You Can Hava a Doula

Recent data from the Centers for Disease Control and Prevention continues to tell the same bleak story we’ve been hearing for years: Black women suffer far worse maternal health outcomes than their white counterparts. In 2020, the maternal mortality rate for Black women was 55.3 deaths per 100,000 live births—nearly three times higher than the rate for white women. And what often gets missed from these statistics are the near-death experiences—according to one study, Black women are likely to experience a severe maternal morbidity event at a rate of 2.1 times that of white women. Black women are also more likely to have C-sections, have their pain minimized or ignored, report mistreatment and have stillbirths than white women.

“In the long ago,” said one mother of two children, “women were raised with a community around them who had experience they didn’t have. I had post-partum depression and couldn’t bond with my baby for the first six months. Thank goodness I had a doula. She helped me so much in all ways.”

The United States is 1 of only 13 countries where the rate of maternal mortality is worse than it was 25 years ago

One pathway to better outcomes is to invest in doulas, professionals who are trained to provide emotional and physical support during pregnancy, childbirth, and postpartum.  We still need to hold medical institutions accountable for their role in the current state of outcomes. This includes requiring implicit bias training, more patient feedback surveys and bedside data, early screenings for treatable health conditions, and extended postpartum coverage to a full year, to name a few.

That said, elevating the work of doulas is one part of the birthing process in which we can affect change immediately and in which we have research to show it makes a difference. In fact, one study found that doula-assisted mothers were four times less likely to have a low birthweight baby and two times less likely to experience a birth complication involving themselves or their baby. A study led by the University of Minnesota School of Public Health found that women with doula care had 22 percent lower odds of preterm birth. The study’s researchers theorize that “doula support during pregnancy may influence this constellation of risks for preterm birth by reducing stress, improving nutrition, improving health literacy, providing referrals and connections to resources, and improving emotional well-being.”

Doulas can also serve as a point of checks and balances to hold medical institutions accountable. They provide power and choice to a birthing person to ensure their birthing plan is executed. And when that plan cannot be executed as envisioned, doulas ensure patients understand their options and make an informed decision about their individual best course of action.

You can get insurance coverage for a doula!

Despite the positive impact doulas can have and their growing popularity, not everyone who wants a doula currently has access to one. The reasons for this are often twofold: Not all insurance carriers cover the costs of doulas, Some insurance companies will reimburse you for the cost of a doula, so it can be worth a call to learn what your benefits plan includes. In California, doulas are covered by Medi-Cal, Kaiser and Blue Shield insurances. If your insurance company balks at covering the service, it is possible to get a letter from your doctor explaining the need for those services.

The other factor is that there simply aren’t enough trained doulas to service women in need. Numbers vary state to state, but many programs highlight the need for more training to expand the doula workforce. Ultimately though, federal policies are critical to ensuring expectant parents no longer have to pay out of pocket or to rely on doulas who volunteer their time, or to go without this critical piece of labor health care. Legislation must be passed at the federal level that will cover doula care, so doulas can be properly reimbursed at a rate that allows them to thrive and the profession to expand in ways that increase access.

Today, the United States is 1 of only 13 countries in the world where the rate of maternal mortality is worse than it was 25 years ago. Ultimately, if we truly want to support pregnant women and help reverse unacceptably poor maternal health outcomes for people of color, prioritizing doula care is one policy action we should all be able to get behind.