What a Difference a Doula Makes!
BirthWell Partners Celebrates 10th Anniversary
& Almost 500 Births in Central Alabama
April 5, 2021
Dalia Abrams, co-founder
If you see an Alabama baby wearing this signature T-shirt -- “A BirthWell Partners Doula Helped Me Out!” – you know it’s a lucky little one.
That’s because a professionally trained doula provided support for the family –before, during and after the birth -- to help make sure that the mother and baby had the best possible outcomes.
“We believe birth is an experience to prepare for, celebrate, and even enjoy,” says Dalia Abrams, who is co-founder of BirthWell Partners Community Doula Project, (BWP), a small, non-profit organization in Birmingham that has had a big impact in Central Alabama.
Abrams, of Birmingham, is a mother of four, holds an M.A. and M.P.H., and is the organization’s Executive Director of Program Operations. Over the past 10 years, she and co-founder Susan Petrus have worked quietly to transform one of the most important experiences a person can have – birth.
“When we started out, nobody knew what a doula was, or that different birth options were even available,” adds Petrus, of Birmingham, who is a mother of two, has an M.A., and is the Executive Director of Business Operations.
A lucky BirthWell Partners baby born with the help of a professional doula. (Photograph courtesy BirthWell Partners.)
So, what is a doula?
A doula is a trained, non-medical, pregnancy and birth support professional, explains Abrams, who is who is a Certified Labor Doula CD (DONA), a DONA Approved Birth Doula Trainer BDT(DONA), Lamaze Certified Childbirth Educator (LCCE), and a Certified Lactation Counselor.
Doula services range from childbirth education and the creation of individual birth plans to techniques for coping with labor, breastfeeding, and post-partum self-care. Care after birth is considered increasingly important since a 2020 Alabama report showed the highest number of maternal deaths occurred in the year that followed the baby’s arrival.
Research shows that doulas improve both maternal and infant health outcomes. Indeed, BirthWell’s outcome data show their clients benefit across several key indicators. BirthWell clients are:
Less likely to give birth by cesarean section (26% vs. Alabama rate of 34%);
Less likely to get an epidural during labor (54% vs. Jefferson County rate of 89%);
More likely to initiate breastfeeding (94% vs. Jefferson County rate of 76%).
“Today, we coordinate 40 to 50 doulas who work with us on and off at any one time,” says Petrus, who is a DONA Certified Birth Doula and a Lamaze Certified Childbirth Educator. “We serve over 100 pregnant individuals and their families each year. And we have worked in every Birmingham area hospital that provides obstetrics.”
BWP’s services are provided by specially trained doulas like ShaTaura Lewis, 36, a Birmingham mother of four, who works as a contract doula for BWP. Years ago, as a single mother, Lewis was forced to leave nursing school to care for a family member. In 2016, she took BWP doula’s training as a work-study recipient, became a DONA certified birth doula, and now runs her own business, Doula & Beyond, LLC.
Lewis attends nearly a dozen births a year for BWP, in addition to her own clients, and enjoys a measure of financial stability. “The advantage is I can work on my own schedule. And when I am not on call, I can be there for my four sons,” she says. “Of course, I have to miss some activities, but they understand that. They know when mama heads to the hospital, she’s working, and she’s doing what she loves!”
She says she tries to provide “a great atmosphere where women feel safe, supported, and become knowledgeable about their birth experiences.” From belly casting to coaching in the use of a peanut ball (which helps reduce C-section rates), Lewis is passionate about providing services for women and families. Currently, she is training to add lactation consulting, childbirth education and grief doula work to her skill set.
Trained doulas like ShaTaura Lewis, right, shown here with a client, left, and new baby, help improve health outcomes for mothers and infants. (Photograph courtesy BirthWell Partners.)
A doula can be a lifesaver
Every pregnant woman could benefit from a doula, but for some, this kind of pregnancy support can be a lifesaver, say Abrams and Petrus. For example, a recent federal report on maternal mortality cited Alabama for the third highest death rate of mothers in the nation in 2018.
At 36.4 mothers lost per 100,000 live births, maternal mortality remains statistically uncommon; yet Alabama’s ratio was more than twice the national level (and the U.S. ranked last among wealthy countries, behind Russia even.)
What’s more, studies show “African American women are three to four times more likely to die from pregnancy related causes when compared to white women.” And, in 2020, a state report said 70% of maternal deaths studied were preventable.
BWP clients like Jonnita Turnes say once you have had a baby with a doula, you will want to repeat the experience. “Nurses can do only so much; a doula is more hands-on,” says Turnes. “I did not have a doula with my first baby, and I wanted something different with my second and third baby.”
For example, she says, with her third baby: “I did not want a lot of extra procedures; I wanted it to be as natural as possible. My BWP doula, ShaTaura Lewis, respected everything in my birth plan, supported me, and worked with me patiently on stretches, exercises, and other techniques to help me prepare physically and mentally for labor.”
“She was there when I had my baby at Princeton Baptist Medical Center. She also helped my husband get ready, which is important. A lot of guys are lost [about birthing]. It felt good to have her there… After the birth, ShaTaura was always available to come to my home or call or text to help me manage my emotions, because they can be a roller coaster. You can’t always talk to a family member about your feelings; it’s good to have a neutral person, a professional, to talk to.”
