Kenda Sutton-El: My client actually had a nine-centimeter fibroid and I had to keep reminding the health care staff that, hey, she actually does have a nine-centimeter fibroid in her chart, it was noted as two centimeters. And so she had a beautiful natural childbirth, but once they got time to like checking to look after delivering the placenta, they realized that she was still bleeding. She was still hemorrhaging. And so they were looking for tears or cuts. And I said, “Hey, I think that’s probably the fibroid. I think we need to look there.” And they were like, “What? What fibroid? What are you talking about?” And I was like, “she has a nine-centimeter fibroid. That’s probably what’s happening.” And so by me constantly reminding them what was happening within my client’s body, that she wasn’t able to tell them that was happening, actually saved her life. 

Black women are nearly 3x more likely to die during childbirth than white women. A growing effort to cover doula care under Medicaid and private insurance could save millions of lives.

Kenda Sutton-El: I’ve been a doula for over 15 plus years. Doulas are a non-medical support person that provides advocacy, education and physical support to the birthing people and their partner.    

Amber Heiskill: A doula is someone who is trained to provide physical comfort and emotional comfort to a person during their pregnancy, while they’re also in labor, and throughout their postpartum experience as well. 

Chelsea Watson: I always like to say my role is not to replace anyone, but to kind of add to your experience like a birthing bestie. 

Black women are more likely to have C-Sections, have their pain minimized or ignored by healthcare providers, and report mistreatment than white women.

Amy Chen: Right now we are in the middle of a maternal mortality and morbidity crisis in the United States.

Kenda Sutton-El: Black women are three times more likely to die during childbirth than white counterparts. And when you look at the data and statistics, according to the CDC, 68% of these deaths are preventable. 

Birth In Color was founded in 2018 because the maternal mortality rates were increasing for Black women. People were unaware of where they can actually find a doula of color. We wanted to create a central foundation so doulas of color actually had faces in a central directory.

Dana Williams: Representation matters. It’s important to have someone in a room that looks similar or just like you that understands where you come from and understands how you think and understand how you talk.

Amy Chen: Doulas have been found to help address maternal mortality and morbidity, in particular for black and indigenous, pregnant and birthing people, in part by providing individually tailored and patient centered care. 

Sequoia Phipps-Hawkins: If Black women are three times more likely to die, no matter their class, their education level, their income level. Then we know the problem is not race, but it is actually racism. 

Within the systems we operate, there are implicit biases that are often permeated through healthcare systems. So it’s really important for people of color to have a doula because they need more advocacy in these spaces.

Amber Heiskill: The biggest role that a doula has in racial disparities is being aware of them, addressing them, and not being afraid of speaking up for what is right, and holding people accountable for the way that they treat their clients.

Kenda Sutton-El: So we provide parent support groups, childhood education, lactation support…

Dana Williams: One of my of my clients, they had a scheduled cesarean. We went to a hospital, unnamed, they didn’t really quite treat her well. They kind of disregarded all her feelings, when I got there, things kind of changed. I made sure that she was advocated for, that she was able to speak up for herself. 

Amy Chen: Among other things, doulas have been found to increase breastfeeding rates, lower rates of preterm births, lower rates of cesarean births. So in the context of, say, Black pregnant or birthing people, or other peple of color, even low income people, doulas can really provide valuable support that is not otherwise present in the medical system.

For a birth doula, individuals can usually expect to pay $1,500 and $4,000. The cost of doula care can put this critical care out of reach for many Medicaid-reliant pregnant people.

Amy Chen: The reality is that most people are on Medicaid are on Medicaid because they’re low-income. They’re just not going to be able to afford the amount that doulas typically cost, sort of market rate, out of pocket.

To help more low-income individuals gain access to this care, states have started to expand Medicaid to cover doula services.

They states that currently have Medicaid coverage for doula care are Florida, Maryland, Minnesota, New Jersey, Nevada, Oregon, Rhode Island, Virginia, California, Michigan and Washington, D.C.

Kenda Sutton-El: We’ve seen a lot of people who have not been able to afford doula coverage previously, actually excited and have the beautiful, joyous births that they’ve always wanted.

We worked hand in hand with our government, with our Department of Health, to ensure that it was something that the doulas wanted. And they promised that they would make sure that the doulas voice was included, and they actually did. It was a team effort, and that’s why it’s so successful here in Virginia.

Rhode Island took things a step further in 2021 by including doula services in private insurance reimbursements, thereby expanding doula care access to families of all economic backgrounds, beyond Medicaid.

With two bills in consideration, Virginia hopes to be the next state to require private insurers to reimburse for doula care.

Amy Chen: For Black pregnant and birthing people, the maternal mortality and morbidity rates, they stay constant regardless of socioeconomic status, regardless of class, regardless of education. And so really, if you’re looking to address just Black maternal mortality, you really need to expand doula access beyond Medicaid coverage, right? It has to be in the private insurance context as well. 

Kenda Sutton-El: So we want to make sure that not only are the underserved, Medicaid population able to obtain doulas but also that across the board, all birthing people are able to have that benefit and have it covered.

Expanding both private and public insurance coverage for doula care could significantly reduce rates of maternal mortality.

Dana Williams: I chose birth work because we don’t have a lot of people who have the hands and the heart to serve Black women, women of color. 

Chelsea Watson: I wanted to make a difference in my community as well as I had my own traumatic birth experiences, and I didn’t know that there was someone who can advocate for me.

Sequoia Phipps-Hawkins: What I love about doula work is helping clients find their ability within them to have the birth that they desire.