As the young female inmate from the San Francisco County Jail prepared to give birth to her first child at San Francisco General Hospital, she found comfort in the fact that she wasn’t alone. Sitting by her bedside was a doula, a trained nonclinical birth companion whom she had been working with for several months through the Bay Area’s Birth Justice Project.

Founded four years ago by two nurses/doulas, Nicole Sata and Darcy Stanley, the Birth Justice Project is one of only a handful of programs in the country that offer doula services to incarcerated women. While the program has been assisting pregnant women who are serving time at the San Francisco County Jail for the past four years, it was expanded in 2014 to include inmates at Santa Rita Jail in Dublin.

Adi Afek, a volunteer doula with the Birth Justice Project, acknowledges that giving birth while incarcerated isn’t easy. An inmate’s loved ones are limited to one-hour visits and new mothers are separated from their babies within 48 hours when they return to jail. The Birth Justice Project strives to change the birth experience for incarcerated women by offering them desperately needed pregnancy, labor and postpartum doula services.

“Inmates are given medical care in jail, but until our project launched, these woman didn’t have access to doula care,” says Afek who is working in the new Alameda County program. “There is a lot of emotional trauma involved with delivering a baby while incarcerated, and having to leave the baby with health care workers when they return to jail.”

As an inmate finishes her jail sentence, her baby is either placed in foster care or with her relatives.

Afek says that doulas can help with this transition by serving as the inmate’s uninterrupted support person. Professionally trained in childbirth, doulas provide emotional, physical, and informational support to expectant mothers. Their purpose is to help women have a safe, memorable and empowering birth experience. A study published in the winter 2013 issue of The Journal of Perinatal Education, also showed that doula-assisted mothers were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.

After seeing the success of the doula program with pregnant inmates in the San Francisco County Jail, the Birth Justice Project, in collaboration with the University of California, San Francisco Schools of Medicine and Nursing and the East Bay’s Black Women Birthing Justice collective, applied for grant funding from Alameda County to expand the program to Santa Rita Jail.

“Until 2012, pregnant inmates were shackled and could have no one with them during labor except the medical staff and deputies,” says Monica McLemore, assistant adjunct professor in UCSF’s Department of Family Health Care Nursing. “Our volunteer doulas offer services that many pregnant women take for granted.”

In addition to offering doula services to incarcerated women, the Birth Justice Project’s doulas facilitate women’s health groups in the Santa Rita Jail and at Jelani House, a residential recovery center in San Francisco. The classes are offered to all women, not just those who are pregnant.

“The classes are unique in that the women in the groups choose the curriculum,” McLemore says. “And rather than lecturing to the women, the doulas are active participants in each class.”

A New Kind of Doula Training

As a result of the Birth Justice Project, McLemore says many of the women serving sentences in the San Francisco County Jail expressed an interest in becoming doulas. This sparked the idea to begin offering doula training to formerly incarcerated women and low-income women of color.

Last February, the Birth Justice Project and the Bay Area’s Black Women Birthing Justice collective, launched The East Bay Community Birth Support Project, a comprehensive nine-month doula training. A total of 16 trainees were chosen to participate in the program, including both formerly incarcerated women and low-income women of color.

“We wanted to train doulas that could provide valuable birthing services to other women of color,” says Linda Jones, a doula and co-founder of the Black Women Birthing Justice who is also involved in the new training program. “At the same time, our trainees are learning how to market themselves and operate their own business as a doula.”

This can be especially helpful to women trying to rebuild their lives after serving time in jail, and often find it difficult to secure employment with a criminal record.

With funding from the Alameda County Department of Public Health, the East Bay Community Birth Support Project offered the 16 trainees 48-hours of classroom experience this past summer to prepare them to assume the role of doulas.

The trainees come from diverse backgrounds. McLemore says that none of those who were formerly incarcerated were arrested for violent crimes, and that all had jobs prior to their arrest.

“We believe our doula training program can help to reduce recidivism and improve reentry outcomes,” McLemore says. “They are learning a skill that will help them to serve pregnant women in the community, and become small business owners who generate income working as a doula.”

Since doula care is not covered by public or private insurance plans, and the cost of a doula in the Bay Area can range from $500-$1400, depending on experience and location, Jones says it can be cost prohibitive for many low-income families to afford a doula’s services.

“As part of their training each of our 16 doula students are volunteering their services at five births in the Bay Area to low-income families,” Jones says. “That’s 80 women in our community who are receiving doula care that couldn’t afford it otherwise.”

Moving forward, McLemore and Jones hope to secure funding that could help to pay for doula services for low-income Bay Area women who can’t afford the cost.

Jones also believes it’s important to train more women of color to be doulas, since there continues to be a lack of diversity in the birthing community. In addition to being able to make a greater impact by relating and understanding more about their ethnic group, doulas also reduce health disparities –one of the key goals of the health care reform law – by supporting positive outcomes. Doula care has been shown to contribute to a 50 percent reduction in caesarean sections that can put women at risk of additional medical complications.

Doulas Making A Difference in Their Communities

For Elena Aurora, one of the 16 trainees to go through the doula training program last summer, the apprenticeship meant fulfilling her lifelong dream of becoming a birth worker, while also helping clients bridge language and cultural barriers in order to meet their health needs.

Elena Aurora, who is Peruvian, and speaks Spanish, was one of the low-income women of color selected to participate in the initial doula training.

“I think being bilingual is a huge plus for a doula,” Elena Aurora says. “They can communicate with expectant mothers in their native language.”

Statistics show that minority women in the United States are also more likely to die during or soon after childbirth than white women, and Elena Aurora believes that increasing the availability of doulas of color can lead to better outcomes.

“When a doula is present there is less need for medical intervention,” Elena Aurora says, and a 2013 study published in the American Journal of Public Health confirmed this, finding that women on Medicaid who gave birth with the support of a trained doula, were 40 percent less likely to have a C-section than Medicaid recipients who had a baby without that support.