The story of how BirthWell Partners has grown is one of equal parts activism, vision, and entrepreneurship.
Making doulas accessible to all moms
Abrams, who had formed a for-profit childbirth education business in 2001 and added a doula cooperative to her model in 2008, met Petrus in 2008 while lobbying for reforms to Alabama’s midwifery laws. Back then, a convergence of trends in Alabama – shrinking numbers of OB/GYN doctors, worsening outcomes for some mothers and infants, rising healthcare costs and limited options for out-of-hospital births – were frustrating women of childbearing age, if not endangering their health.
The pair realized that political change could be slow, says Petrus, so they started thinking: “In the meantime, how do we raise consumer awareness of the need for more evidenced-based birth options?’”
For two years, they held monthly “Birth Stories & More” meetings at the YWCA in Birmingham for pregnant people and new parents. It was a space where people could ask questions about birth and hear about different birth experiences in other states, including births at home with midwives, births in hospitals with doulas, and births in birthing centers very different from hospital settings.
BirthWell Partners co-founders Dalia Abrams, left, and Susan Petrus, right, expect the Birmingham non-profit to surpass 500 births this year. (Photograph courtesy BirthWell Partners.)
At the same time, Abrams was working at an Early Head Start (EHS) program, a position she took after completing a Master’s degree in Public Health with a concentration in maternal-child health. She realized that many local families in need were going without doula services that could improve outcomes and reduce overall healthcare costs.
“At EHS, I worked with under-resourced parents who were pregnant, or had children from birth to age three. There, I met the people behind the poor maternal and fetal health outcomes I had studied,” she recalls. “Many of these families didn’t know they had choices about how and with whom they gave birth; they didn’t have access to so-called luxury services, like doulas and out-of-hospital childbirth classes.”
In May, 2011, Abrams and Petrus teamed up to create the innovative non-profit, BWP. They wanted to reach “the people who need the support most and can benefit the most from it,” says Petrus. “Also, there was no diversity locally in doulas. We wanted to change that.”
While researching ideas, they discovered Patty Brennan’s The Doula Business Guide, in which she describes her community doula program Doulas Care. “Patty recruited new doulas from her doula workshops to volunteer for families that couldn’t afford to hire their own doula. We felt inspired by this win-win model, wherein new doulas gained experience while supporting families that couldn’t otherwise have one,” recalls Petrus.
Toward a Birth-Friendly Alabama Future
Indeed, since its founding, BWP has held 24 birth doula workshops, trained 315 people, 88 of whom were on a “work-study program” designed to eliminate cost barriers to doula training. Additionally, 99 trainees were people of color, five were Hispanic, and 20 were labor and birth nurses. BWP has worked in a variety of hospitals, attended 466 births in person and 16 virtually, and provided some form of pregnancy support and/or childbirth education to at least 713 people.
To date, BWP remains the only program of its kind – raising money to train doulas, hire these doulas, and offer free/affordable doula services to under-resourced families – in the state. The vision is to embed a trained doula in every community so that a self-sustaining birth support professional can serve friends, neighbors, and other people who live in and around the neighborhood.
As the organization moves into the next decade, Abrams and Petrus also want to spread the word about the benefits of doulas to the whole birth support team, from the husband to the OBY/GYN, in addition to the birth giver.
Says Petrus, who has assisted more than 75 births: “As a doula, I provide support for the whole birth team, not just the pregnant person. By being observant, reading what’s going on with medical professionals in the room, I can improve communication and help everyone stay calm. I help others on the team -- a husband or partner, a mom, a nurse – be more effective.”
For example, when a woman in labor is no longer able to advocate for herself, a doula can coach a husband or partner to be her voice about her birth plan, she adds. If emergency surgery is needed, a doula can explain to family members what to expect. “An unplanned Caesarian section can be scary, and often, the nurses don’t have the time to tell everyone exactly what’s happening.”
The organization will also continue to grow the doula profession and advocate for the rights of birth givers, says Jen Havard, of Birmingham, who chairs BWP’s volunteer Board of Directors. Havard appreciates the profession on multiple levels since she had a doula at the birth of her baby girl here in February of 2020.
“It was my first child,” Havard recalls. “My doula helped me process my emotions and made me believe I was capable of doing this very hard thing. She encouraged me to step into my own power.”
Havard adds that working with BirthWell is a way for her to “help other birth-givers experience that transformation.”
As an organization founded by doulas, BirthWell Partners looks toward the next 10-years of serving the Central Alabama community, says Havard. She hopes the next decade will be transformational for the doula profession and clients as well.
“At BirthWell Partners, we are not only working birth by birth, but we are speaking out on issues like Medicaid expansion and urging residents of Alabama to advocate for themselves and their families at the ballot box. Quality universal healthcare – before, during, and after birth -- is the only road that leads to BirthWell’s ultimate goal, providing access to doula care for every birthing Alabamian.”
In the words of the late pediatrician, researcher and international doula educator, Dr. John Kennell : “If a doula were a drug, it would be unethical not to use it."
BWP-trained doula Leah Hayes, left, holds new baby with a happy client, right. (Photograph courtesy BirthWell Partners.)