- Meghan Markle may use a doula, a non-medical childbirth support expert, during her second birth.
- Doula-assisted births are linked with better outcomes and a more positive experience.
- Doulas can lessen maternal mortality disparities, which affect Black women no matter their fame.
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Some aspects of Meghan Markle's second birth will be a lot different than her first: She'll be in the US instead of the UK, and is rumored to deliver at home – something she reportedly planned on doing for her first child Archie's delivery but wound up at a hospital instead.
Using a doula, however, may be one constant in her birth experiences, though the Duchess herself has never confirmed hiring one.
Insider talked to Sabia Wade, known as "The Black Doula," about what doulas are and why they can be especially important partners for Black people during birth.
Doulas provide physical, emotional, and educational support
Doulas are non-medical professionals trained to support women before, during, and immediately after childbirth.
That may look like suggesting and facilitating a change of position during birth, offering hands-on touch to ease a poorly-positioned baby out, or advocating for a patient in a hospital who wants to push a little longer before being wheeled off for a c-section.
But a lot of what doulas do isn't so tangible, Wade told Insider.
"We're the friend, we're the sister, we're the stand-in mother or aunt, we're the advocate," she said. "Sometimes, we have to be the fighters."
Research has linked "continuous support during labor," which is what doulas provide, with better maternal and child health outcomes. Using a doula can translate to a higher likelihood of spontaneous vaginal birth, shorter labors, fewer c-sections, less anesthesia, fewer low Apgar scores (an assessment of how well a baby is doing in the world immediately after birth), and less negative feelings about childbirth experiences.
Doula usage isn't linked to any negative effects, though doulas do cost money and typically aren't covered by insurance. Most people pay between $800 and $2,500, according to WhatToExpect.com, and organizations like Wade's nonprofit For the Village offer free or low-cost doula services to underrepresented communities.
But not everyone who wants and can afford a doula will be able to find one. New York City had only 200 to 300 active doulas in 2019. That same year, 221,539 babies were born in the city.
Black women, no matter their socioeconomic status, can especially benefit from doulas
In the US, Black women are at least two and a half more times likely to die in pregnancy, childbirth, or immediately postpartum than white women. Other statistics show pregnancy-related deaths for Black, American Indian, and Alaska Native women over 30 years old are four to five times as high as they are for white women.
"It's really easy for people to look at maternal mortality disparities for Black people and say, 'If they make this much money or have this much education, it should be better,' but research shows it doesn't matter. It doesn't make a difference," Wade said.
Experts have pointed to a variety of factors that could explain the outcomes, including socioeconomic status, access to prenatal treatment, racial bias in the medical system, a culture that doesn't encourage Black women to speak up about health concerns, and medical complications during pregnancy, like pre-eclampsia.
Leveling the playing field involves improving the healthcare system on all levels, from how physicians are trained, to how hospitals are structured to how insurance companies reimburse, Wade said.
"There's not one answer to this crisis, but what we can say is the that a doula is probably the quickest option that we could have available for a Black birthing person," Wade said. Implicit bias training does nothing, she added, when someone is six centimeters dilated.
Not only has research shown doulas can reduce negative birth outcomes that are more common among Black women like preterm birth and c-sections, but they can also improve the childbirth experience - especially if the doula herself is also a person of color.
Wade remembers one woman she assisted who was encouraged to stand in the shower at the hospital to ease contraction pain. Wade understood the patient was hesitant because the water would mess up the hair weaves she'd gotten prior to the birth, so Wade quickly fashioned a shower cap out of a plastic bag.
Two years later, the patient is still grateful she didn't have to explain what she needed to doctors and nurses, Wade said.
"No matter if you're Meghan Markle or Sabia Wade, when you're in the birth experience, the physical part is a lot, the emotional part is a lot," Wade said.
While clinicians and family members have different expertise, opinions, and emotions, a doula can look at the full picture and be the "leveler" between everyone, she said.
"Being in the moment is essential," she said. "No matter how much money you make or what you have access to, you still need that person."