Doula support can change the way young mothers interact with their babies. (Photography by Lloyd Degrane)

Labor and love

Doulas can make an important difference for young, low-income mothers and their babies.

When Tikvah Wadley encourages a young mom to read to her baby, she often gets a stunned response. “They are like, ‘Read?’” Wadley says. “And I say, ‘Yeah, she likes your voice, she likes to hear from you.’”

A gentle woman with a sparkle in her voice, Wadley has been by the side of hundreds of adolescent mothers in her South Side community during pregnancy, childbirth, and beyond. She’s a doula—or support person for a new mom—whose roles include parenting coach, hand holder, comforter, and advocate. Doulas are perhaps more popularly associated with upper-middle-class women who can afford to pay for their help, but a project by Sydney Hans, the Samuel Deutsch Professor at UChicago’s School of Social Service Administration, showed that community doulas, including Wadley, could make a big difference in the lives of young, low-income African American moms and their babies.

Throughout her career, Hans has studied risk and resilience in families and the long-term effects of early life experiences. As an undergraduate at Cornell University, she majored in human development and family studies; her PhD from Harvard is in psychology and social relations. Hans’s scholarly focus formed in her early days at UChicago. She first joined the faculty in 1978, as a member of the psychiatry department (her move to the SSA came in 2005), and in psychiatry, she studied the cognitive development of babies whose mothers were using drugs during pregnancy.

Hans expected to see brain damage in the children, whom she and her team followed until they were teenagers, “and we didn’t,” she says. Instead, she identified only subtle cognitive deficits in attention. “The big thing we saw was that children who had caring, really supportive parents—and many addicted women fell into that category, or there were family members who fell into that category—those kids did OK. And some of them thrived.”

The children without such support struggled. “It became really apparent to me how important those relationships in the first year were in providing those kids with a strong emotional foundation for everything that was to come.”

Hans became interested in the work of doulas through Irving B. Harris, child advocate and philanthropist (and namesake of the University of Chicago Harris School of Public Policy). In the mid-1990s, Harris helped fund three doula programs, collectively called the Chicago Doula Project, which partnered with established teen parenting programs. He was looking for research data on whether the programs actually worked, and he came to Hans to help him find it. “I started visiting these programs and seeing what they were like on the ground,” she says.

She was impressed. “It wasn’t an adult coming to them and saying, ‘We’re going to teach you to be a good parent.’ ... It was an adult coming to them and saying, ‘Boy, you’re having a baby soon, and that’s a big deal.’” Especially for teen moms-to-be who are frightened and perhaps uncertain about their futures. “Here’s this warm, caring woman who basically says, ‘I want to be with you throughout this whole thing’”—through the pregnancy and the labor and afterward—“‘and I won’t leave you until everything’s OK.’ That really resonated with these teenagers, and it was something they really did want,” Hans says.

In 2001, with a federal Maternal and Child Health Bureau grant and the support of UChicago’s Department of Pediatrics, Hans launched a fourth site of the Chicago Doula Project at the University of Chicago to put some data behind her observations on doula intervention.

Her research affirmed the doula model. One study, published in Pediatrics in November 2013, looked at breast-feeding—“an important public health goal,” Hans says. She found that 64 percent of mothers with community doula support through 12 weeks postpartum attempted to breast-feed their babies immediately after birth, compared to 50 percent of mothers in a control group. Mothers with doula support were also much more likely to continue breast-feeding longer than six weeks.

In another study, published in Infant Mental Health Journal, Hans found that moms with doulas did better at encouraging their infants’ learning at four months—by talking to the baby, using animated voices, and making expressive faces—than moms without doulas. They were also more likely to respond quickly when their babies were in distress.

Hans recorded video of mothers with their babies at four months, one year, and two years. The differences in parenting faded over time, which Hans says is an indication that good parenting behaviors need reinforcement with home visits beyond the first few months after a baby is born. “And the doulas got them looking into their babies’ eyes and having conversations with them when they were teeny tiny—they need to be reminded of those things,” Hans says. “They’re living in communities that are under a lot of stress, where the kind of interactions with young children may not always be what we now know are most supportive of brain development and other good outcomes.”

The four doulas worked out of two South Side prenatal clinics. Three had breast-fed their own babies, “which made them very unusual in their communities,” says Hans. One had been a parent to a teen mom; the others had been teen moms themselves.

Wadley was working as a medical aide when she heard about the project. “I was like, ‘Yeah, I want to do that. I know what it’s like to be in labor and delivery and not have anyone.’”

Wadley, whose children are grown now, had her first pregnancy at 17 and hid it until her third trimester. She learned to breast-feed unexpectedly, from a woman who, not unlike a doula, was caring but not a family member. She was a staffer at a federal aid office where Wadley had come asking for formula. Wadley and her newborn were nearly penniless, but because she’d only just started working, she couldn’t produce proof that her income was low enough to qualify for formula from the Women, Infants, and Children program. Instead, the WIC staffer taught her how to breast-feed in the back room. “She said, ‘You can still feed your baby,’” Wadley recalls. Crying, Wadley asked how. The WIC staffer explained, “You can feed your baby with your chest.”

Today Hans continues her research with studies on doula intervention for at-risk moms in four communities across Illinois. She hopes to follow the children until they’re a year old, or beyond. “These are programs,” she says, “where they have the opportunity to remain engaged for the long haul.”