Name: Vanessa J.

Celebria Course & Section: BSN 4B Date: October 25, 2025

Article:

Advocates: Doulas could lower Indiana's pregnancy-related deaths

by: Abigail Ruhman on October 24, 2023

Indiana has the country’s ninth highest infant mortality rate and the third highest maternal mortality rate.
Advocates said doulas can educate patients and help prevent pregnancy-related deaths. In its review of pregnancy-
related deaths in 2020, the Indiana Maternal Mortality Review Committee found 77.8 percent of them were
preventable.

Joslyn Cunningham is the founder of Blissful Birth Doula Services, and spoke at the State of Women in
Indiana conference last week. Cunningham said during the pregnancy, the pregnant person and the infant are
viewed as a unit. But after the birth, someone needs to focus on the parent to identify the signs of preventable
complications.

“The support that you had while you were pregnant is not the support that you had after you had the baby,”
Cunningham said. Cunningham said doulas provide one-on-one support that allows them to identify signs of
preventable complications. Part of that support is teaching patients how to advocate for needed care. “There are
a lot of people, especially people of color, especially Black birthing people who do not realize that they have a
voice in this process,” Cunningham said. Cunningham said doulas can provide “wrap-around” care — starting
when someone finds out they are pregnant and going into postpartum care. While doulas are not medical
providers, a birthing person matched with a doula is two times less likely to experience a birth complication.
Cunningham said doulas know to ask questions that may prevent risks during labor and delivery — such as
medically unnecessary cesarean deliveries, or c-sections. “We are here to support the birthing person — to support
my client, and make sure that everything that they feel like they need and want within their birth and in their plan
is essentially succeeded to the best of our abilities,” Cunningham said.

Doulas are also linked to better outcomes for the infant. Data shows infants are four times less likely to
have a low birth-weight when a birthing person has a doula. In Indiana, about 40 percent of births in 2021 are
financed by Medicaid. According to the Indiana Department of Health, three out of four people who died within
one year of pregnancy were enrolled in Medicaid. In 2019, state lawmakers passed legislation that allowed doulas
to be reimbursed, but did not require it. It also didn’t assign any funding to reimbursements for doulas.
Cunningham said doulas are underpaid, but want to provide care to those who need it most. And she encouraged
people to reach out to lawmakers and ask for funding to be added to legislation.
Reflection:
We have learned about doulas when they introduced them to us during our Fundamentals of
Nursing and also was mention during our Maternal and Child nursing however as a fourth year student, I
have not seen a doula before. This article piqued my interests because doulas could also be used and
introduced to patients in the Philippines to help lower pregnancy related deaths. As a student nurse, I am
aware that it is also part of the nurse’s responsibility to take care of the patient (mothers) by monitoring
for complications and as advocates for their rights however taking into consideration that the time might
be limited due to Philippine nurses takes care of many patients per shift and may miss some topics to teach
her patients and also it is possible to have overlooked some data assessment. Personally, I think a doula is
helpful not just to the nurse but especially to the patient because he/she could provide one on one care for
the patient, but this statement doesn’t indicate that nurses are incompetent in providing care its just that
doulas exists to focus monitoring on their patient and could be a great key factor to prevent pregnancy
related death.

As the article stated, the infant also could benefit if the mother has a doula by having a healthier
birth weight. “Newborn Health Begins With Mothers. To a considerable extent, the well-being of a
newborn depends on the health of the mother. When mothers are malnourished, sickly, or receive
inadequate prenatal and delivery care, their babies face a higher risk of disease and premature death”
(Healthy Mothers and Healthy Newborns: The Vital Link, 2022). It would be beneficial for the country to
have implemented a law to provide doulas for pregnant mothers, starting off with teenage pregnancy and
high risks pregnancies with comorbidities, as they are the most at risks for pregnancy related deaths.

The nurses and doulas can work together hand in hand to provide the best care for the patient and
her newborn/s. This could be a step towards the future of labor and delivery where pregnancy related
deaths are decreased, the pregnant mother taken care of especially with the possible occurrence pregnancy
depression and newborns with healthy weights.

Reference:
Ruhman, A. (2023, October 24). Advocates: Doulas could lower Indiana’s pregnancy-related deaths.
WFYI Public Media; WFYI. https://www.wfyi.org/news/articles/advocates-doulas-could-lower-
indianas-pregnancy-related-deaths
Healthy Mothers and Healthy Newborns: The Vital Link. (2022). PRB.
https://www.prb.org/resources/healthy-mothers-and-healthy-newborns-the-vital-
link/#:~:text=Newborn%20Health%20Begins%20With%20Mothers,for%20her%20newly%20bor
n%20child.