On International Women’s Day, many American women have to reckon with a bleak reality: They are more likely to die from complications related to childbirth than every other developed country in the world. The numbers get even worse for Black mothers in New York specifically, who are five times more likely to die in childbirth than white mothers, a rate higher than the nation as a whole. And according to state data from 2018, when 41 women died from pregnancy-related causes, discrimination was found to have played a role.
It’s why lawmakers in Albany want to expand access to doulas, nonclinical professionals who provide guidance and support throughout pregnancy and after. A handful of them held a hearing on Tuesday on how to better integrate doula services into the state’s health care system, as well as increasing their rates of reimbursement from Medicaid. “A theme that we hear is that (doulas) have felt left out in policymaking when (reimbursement) rates are set and things like that,” state Sen. Samra Brouk, a staunch advocate for expanding doula care who co-led the hearing, told City & State. “The fact that we hosted this hearing and had doulas from all over the state come, it was really amazing to hear their stories.”
The importance of reducing racial disparities through culturally competent support and advocacy was a common theme among doulas who testified. “Being present during so many births, there have always been two consistent asks of the birthing person or mother,” Shannon Johns, a doula and founder of Calming Nature Doula Services, said at the hearing. “The first is, ‘Will you be there?’ And the second ask that I get is from my Black mothers say, ‘Can you make sure they don't let me die?’” Brouk, who is Black, told City & State that she had a similar experience when she gave birth less than a year ago.
Research on the topic has shown that doulas have led to more positive birth experiences, particularly for mothers of color. The American College of Obstetricians & Gynecologists and the Society for Maternal-Fetal Medicine have called doulas “one of the most effective tools to improve labor and delivery outcomes” all the way back in 2014, with more recent data only offering greater support. “Doulas save lives, period,” Esther Patterson, co-chair of the leadership council at BirthNet NY, testified on Tuesday. “Doulas are a part of the solution to this health care crisis, Black and brown doulas particularly.”
Despite the proven success of doulas in improving birth outcomes, every person in the field who testified said that reimbursement rates from Medicaid remain too low. “We’re looking for… a living wage for this very, very grueling – both emotionally and physically – difficult work,” Brouk said. She said that under a state doula pilot program launched in Erie County and parts of Brooklyn in 2019, the caregivers were getting only $600 per birth, which she called “abysmally low.”
But Brouk expressed confidence that after decades of disparities in birth outcomes and dismal maternal mortality rates, the time is ripe for change. “When you look around, there are more women and Black women than ever before in the state Senate, there are more mothers who have had a doula,” Brouk said. She added that she feels especially hopeful to have a woman and mother like Gov. Kathy Hochul serving as the state’s chief executive for the first ever. “I am reminded of what happens if we only have men in these spaces, and the lack of knowledge they have about maternal health,” Brouk said of conversations she has had with colleagues both before and after taking office. In New York City, the majority-women City Council has passed legislation supporting doula care for mothers.
The state Senate has made some recent headway in increasing access to doulas as part of a package of bills it passed last week meant to improve birth and maternal health outcomes. The chamber unanimously approved legislation from Brouk that would create a community doula directory specifically for those serving Medicaid patients meant to make it easier for pregnant people to find and connect with that support.