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View ProfilesPublished March 1, 2023 at 10:00 a.m.
Montpelier resident Allie Perline had never considered using a doula during her pregnancy, in part because of the expense — which is not typically covered by health insurance. But in fall 2021, during a first-trimester doctor's appointment, Perline learned about a program that provides free doula care to all Washington County residents and decided to enroll.
Perline said doula care — before, during and after the birth of her child — was a big help in navigating the intense, emotional experience of becoming a new parent.
"To have someone in the room that was specifically there for me, to support me and be another voice for the intentions I had going into delivery ... shaped my overall experience," she said.
Pregnancy and new parenthood are moments of great change that for many lead to mental health challenges. Since COVID-19, the share of pregnant and postpartum Vermonters showing symptoms of depression and anxiety has ticked upward to around 25 percent, according to state health statistics.
In a modest effort to address the problem, Washington County Mental Health Services is employing federal funds to provide doulas, the nonclinical birth workers who for decades have tended to expectant parents.
The county's Doula Project is based on findings that access to a doula has been shown to improve physical and mental health outcomes for those giving birth. Doulas are certified through training programs to provide emotional and physical support to women and to connect them with community resources. But doula services often cost thousands of dollars, making them inaccessible for many.
Health officials say the services provided by Washington County's Doula Project — from helping expecting families craft a birth plan to caring for newborns so that parents can catch up on sleep — could be a model for perinatal care elsewhere in the state.
"The doula work is really a shining star of the federal grant work that we're doing," said Laura Pentenrieder, program manager for the Vermont Department of Health's Division of Maternal & Child Health. "[We're] a huge supporter of doulas and a proponent of elevating their work."
Washington County Mental Health Services first began offering free doula support more than eight years ago, but only for those who received Medicaid assistance, qualified for mental health services and gave birth at Central Vermont Medical Center, said Maria Rossi, the Doula Project coordinator. But in May 2021, the agency used funding from a federal grant called Screening, Treatment, and Access for Mothers and Perinatal Partners, or STAMPP, to make the program available to all women in Washington County, regardless of income.
Vermont was one of seven states to receive the competitive, five-year grant in 2019. The funds have also been used to launch statewide initiatives, including a Parents and Babies program that trains social services providers to prevent and treat mild or moderate mental health issues and a hotline called Support Delivered that helps connect families with mental health resources.
Under the Washington County program, which is now funded by a separate federal health equity grant, participants can choose from among six doulas on staff. Though each doula has their own approach, they've all participated in the same trainings around topics such as trauma in childbirth, mental health and domestic violence and offer the same core set of services: two to three prenatal meetings, support during birth and three postpartum home visits. Participants are also eligible for free wellness services, such as massages and acupuncture. Since the program broadened its reach almost two years ago, it has served 89 families — a significant number, considering that only 243 babies were born in Washington County last year.
For Lauriana Capone, one of the doulas, the most important part of her work is helping to ensure that her clients' rights and choices are honored during birth.
"Because the memory of their birth experience is one they will replay over and over throughout their life, we have a moral obligation to birthing people to help this memory be as positive as possible," Capone said. "I have seen over and over how, when a person's rights are upheld in the birth space, that is a powerful experience of self-agency that helps them be stronger, more confident parents and have better mental health outcomes later on."
Sandra Wood, a psychiatric nurse practitioner at the University of Vermont Medical Center who screens and treats women for perinatal anxiety and mood disorders, said she sees a strong connection between doula care and positive mental health outcomes for pregnant and postpartum women. Though medication might be called for in cases of severe depression, bipolar disorder or psychosis, doulas can play an important role in helping people navigate the challenges of pregnancy and parenthood, connecting them with information and providing emotional support, said Wood, who is not connected to the Doula Project.
The Doula Project served that role for Megan Cherry, who had moved to Vermont when she found out she was pregnant in fall 2021. The Barre resident heard about the program from her sister-in-law, who was also pregnant at the time, and signed up, selecting Capone as her doula. Cherry and her husband spoke with Capone about what to expect during labor and wrote a set of birthing wishes, including strategies for pain management and the atmosphere in the delivery room.
Cherry said those meetings fortified her for what would end up being an arduous, 31-hour childbirth at Central Vermont Medical Center last July, during which she suffered a high fever and her baby's heart rate dropped. During labor, Capone supported Cherry and helped her worried husband understand what was happening, Cherry said.
After Cherry's son was born, Capone connected her with a group for new moms and suggested local events that would help the family get out of the house with their new baby.
"I don't know if I would be in the same mental and physical state I am now if not for the program," Cherry said.
Jess Lynch of Moretown, who is expecting her second child this month, enrolled in the Doula Project recently because she wanted a less clinical, more nurturing childbirth than when her first child was born two years ago.
"I feel so much more comfortable having someone to be that go-between so I don't have to be in my thinking brain" during labor, she said.
Washington County isn't the only place in Vermont that provides universal access to doulas. In St. Albans, the Parent Child Center of Northwestern Counseling & Support Services employs a seven-person team — three mental health clinicians, three doulas and a resource coordinator. They make home visits to anyone in Franklin or Grand Isle counties who is pregnant, has given birth, has experienced a pregnancy loss or is caring for a baby born to someone else.
The program, which is called HEART and serves between 85 and 100 families annually, began four and a half years ago, after nurses from Franklin County Home Health Agency reported seeing high numbers of families affected by perinatal depression and other mood disorders. The program started small, with just one home-visiting mental health clinician, but has steadily built up its staff. The efforts are funded primarily through state support for the 15 parent-child centers in Vermont, as well as money from the STAMPP grant and Medicaid reimbursement for clinicians' services.
"We know that [when] families that have good mental health and wellness, it supports caregiver-child attachment, which then positively impacts development," said Amy Johnson, director of the St. Albans center.
Johnson said she's encouraged to see more advocacy work at the state level for increasing access to perinatal support, including doulas.
One of those efforts is H.154, a bill recently introduced in the legislature that would help more Vermonters gain access to doulas by requiring Medicaid to cover up to $850 for doula services before, during and after birth.
Similar bills were introduced in 2019 and 2014 and failed to make it out of committee. But two of the new bill's 23 sponsors, Reps. Sara Coffey (D-Guilford) and Barbara Rachelson (D-Burlington), said they are hopeful that the effort will get more traction this time around. The legislators noted that in the past few years, other states have adopted similar legislation. Eight states and Washington, D.C., now provide Medicaid coverage for doulas.
Rachelson pointed to data indicating that being supported by a doula reduces the probability of a C-section, strengthens parental bonding and increases the likelihood of successful breastfeeding.
Advocates also point to benefits from doula care that are harder to quantify. Katelyn Brose, a Doula Project participant from Middlesex whose first child was born in December, said the postpartum support was particularly valuable.
Brose recalled her doula watching her son while she napped, then helping prepare dinner for the family.
"A big pot of chili, which was so wonderful," Brose said. "It filled my soul."
The original print version of this article was headlined "Helping Hands | A mental health agency in Washington County provides doula services to families — free of charge"
Tags: Health Care, Washington County, Washington County's Doula Project, doula services, pregnancy, mental health
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