Recent provisional data from the CDC’s National Vital Statistics System reveals that in 2022, Arkansas’ cesarean delivery rate is above the national average of 32.2%. Many cesarean deliveries are unnecessary, causing women to experience postpartum stress, trauma, and morbidities that could be prevented with the right information and support. Too few women have the information they need to make an informed decision about their delivery options. Trained and Certified Doulas, like those at Ujima Maternity Network in Conway, can provide the education and support women need to make an empowered and informed decision about their health and the well-being of their unborn baby.
Nicolle Fletcher, a certified doula, apprentice midwife, childbirth educator, co-founder, visionary, and executive director of Ujima Maternity Network, has been an active supporter and leader in maternal health since 2010. She helps Ujima achieve its goal of raising awareness about doulas and changing the narrative of childbirth.
“Ujima is a Swahili word that translates to collective work and responsibility,” Nicolle said. “It’s about making the problems of my brother and sister my own and solving those problems together.” In the midst of a maternity health crisis, organizations like Ujima provide a solution: collaborative effort from all parties.
“Everyone that touches maternal health on a small or grand scale, from the provider, mother, partner, grandmother, to best friend, has a responsibility in providing education and support and creating an environment where everyone is invested in saving maternal and infant lives,” Nicolle explained. Ujima Maternity Network works to bring people and resources together to streamline the quality of care provided to every birthing person.
Cesarean Deliveries Are Major Surgeries That Require Ample Recovery Time.
The World Health Organization warns that when the national percentage of cesareans exceeds 12%, the procedures are doing more harm than good for women. While there are appropriate scenarios for mothers to have a cesarean delivery, it is a major abdominal surgery that can cause more complications for a mother than a vaginal birth.
Doctors typically follow up 24 hours after surgery and then schedule an additional follow-up appointment 3-4 weeks later. After about four weeks, if a mother is doing well, the doctor may no longer follow up. “We don’t do this for any other type of major surgery,” Nicolle said. “So why do we do this for mothers?”
On top of the procedure and recovery, the mother must also take care of her new baby. All of this puts a significant amount of stress on the mother, who should be resting after such a major surgery.
Additionally, once a woman has a cesarean delivery, she is more likely in future pregnancies to have another. The more cesarean deliveries she has, the more problems she and her baby may develop.
The International Cesarean Awareness Network (ICAN) believes women deserve a trial at labor, meaning every woman who has had a previous cesarean should have the opportunity to have a trial at a vaginal birth. Vaginal birth is often the safer option. The mother’s recovery time is shorter, and there is less room for surgical error or postpartum complications from hemorrhage or medical equipment being left in the body. Vaginal birth also makes it less likely for a doctor to encounter a patient who’s allergic to anesthesia or other medication, as vaginal delivery often requires minimal medication.
“There is also a mentality right now that the term ‘healthy mom, healthy baby’ is focused on ensuring the mother lives through surgery and recovery. We’re not addressing the morbidities or psychosomatic behaviors that come from a traumatic birth,” Nicolle said.
Other Factors at Play
An increase in cesarean births doesn’t necessarily mean the rate of unnecessary procedures has risen. There are other factors that can be addressed:
A rise in sick patients. Conditions like gestational diabetes and hypertensive disorders during pregnancy are on the rise. Opting for a vaginal delivery in these situations would cause harm to the mother and baby.
Provider shortages. Because of the growing shortage of healthcare professionals, a mother may opt for a cesarean delivery (or be highly encouraged by her provider to do so) as a way to quickly perform the procedure and move on. Additionally, many providers are overworked and under-resourced, causing a dip in quality patient care.
A lack of education or information. Women are often uninformed or unaware of their options and, therefore, may not think to ask questions about the best delivery needs for their situation.
These factors support the important role that doulas, like those at the Ujima Maternity Network, play in providing mothers with evidence-based information to help them make informed decisions about the birthing option that is best for their health and the health of their baby.
Maternal Health Education and Support for Patients and Providers
Every second Saturday of the month, Ujima Maternity Network provides a free maternity care community outreach event. Women can attend alone, with their mothers, or with the whole family. “We provide support from the midwifery model of care and talk with mothers about the changes occurring in their bodies, what are normal changes, and what to expect overall during childbirth,” Nicolle said. “We offer information so that women can decide what makes the most sense for them.”
Women can also schedule appointments to meet with licensed midwives, doulas, and lactation counselors to receive comfort techniques and strategize a plan to support the mother and baby during the pregnancy and postpartum journey.
