach to maternity care that has been adopted in the US, which overly medicalizes pregnancy and treats it as a pathology rather than a natural occurrence.

“There’s research that suggests that, while medical interventions are sometimes really important for making sure that happens, much of what ensures a healthy birth outcome is really much more social, psychosocial and emotional, and so having an advocate, people who support you, having access to the resources you need to survive and thrive are all really important, not just access to Cesarean sections,” Cheyney said. 

This program prioritizes women who are belong to vulnerable or at-risk populations including underhoused or homeless women, women with little or no family support, English language learners, women who are medically high-risk, younger than average mothers, survivors of sexual violence and women with a history of mental illness, addiction, or incarceration. 

In order to become a doula in this program, participants must undergo vigorous training. This includes all the trainings mandated by the state of Oregon to become a doula along with a number of additional steps, many of which are specifically intended to prepare these doulas to work with the vulnerable folks this program prioritizes. 

The services offered by the doulas in this program include two meetings before the birth, used to build a relationship and make a birth plan, support during birth and two visits following birth used to check on the welfare of the mother and the baby. Topics covered during these postpartum visits may include breastfeeding, bonding and postpartum depression, among others.

“Those are midwives and doulas who believe that, at the core, a woman’s body is capable of giving birth if she is adequately supported,” Cheyney said. “There will certainly be some instances in which the pregnancy is pathological, there’s something complicated about the pregnancy related to some other disease condition where you need medical intervention, but it wouldn’t be every birth.” 

Karabatsos said that she first heard about the program through word of mouth and in some of her classes. She then decided to give the program a try. The idea of becoming a nurse midwife had been in the back of her mind for some time, but being in the program was different than she had expected. 

“I think you can’t plan life,” Karabatsos said. “I think everything in life is like a birth: you plan for as much as you want, you plan for no epidural, you’re like ‘I want an all-natural birth with essential oils,’ and it’s not always like that, you know. Sometimes you need an epidural and sometimes you need someone wiping the sweat off your brow. Life happens.” 

Karabatsos aims to become a CNA now and a nurse midwife after her Bachelor of Science. She  views participating in this program as a good first step as well as a meaningful experience. 

“I just want to help women,” Karabatsos said. “It’s not the paycheck or whatever. It’s about being able to help people and do something positive.”

The goal for the program is to ultimately become a model for other healthcare providers and to change maternal care during pregnancy, birth and after birth for the better. By demonstrating the effectiveness and importance of providing access to doulas for at-risk populations, the folks involved with the program hope that this one can be expanded and help lots of mothers and babies. According to Holly Horan, doctoral candidate and program coordinator for the Doula Program, this program has found success thus far and other programs like it have already begun to reach out for consultations. 

Thus far, the program has received more than 100 mother referrals and the doulas have aided in approximately 60 births, less than 10% of which have required medically necessary C-sections. Many more doulas also signed up for the trainings than were expected, according to Horan. These outcomes, according to Horan and Cheyney, indicate higher levels of interest than they expected going into the program and the C-section rate is right on par with that recommended by the WHO. According to Horan, perhaps their greatest challenge thus far has been managing the program’s success. 

“I just want to recognize that all the doulas involved in this program are willing to be a part of the learning process, as beautiful and messy as that is,” Horan said. “You know, they’re not getting reimbursed enough, they’re doing hard work, they’re working harder than some of your standard doulas who are taking care of people who have more than enough resources, time and energy, and they are getting reimbursed at a fraction of the cost. So it’s just important to keep in mind that we are currently in the process of figuring this out and that the people who are standing by our sides, those doulas, we are really,  really grateful for. They are the true leaders of change and improvement in maternity care.” 

For more information, contact Holly Horan at [email protected].