MONA ISKANDER: Amadoma Bediako is a retired grade school teacher. But she's still dispensing plenty of information - these days to pregnant women.
AMADOMA BEDIAKO: The most important thing is healthy mommy, healthy baby.
MONA ISKANDER: On this day in early August, Bediako was visiting Jessyca Marshall, then seven and a half months pregnant, at her home in Brooklyn. They discuss issues like pre-natal health and a birth-plan.
AMADOMA BEDIAKO: 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...
MONA ISKANDER: Bediako isn't a doctor or a midwife, she's what's known as a doula. That's ancient Greek for "a woman who serves." Doulas support pregnant women before, during and after childbirth.
JESSYCA MARSHALL: Being a first time mother-- I really wanted to take advantage of all the information that I could. 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.
AMADOMA BEDIAKO: The doula serves the woman. We don't work for the hospital. We don't work for the birthing center. We don't work for the midwife. We work for the woman. And we're there for her.
MONA ISKANDER: The service is provided -- for free -- through a program backed by New York City's Department of Health. 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... where there are high infant and maternal mortality rates.
According to the Centers for Disease Control's latest statistics, nationwide, black women are three times more likely to die of pregnancy-related complications than white women. In New York City, 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.
MONA ISKANDER: Why do you think there are these high rates of maternal mortality?
MARY-POWEL THOMAS: I think health care in general is not as good in this area as in others.... 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.
MARY-POWEL THOMAS: This is Mary Powel Thomas...
MONA ISKANDER: Mary-Powel Thomas is the director of the By My Side Birth Support Program. It was established through a federal grant three and a half years ago when health care professionals wanted to address a troubling trend: 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.
MARY-POWEL THOMAS: 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.
MONA ISKANDER: But why a doula? Why not concentrate in giving the woman more support through her doctor?
MARY-POWEL THOMAS: In a lot of cases the doctor comes in at the last minute to deliver the baby, or maybe comes in a few times to check on the woman but then goes off to do other things. We have doulas who, you know, arrive in the morning, and they meet the morning nurse, and then the night nurse. And then, when the morning nurse comes back the next day, the doula is still there.
AMADOMA BEDIAKO: Traditionally women birth with other women. The village comes around when the woman's laboring. You know, she has her mother, her grandmother, her sisters, her aunties. And they encourage her. They let her know she can do it. They tell her stories. They laugh together. They cry with her.
MONA ISKANDER: But critics question whether it's government's role to finance programs like these. Doula care isn't regulated and doulas aren't licensed professionals. Although certification is available, it isn't required. The American College of Obstetricians and Gynecologists doesn't take a position on doulas but says that "continuous support during labor from physicians, midwives, nurses, doulas, or lay individuals may be beneficial for women...."
RAYMOND SANDLER: They should work together as a team and they're part of the delivery team and delivery experience.
MONA ISKANDER: Doctor Raymond Sandler is the director of Labor and Delivery at the Mount Sinai Hospital in New York. He is a big supporter of doulas and works with them often. However he says that in some cases there can be challenges.
RAYMOND SANDLER: They are non-medical and should stick to non-medical decisions making. At times and if you interview others, you'll find that there is some tension between the doula and the physician 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
MONA ISKANDER: 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.
MARY-POWEL THOMAS: 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. And it's also important for doulas to be responsible about that.
MONA ISKANDER: A main source of tension between doulas and doctor is over the use of C-sections.
While the world health organization says a C-section is appropriate up to 15 percent of the time. In the United States, nearly 33 percent of all deliveries are done by C-section...
Mary-Powel Thomas points to a recent review by the Cochrane Collaboration -- a non-profit group that studies the effectiveness of health care. After reviewing pregnancy support trials from 16 countries it determined that continuous support in labor, including the presence of a doula, reduces the likelihood of a C-section by as much as 22 percent.
AMADOMA BEDIAKO: 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, "Does she need more information?" So in that way we advocate for the mom.
MONA ISKANDER: It's the power of information that Jessyca Marshall says she is counting on in order to have a natural birth.
JESSYCA MARSHALL: I think some of the things that surprised me are-- what-- having a lack of knowledge, how that affects a mother when she goes to actually give birth and deliver. And how that can produce results that she didn't desire, such as a C-section or-- you know, some other health complication.
AMADOMA BEDIAKO: We offer free doula services...
MONA ISKANDER: Despite what program participants believe are the benefits of doula programs and despite the growing popularity of using doulas, there is still only limited insurance coverage to pay for them. The federal government supports a small number of local programs and Oregon and Minnesota have passed laws allowing Medicaid to pay for doula care. But most women pay anywhere from a few hundred to a few thousand dollars out of their own pocket.
MONA ISKANDER: Many people see doulas as a luxury. The services are not included in insurance. And, here you are, providing this luxury to women i in, you know, low-income areas.
MARY-POWEL THOMAS: Uh-huh (AFFIRM).
MONA ISKANDER: Yes? Yeah? Why--
MARY-POWEL THOMAS: Isn't that great?
MONA ISKANDER: Why?
MARY-POWEL THOMAS: Because it's a proven way to improve birth outcomes. And that's our mission.