In her role as a birth and postpartum doula, Jesse Pournaras is used to working erratic hours and offering her clients a range of services, from gripping their hips as they work through contractions, to preparing them meals in the blurry postpartum days.
But she never expected to plunge deeply into advocacy work like she did last spring when, facing skyrocketing COVID-19 case counts, several New York City hospitals abruptly banned support people from labor and delivery wards, leaving women to give birth on their own. Pournaras launched an online petition calling for an immediate end to the partner ban that quickly went viral, and worked with other doulas to relentlessly call and write elected officials. In those frantic early weeks, Pournaras estimates she and her fellow New York City-based doulas helped thousands of women find new hospitals and health care providers that would allow them to at least have their spouse or partner with them, and became deeply versed in ever-shifting hospital and public health policies as the pandemic rocked the city.
“Doulas did so much,” Pournaras told HuffPost.
“We got people through the hardest moments of their lives,” she said. “And we often did it for free or for extraordinarily low fees.”
Doulas are birth professionals who provide nonmedical support to women before, during and sometimes after giving birth. Working with a doula is still relatively rare — roughly 6% of women in the United States said they used one in a 2012 survey — but that data is nearly a decade old and many more women and their partners are aware now that doulas exist.
Part of that increased awareness stems from the fact that scientific research shows that doulas can improve birth outcomes, and public health efforts have aimed to make them more widely available to women, regardless of income. A handful of states have moved to support doulas who serve women covered by Medicaid — all with the hopes of reducing longstanding inequities in birth outcomes. Experts increasingly understand that doulas are not just a luxury for women chasing a very specific vision of unmedicated childbirth or for those who can afford them; they are an essential public health tool.
But when COVID-19 hit, doulas like Pounaras were suddenly confronted with a wave of obstacles keeping them from offering their clients the kind of comprehensive care they see as the backbone of their work.
And overnight, doulas around the country had to find ways to make a relationship firmly rooted in the physical — like holding a laboring woman’s hand, or helping her breathe — somehow work online.
Many doulas quickly whipped up “virtual tool kits,” explained Tara Campbell Lussier, founder and chief development officer with Arrow Birth, which provides online childbirth classes and virtual support. But it was a challenge to make sure women and their partners had the technology they needed, Lussier said. And making sure they could actually use it.
“Hospitals have historically always had spotty WiFi,” she explained.
“I am so proud of my community of birth workers — including midwives and nurses and OBs — who have put everything on the line to fight for our clients and patients.”
– Jesse Pournaras, New York City-based doula
Chanel Porchia, founder of Ancient Song Doula Services, which offers free and low-cost doula services to women in New York and New Jersey, estimates that between March and early May, she and her team trained 350 doulas and doula organizations in how to pivot to online care.
Porchia and her team also provided training to labor and delivery nurses, helping them understand the kind of nonmedical support doulas provide in the moment during childbirth alongside medical providers, like nurses, doctors and midwives. Porchia created a platform, JustBirth Space, which lets women text their birth-related questions and get immediate answers — all in the hopes of making sure women, and particularly those who have traditionally struggled to get equitable care, did not fall through the cracks during the pandemic.
Doulas jumped in to help in other ways, too. Pournaras and Porchia both spoke of helping women get groceries, and donating new baby gear like diapers and formula. They helped to track down PPE for health care providers they’d worked alongside in the past, and face shields and masks for concerned clients.
That broadened scope of work and care was not without challenges, of course.
Many doulas struggled to balance their already unpredictable schedules with the demands of watching their own children who were home during the pandemic, and some lost clients along the way. Under even the best of circumstances, doula-ing is a hard way to eke out a living.
“Some people canceled contracts. Some folks lost out on money. And you can’t just file for unemployment — it doesn’t work like that,” Porchia said.
“A lot of doulas are exhausted,” she added. “Like everybody else.”
Yet despite the trying circumstances they faced, Pournaras said she is proud of what doulas as a collective group were able to accomplish in 2020, a year in modern childbirth for which there truly is no precedent.
“I am really, really proud to be a doula,” Pournaras said. “I am so proud of my community of birth workers — including midwives and nurses and OBs — who have put everything on the line to fight for our clients … to keep them healthy and safe, to ensure their voices are heard and their choices are respected.”