'One baby, one birth, one family, one doula at a time'

PORTLAND, Ore. (KOIN) -- Chinelo Nkwonta's fourth child, Okoorie, is thriving at 8 months old. She is also thriving in motherhood. This birth was a lot different from her previous experience.

This positive birth experience is completely opposite her first traumatic birth that led to a hemorrhage and a week-long hospital stay. She attributes her healthy, happy birth to her doula, Jesse Remer.

"I had a wonderful doula. I got to navigate the birthing space on my terms, set the tone for what I wanted to experience, what I wanted my labor to be like and what I wanted my baby to enter into," Nkwonta told KOIN 6 News. "It was wonderful."

Jesse Remer is a birth-and-postpartum doula. Doulas are not medical professionals and do not provide medical services, but work alongside health care providers. For example, Remer provides her clients with continuous physical, informational and emotional support before, during and after the birth. She guided Nkwonta through her fourth pregnancy.

During pregnancy, Remer helps pregnant couples develop a birth plan and learn the best birthing positions. During labor, she's an advocate in the hospital or home and gives emotional and physical support and guidance. Then after birth, during home visits, she can help with breastfeeding and teaching the fundamentals of infant care.

Through this months-long relationship, Remer said the most important thing she develops with the moms-to-be is trust.

"That kind of care is really unique in the birth team," she told KOIN 6 News.

Medical professionals, like OHSU Schools of Nursing and Medicine Professor Ellen Tilden, say doula care is a simple yet underutilized tool that significantly improves birth outcomes.

"It's not a fancy medication, it's not a fancy app, it's not a device. It's human presence," said Tilden, who is also a certified midwife.

Tilden has decades of experience. She was on the Oregon House Bill Committee in 2011 that created a report to advise the Oregon legislature about having Medicaid cover patients' doula care.

"Doula care is one of, I would say, it's one of the strongest, most impactful interventions we can offer to people," she said. "The research on doula care is incredibly impressive."

Research shows doula care reduces unnecessary cesareans by more than half, leads to fewer preterm births, higher breastfeeding initiation, safer sleep practices and a 64% decrease in postpartum mental health issues.

These supports are life-altering for mom and baby, especially as healthcare workers continue to be strained. Doctors and nurses are busy, often juggling the care of multiple people who are simultaneously in labor, Tilden said.

"We may not always be able to just completely focus on the continuous support and social and emotional needs of that individual who's birthing," she said. "So I really see doula care as this critical aspect and critical element of what is ideal maternity care."

Moms like Nkwonta say having a knowledgeable birth advocate at her side made all the difference.

"I had gone through births before then, but having a doula opened up what could be to me," Nkwonta said. "I didn't know that I had the options to say what I wanted to happen. I thought, OK, well, this is just happening to me versus I'm in control—which is what I feel like a doula brings to this space is that education and that empowerment."

The fact she didn't have a traumatic birth experience this time "means that I was able to enter into early motherhood with a better energy reserve for myself and to provide for him."

Doulas can also help reform maternity care for the next generation.

"My hope is that we create a culture of nurturing," Jesse Remer said. "And so to me, that's one baby, one birth, one family, one doula at a time."

Oregon's Medicaid currently covers doula care—now lawmakers are aiming to expand it to private insurance. Soon they'll be introducing a bill to reform maternal health care. KOIN 6 News will have more information and follow this story.