Advocates: Doulas could lower Indiana's pregnancy-related deaths

Indiana has the country’s ninth highest infant mortality rate and one of the highest maternal mortality rates. Advocates said doulas can educate patients and help prevent pregnancy-related deaths.

In its review of pregnancy-related deaths in 2020, the Indiana Maternal Mortality Review Committee found 77.8 percent of them were preventable.

Joslyn Cunningham is the founder of Blissful Birth Doula Services, and spoke at the State of Women in Indiana conference last week. Cunningham said during the pregnancy, the pregnant person and the infant are viewed as a unit. But after the birth, someone needs to focus on the parent to identify the signs of preventable complications.

“The support that you had while you were pregnant is not the support that you had after you had the baby,” Cunningham said.

Cunningham said doulas provide one-on-one support that allows them to identify signs of preventable complications. Part of that support is teaching patients how to advocate for needed care.

“There are a lot of people, especially people of color, especially Black birthing people who do not realize that they have a voice in this process,” Cunningham said.

Cunningham said doulas can provide “wrap-around” care — starting when someone finds out they are pregnant and going into postpartum care. While doulas are not medical providers, a birthing person matched with a doula is two times less likely to experience a birth complication.

Cunningham said doulas know to ask questions that may prevent risks during labor and delivery — such as medically unnecessary cesarean deliveries, or c-sections.

“We are here to support the birthing person — to support my client, and make sure that everything that they feel like they need and want within their birth and in their plan is essentially succeeded to the best of our abilities,” Cunningham said.

READ MORE: Doulas can improve maternal outcomes. But efforts to expand access in Indiana are slow

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Doulas are also linked to better outcomes for the infant. Data shows infants are four times less likely to have a low birth-weight when a birthing person has a doula.

In Indiana, about 40 percent of births in 2021 are financed by Medicaid. According to the Indiana Department of Health, three out of four people who died within one year of pregnancy were enrolled in Medicaid.

In 2019, state lawmakers passed legislation that allowed doulas to be reimbursed, but did not require it. It also didn’t assign any funding to reimbursements for doulas.

Cunningham said doulas are underpaid, but want to provide care to those who need it most. And she encouraged people to reach out to lawmakers and ask for funding to be added to legislation.

Abigail is our health reporter. Contact them at aruhman@wboi.org.

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