New York City passes a new policy targeting soon-to-be parents with limited income and offering more support during birth.
Kohn and baby Louisa in Brooklyn, NY. Source: Kohn
By Kaitlyn Conway
Nataleigh Kohn, 33, of Hudson, New York, gave birth to her first child nearly two years ago. Contrary to what she’d expected, she found much of the experience of childbirth and its aftermath difficult and isolating.
“Before giving birth, all the emphasis is on your health, and the baby’s health, but the baby’s in your body. And then, after you give birth, all of the emphasis and the attention is on the baby,” Kohn said. “It’s a very vulnerable time health-wise, physically, emotionally, all of that. And it’s strange how little support there is for new moms.”
Kohn paid a premium to ensure top care; however, she said her own birth experience was anything but exceptional.
“I kind of felt like I was in The Handmaid’s Tale,” Kohn said. “With the doctors and everyone emphasizing ‘the baby, the baby,’ and then it’s like, ‘Wait, what about my health?’ and it feels like they’re saying, ‘No, your only job now is to provide milk.’”
Kohn said the experience brought to mind Margaret Atwood’s The Handmaid’s Tale, a dystopian novel where women are used for the sole purpose of reproduction.
“It’s very isolating and scary to be going through and not have any agency,” Kohn said. “I felt like I was being restrained.”
Kohn is not alone in that feeling. A study by the Reproductive Health Journal found that one in six people reported experiencing mistreatment, loss of autonomy, being scolded, or not receiving help when they asked during and after their hospital birth. When asked what would have allowed for more agency, Kohn said she wanted someone to help her through those challenging first moments of being a parent— a longing that might be familiar to many parents.
In some areas in the United States, doulas try to fill that role.
Julia Mannes, a childbirth consultant, educator, and retired doula in Harlem, New York, has helped thousands of people through births and coached them through those harrowing first moments.
Mannes taught childbirth education at Mount Sinai Hospital in Manhattan for years. While working, Mannes was told by administrators to ‘empower and inform women… to an extent.’ Her supervisors told her not to tell anyone about doula services unless they explicitly asked.
Doulas are non-medical birth workers who can support the person while pregnant, preparing for birth, during labor, and offer support in post-partum care. Birth doulas can work with the laboring person in the hospital, help coach the person through their labor, and maintain pre-established boundaries for the family to find calm during the typically hectic time.
“If I could go back, I would want someone who was really there just to support me in the birth process,” Kohn said. “And also to be there right after because you are left on your own, and it’s so hard.”
In New York City, the City-Wide Doula Program offers low-income parents access to doulas like Mannes at no charge. This initiative, signed into legislation by Mayor Eric Adams in the fall of 2022, aims to reduce maternal mortality, provide a more positive birth experience, and have more secure baby-parent bonding for New York parents.
“A lot of the conditions that birth works best under are the conditions that sex works best,” Mannes said. “Intimacy, privacy, trust, and feelings of security.”
Those conditions are what doulas try to maintain for the families they work with. In hospital settings, with bright lights and loud noises, that’s easier said than done.
“It’s about being informed and empowered and knowing their options and knowing that you have a care provider who has other tools in their bag of tricks,” Mannes said.
Unfortunately, feelings of isolation and fear, as Kohn felt during the birth of her baby girl, are not uncommon. What also happens are the stories of nightmares; ask a room full of parents about their birth stories, and you will likely get just as many stories that make your jaw drop from shock than you might tales of picturesque chubby cheeks and first kisses.
“I have witnessed one woman who didn’t have an epidural, and the obstetrician reached her hand inside this woman and pulled her placenta out,” Mannes said.
The placenta, an organ that develops in the uterus during pregnancy, provides oxygen and nutrients to the fetus. Amazingly, it is the only organ the human body develops when needed and then discards. Typical delivery of the placenta is ten to twenty minutes after the delivery of the baby. Some hospitals have a protocol to remove the placenta after 15 minutes after the delivery of the infant if it has not yet naturally detached. Many people are given the drug Pitocin, which accelerates labor and the process of placental detachment without the need for outside physical intervention.
“[The doctor] did it because she felt that was like the right thing to do. She didn’t give the mom any warning,” Mannes said. “And so that’s like one example of something horrifying that can happen in birth. I can still hear her screams.”
Removing the placenta, or any other internal organ, by force is reported to be extremely painful.
“I mean, the question is how rare are these stories and how common are some of these,” Mannes said. “That is what the challenge is.”
The City-Wide Doula Program aims to reduce the commonality of these horror stories and replace them with support and community care. People who receive doula support have lower preterm and cesarean birth rates when compared to other Medicaid beneficiaries, and have 22% lower odds of preterm birth. Both numbers indicate lower rates of trauma during birth. In addition, cost analyses show that with doula support, state welfare saves an average of $986 per birth due to fewer complications and less time spent in the hospital for both parent and baby.
The experience of birth for someone with marginalizing characteristics is likely to be significantly different from that of an affluent, non-disabled white woman such as Kohn. Marginalized and low-income families are the target of the New York program. To qualify, parents must live in neighborhoods indicated by the New York Taskforce on Racial Inclusion and Equity, live in shelters, or qualify for Medicaid.
Despite her misgivings, Kohn is repeating the experience. This time, she will have a hired doula on hand. She is expecting her second child later this year.