“We also have what’s called a ‘Sista Circle,’ which is a prenatal model where all women come together to talk about systemic bias, racism, potential complications, and birth options in a safe space,” Nicolle said.
Doulas are an out-of-pocket service for women. Most private insurance and Arkansas Medicaid plans do not cover doula support. “Around 60% of Arkansas’ birthing community is on Medicaid, so women may have trouble affording doula support,” Nicolle said. “To help buffer the cost, we offer an ongoing scholarship women can apply for at any time.”
For providers, Ujima creates rack cards, brochures, and other resources for clinics. “Someone can call us (501-777-5245) and say they need a stack of 500, and we’ll send it right to their office. That way, women who visit the office can find the resources and learn more information about doulas, midwives, or other support systems.”
Doulas Are Always in a Mother’s Corner.
A doula provides an informed confidante working for mothers, asking them questions and giving them information unique to each birthing situation. “Doulas help mothers get curious,” Nicolle added. “We ask questions to help clients think of things outside of how they normally would.”
If a provider tells a mother at 30 weeks that he needs to induce your baby at 38 weeks, doulas help mothers ask what other options are available to them. “We teach the BRAIN acronym. Benefits, Risk, Alternative, and Nothing. This will provide education and bring the patient into a more trusting relationship with their provider. What are the reasons I need this labor to be induced?” Nicolle said. “If a woman is not prepared to go into labor, and we induce her labor, we increase her chance of needing a cesarean delivery by 50%. That’s what too many women are experiencing today.”
While doulas are non-medical personnel, they create a pack mentality. “All of a sudden, you have a gang of experts, a pack of support, in your corner to ask if you’ve thought about everything you need to and if you’ve fully prepared for childbirth,” Nicolle said.
Collaboration Drives Positive Outcomes.
Arkansas ranks first in the U.S. in maternal mortality. According to the Arkansas Maternal Mortality Review Committee, 92% of Arkansas maternal deaths are preventable. “That is disheartening, but it also provides me hope knowing that there are actions we can take to prevent a majority of the maternal deaths in Arkansas,” Nicolle said.
“But it will take us working collaboratively with providers, nurses, and medical professionals. It will take critical thinking and bringing experts to the table who normally wouldn’t have a seat.”
One way to work collaboratively is to involve patients in the decision-making process. “Including the expectant mother in the decision-making is hugely empowering,” Nicolle said. “Often, a woman knows much more about her body than you might think.”
Doulas are an effective, underutilized resource in the fight to improve maternal healthcare. Often, providers do not think to recommend a doula or refer the mother to community resources to help with support and recovery. “One of the best ways providers can help make the connection between a mother and a doula is just to ask your patient if they have a doula,” Nicolle said.
“Something as simple as asking a mother about her support system at home can change the narrative and get moms searching for options and additional support. If their provider asks about it, the patient will believe it bears weight.” Healthcare professionals who utilize the support of a doula will soon realize the benefits they provide to patients and providers.
For more important healthcare topics, follow AFMCon on Facebook, Instagram, LinkedIn, X, and YouTube.
Subscribe to our newsletter for the latest news and updates, including the most recent episode of AFMC TV.
{slider title="Meet Nicolle Fletcher"}
Nicolle Fletcher is a native of San Diego, California. She is a wife and mother of three adult children. Nicolle was an Army officer's wife for 7 years until they moved to Conway, Arkansas, in 2007, where they still reside. While the move to Arkansas was intended to be a short 2 years, there was a mission beyond what she could even imagine. Nicolle co-founded the 501c3 non-profit City of Hope Outreach alongside her husband and their three children in the Fall of 2007. She then trained to become a Certified Doula in 2010 after a year of training. In 2011, she became a childbirth educator, and in 2012, she became a doula trainer and mentor. Nicolle has trained 45 doulas over the course of 12 years. In 2017, she became a Certified Lactation Counselor through the Healthy Children Project. She then added a Health Coaching Certification through Dr. Sears Wellness Institute in 2019. Ujima Maternity Network, Inc was formed on Ujima Day, December 28, 2019, and became a 501c3 nonprofit in 2020. Nicolle is the Visionary, Co-Founder, and Executive Director.
Nicolle is passionate about improving maternal health in Arkansas and has actively utilized all of these certifications and skills to better serve the community of birthing women.
{/sliders}
