[00:02.03]Amadoma Bediako is a retired grade school teacher. But she's still dispensing plenty of information - these days to pregnant women. [00:13.09]The most important thing is healthy mommy, healthy baby. [00:15.68]On this day in early August, Bediako was visiting Jessyca Marshall, then seven and a half months pregnant, at her home in Brooklyn. [00:23.37]They discuss issues like pre-natal health and a birth-plan. [00:27.00]If you can relax and go into this, you're not so afraid you're not so tense because if you're tight and you're tense and you're worried, it slows it down... [00:35.46]Bediako isn't a doctor or a midwife, she's what's known as a doula. [00:40.13]That's ancient Greek for "a woman who serves." doulas support pregnant women before, during and after childbirth. [00:48.00]Being a first time mother！ I really wanted to take advantage of all the information that I could. [00:53.44]And I know that doulas typically are very supportive of mothers' birth plans. So I wanted a doula that was supportive of me having a natural birth. [01:03.19]The doula serves the woman. We don't work for the hospital. We don't work for the birthing center. [01:08.10]We don't work for the midwife. We work for the woman. And we're there for her. [01:11.31]The service is provided ！ for free ！ through a program backed by New York City's Department of Health. [01:16.49]It's called the "By My Side Birth Support Program" and it's aimed at women living in low-income, largely African-American neighborhoods in Brooklyn... [01:24.58]where there are high infant and maternal mortality rates. [01:28.04]According to the Centers for Disease Control's latest statistics, [01:31.87]nationwide, black women are three times more likely to die of pregnancy-related complications than white women. [01:39.28]In New York City, [01:40.75]it's almost seven times higher... an average of 63 deaths per 100,000 births for black women compared to 9 deaths per hundred thousand births for white women. [01:50.69]Why do you think there are these high rates of maternal mortality? [01:54.99]I think healthcare in general is not as good in this area as in others.... [01:59.90]The women have a lot of pre-existing conditions, whether it's high blood pressure, asthma, obesity which also contributes... they just may not be in as good health. [02:11.70]This is Mary Powel Thomas... [02:13.01]Mary-Powel Thomas is the Director of the By My Side Birth Support Program. [02:17.54]It was established through a federal grant three and a half years ago when healthcare professionals wanted to address a troubling trend: [02:24.83]many women were showing up to the hospital alone when they were ready to deliver. So far, this program has helped more than 240 women give birth. [02:34.00]It became clear that it was really helpful to have a woman who was experienced in childbirth and to be！ who could be there to support the woman. [02:41.86]But why a doula? Why not concentrate in giving the woman more support through her doctor? [02:47.28]In a lot of cases the doctor comes in at the last minute to deliver the baby, [02:51.92]or maybe comes in a few times to check on the woman but then goes off to do other things. [02:56.07]We have doulas who, you know, arrive in the morning, and they meet the morning nurse, and then the night nurse. [03:02.05]And then, when the morning nurse comes back the next day, the doula is still there. [03:04.99]Traditionally women birth with other women. The village comes around when the woman's laboring. [03:10.56]You know, she has her mother, her grandmother, her sisters, her aunties. And they encourage her. They let her know she can do it. [03:17.46]They tell her stories. They laugh together. They cry with her. [03:21.66]But critics question whether it's government's role to finance programs like these. [03:26.27]Doula care isn't regulated and doulas aren't licensed professionals. Although certification is available, it isn't required. [03:34.63]The American College of Obstetricians and Gynecologists doesn't take a position on doulas [03:40.78]but says that"continuous support during labor from physicians, midwives, nurses, doulas, or lay individuals may be beneficial for women...." [03:49.71]They should work together as a team and they're part of the delivery team and delivery experience. [03:57.50]Doctor Raymond Sandler is the Director of Labor and Delivery at the Mount Sinai Hospital in New York. [04:03.21]He is a big supporter of doulas and works with them often. However he says that in some cases there can be challenges. [04:09.89]They are non medical and should stick to non-medical decisions making. [04:13.80]At times and if you interview others you'll find that there is some tension between the doula and the physician [04:21.46]because the doula for instance if the physician wants to do certain interventions, the doula may feel it's not necessary and injects herself into the decision making process. [04:33.15]I think there are some obstetricians that feel this is just an extra person in the room who, they may be getting in the way sometimes. [04:39.50]There's definitely a range of attitudes I think generally, as！ as there are more and more doulas in a hospital, the staff becomes more comfortable. [04:50.71]And it's also important for doulas to be responsible about that. [04:56.55]A main source of tension between doulas and doctor is over the use of C-sections. [05:02.02]While the world health organization says a C-section is appropriate up to 15 percent of the time. [05:07.50]In the United States, nearly 33 percent of all deliveries are done by C-section... [05:12.77]Mary-Powel Thomas points to a recent review by the Cochrane Collaboration - a non-profit group that studies the effectiveness of health care. [05:21.04]After reviewing pregnancy support trials from 16 countries it determined that continuous support in labor, [05:27.88]including the presence of a doula, reduces the likelihood of a C-section by as much as 22 percent. [05:34.08]If a woman is in a situation that is scary, and a medical professional gives her a quick medical-ese answer to a question she asks, we might ask, [05:44.06]"Does she need more information?" So in that way we advocate for the mom. [05:48.60]It's the power of information that Jessyca Marshall says she is counting on in order to have a natural birth. [05:54.61]I think some of the things that surprised me are！ what！ having a lack of knowledge, [06:00.76]how that affects a mother when she goes to actually give birth and deliver. [06:06.45]And how that can produce results that she didn't desire, such as a C-section or！ you know, some other health complication. [06:14.21]We offer free doula services... [06:16.15]Despite what program participants believe are the benefits of doula programs and despite the growing popularity of using doulas, [06:23.23]there is still only limited insurance coverage to pay for them. [06:26.59]The federal government supports a small number of local programs and Oregon and Minnesota have passed laws allowing Medicaid to pay for doula care. [06:34.79]But most women pay anywhere from a few hundred to a few thousand dollars out of their own pocket. [06:40.52]Many people see doulas as a luxury. The services are not included in insurance. [06:45.84]And, here you are, providing this luxury to women i in, you know, low-income areas. [06:50.93]Uh-huh (AFFIRM). [06:52.37]Yes? Yeah? Why！ [06:52.40]Isn't that great? [06:54.45]Why? [06:55.38]Because it's a proven way to improve birth outcomes. And that's our mission.