Kanwal Haq, a New York-based doula, was on a plane home from a vacation last September when she received a text from her client: “It’s game day here.”
The baby was arriving a week earlier than planned.
“They are keeping me in triage right now though because I’m only 3cm,” her client, Alyssa Coats-Clark, wrote. “But boy do these contractions hurt!”
“Let’s get BABY BOY EZRA HERE!!!” Ms. Haq wrote back, adding a series of suggestions for what Ms. Coats-Clark could ask the nurses for in order to reduce her discomfort.
It was the first birth Ms. Haq, 34, had helped with. And, though she hadn’t envisioned doing so while in the air, the plan was always to support Ms. Coats-Clark, who lives in Indiana, remotely.
Ms. Haq, in conversation over text with her client, as well as with Ms. Coats-Clark’s husband and mother, was able to support the delivery from afar, offering guidance about labor positions, pain-relief and insights into how things would likely progress.
“I was still getting the support I needed from the people closest to me while Kanwal was giving them the tools and the things that they needed to be that support,” Ms. Coats-Clark said.
Roughly six percent of pregnant mothers in the United States have sought the care of doulas, who have expertise in pregnancy and childbirth and offer nonmedical services. Studies have repeatedly found that in-person doula support during birth can improve circumstances for mothers, particularly women of color, including by reducing anxiety during labor, the length of labor and the chances of a premature birth.
In the same way that many therapy appointments and visits with primary care physicians went virtual during the pandemic, so did doula care. Since then, virtual sessions have become a standard part of many doulas’ care packages. Data is scarce, but experts believe that even when a doula isn’t physically in the room with a client — instead providing care and advice over the phone before, during and after labor — mothers may have a reduced risk of unwanted medical interventions during birth and be more likely to feel satisfied and supported during and after pregnancy.
The U.S. has persistently high rates of maternal health complications and deaths, and a growing number of medical professionals and lawmakers are embracing virtual doula care as a potential part of the solution. In April, Democratic senators introduced a federal act to expand Medicaid programs to cover access to doula care, including on telehealth platforms, and already, more than half a dozen state health departments have started to include virtual doula care in their programs.
Though the bulk of a doula’s job is to provide physical and emotional support during labor, they also offer a range of services before and after birth. “They offer breastfeeding support, they offer birth planning, they provide emotional support, they help parents navigate the health care system — a lot of those services really lend themselves to virtual care,” said Lori Uscher-Pines, a health policy researcher at the think tank Rand Corporation and a co-author of an editorial about virtual doula care that was published in a medical journal in January.
According to some estimates, more than 6 million women live in areas with limited or no access to maternal care, she noted, and doulas are still a luxury predominantly used by high-income white women because many insurance plans don’t cover the service. Hiring an in-person doula before, during and after birth can cost a few thousand dollars out-of-pocket; virtual support is a fraction of that amount, with doulas often charging a few hundred dollars for sessions, including support during birth.
Going virtual, Ms. Uscher-Pines said, also delivers access to more people across the country.
For Janay Hall, who lives in Florida, having a virtual doula during her high-risk pregnancy may have saved her life, she said. She was pregnant with her second child in 2020, at the height of the pandemic, and was diagnosed with pre-eclampsia, a potentially fatal form of high blood pressure. One day, three months before her due date, her left arm went numb while she was driving. She pulled over and called her doula, Bridgette Jerger, who is also based in Florida and works for a network called G.R.O.W. Doula.
“She was like, ‘you need to call your provider right now,’” Ms. Hall recalled. “I called my provider and they told me that I needed to go to the emergency ward immediately. So I went to the hospital, not thinking anything because I was so early at that point.”
Ms. Hall’s blood pressure was so high she had to be admitted for about a month and, because only one visitor was allowed, her doula provided virtual care. She was monitored to see if her blood pressure would come down and, after each check up, Mr. Hall would call her doula in order to better understand her prognosis. Her doula would also offer breathing techniques to reduce stress and logistical advice for her partner, like what to bring to the hospital.
At 34 weeks, when Ms. Hall’s blood pressure still wasn’t coming down, she had to be induced. Ms. Jerger got on FaceTime to demonstrate the methods her partner could use, like specific back massages, to reduce Ms. Hall’s pain and soothe her nerves.
In the end, Ms. Jerger watched the baby be delivered over FaceTime, too.
“A lot of people feel like ‘Oh, I can just Google.’ But it’s not like Googling because you can actually have someone hands-on walking you through the process,” Ms. Hall said.
Anecdotal evidence from doula networks around the country have found that the health outcomes for mothers who receive virtual support are better than those who receive no care, and are often comparable to those who receive in-person care. A study funded by Maven, a telehealth platform that offers fertility, pregnancy and postpartum care, found that out of roughly 8,900 patients on its platform, women who had at least two virtual doula visits were less likely to have a cesarean birth than those who didn’t have virtual doula visits.
A collaboration between Mount Sinai Hospital, New York City’s public health care system and two doula networks offers care for immigrant, low-income, homeless and incarcerated women in Queens, New York, often via FaceTime and WhatsApp. This has allowed them to reach women in domestic violence shelters where visitation restrictions are tight, for example, and people who live in their cars.
Pregnant women in those populations are often wary of, or shut out of, formal medical systems. But those who participated in the hybrid doula program went to more doctor visits, particularly postpartum visits, compared with new mothers who didn’t use the program, said Dr. Sheela Maru, an assistant professor of global health, obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai and director of the doula program.
Angelene Love, a Michigan-based doula who works with Mae, a doula network that works with Medicaid in six states to provide in-person and virtual care, said that in September, she helped one of her clients via an iPad that a family member set up in the labor and delivery room.
“When she got induced, they Zoomed me. When they got to the hospital, they Zoomed me — her mum was just, like, holding up the iPad.”
When her client went into active labor, Ms. Love got back on the Zoom call and coached her through breathing exercises. It was also important “just to be in the room to hear what the providers were saying to ensure that, whatever was going on, my client completely understood it and was able to make informed decisions,” she said.
There are drawbacks to virtual doula care compared to in-person support, Ms. Love said. Key among them is it hinders a patient’s ability to build intimacy with their doulas. Ms. Love’s preference, she said, “is that we’re able to meet each other in person to make sure that we have a great connection and rapport and trust.” There are also subtle signs of physical and emotional concerns that doulas can more easily pick up on in person than on a video call, she added, like when a headache might seem serious enough for medical attention or, postpartum, if the baby is showing signs of distress.
But those challenges, she said, are surmountable, particularly in situations where virtual doula care might be a patient’s only option.
“For some folks, being able to get a doula that they want is just not feasible in their price range,” she said. “Anything we can do to break down barriers, we have to do it.”
