This story is being published in partnership with MindSite News, a nonprofit news site that reports on mental health.

Jacquesta Michel’s baby shower was supposed to be themed around her favorite Disney movie, "The Lion King." Then her blood pressure spiked. Instead of dancing and eating Simba cake, the Florida mom and licensed clinical social worker found herself in the hospital in July, nearly three months before her due date. At night, she slept fitfully, worrying that she and her baby wouldn’t survive. 

During those stressful weeks, her lifeline was Sabine Renois, a birth doula. Renois would show up at the hospital in Fort Lauderdale, Florida, every day for hours at a time. Michel had a midwife, but it was Renois who translated and softened the alarming language from nurses and doctors. She massaged Michel’s neck and ears with essential oils and assured her that whatever happened, she could handle it.  

With Renois’ help, Michel would fall back asleep, sending her blood pressure down. But over time, it crept back up and eventually she had to undergo an emergency cesarean section. While that wasn’t in her dream birth plan, Renois had already given baby Ezra more time to grow and eased Michel’s anxiety, making everything more bearable.

“This is the most traumatic thing I've ever experienced in my life,” Michel said. “And I'm so glad Sabine was there. Her whole presence  – her voice, the words she used – it was all very calming.”

Doulas like Renois are non-clinical health care workers trained to tend to the physical and emotional needs of women during pregnancy, childbirth and beyond.

They’ve been around for centuries – the word comes from the ancient Greek and today means “one who mothers the mother.” In the U.S., they are slowly becoming more widely used, partly as a way to address longstanding inequities that lead to higher rates of premature births, pregnancy complications and maternal deaths among mothers of color.

While the first year after a child’s birth is a time of joy and bonding, it can also be a time of risk: Suicidality is now considered a leading cause of maternal mortality for women in the year after they give birth. Postpartum mood disturbance, although usually mild and short-lived, affects up to 85% of women, with 10-15% experiencing depression and anxiety and 1-2 women per 1,000 developing postpartum psychosis.

But doula support not only leads to reduced birth complications and higher rates of breastfeeding, it also boosts new mothers’ mental health. A recent study found that women using doulas had a nearly 65% reduction in odds of developing postpartum depression and/or postpartum anxiety, provided doulas were present during labor and delivery.

Yet doula care is often unaffordable to low-income Black women and other women of color, who have the highest risk of birth-related complications and postpartum mental health conditions. That is starting to shift, as doulas become available in more communities. The Doula Network, an Orlando-headquartered company that provides health plans with credentialed doulas, has expanded doula services and pilots to 11 states. 

While most women go through birth without a doula, more insurers now provide coverage. Bills passed, introduced or under consideration in California, Massachusetts, Missouri, Virginia and New York encourage private insurance plans to pay for doula care, and Rhode Island requires it.  

Today, at least 12 states are paying for doula care through Medicaid, the joint federal-state health insurance program for people with low incomes, and eight are in the process, according to the National Health Law Center’s Doula Medicaid Project. In Florida, where about 100,000 Medicaid births occur each year, only Medicaid enrollees in managed care plans have access to the doula benefit. Recently, the Biden Administration approved Florida’s application to extend postpartum coverage from 60 days to 12 months.

'Doulas bring humanity back'

From its base in Miami, the nonprofit Southern Birth Justice Network trains and matches community-based doulas across the country and runs a mobile midwifery clinic that travels to historically Black neighborhoods in Miami. Nadirah Sabir, a newly certified doula there, sees her work as providing care that once came from grandmothers and aunts. 

“Everything around pregnancy and childbirth is a ritual that requires community,” Sabir says. “Doulas bring humanity back and put clients center.”

Black women are three to four times as likely as white women to die during or after delivery regardless of income or education level. They’re also more likely to suffer life-threatening postpartum complications.

Doulas from organizations like the Justice Network pair tradition with Western medicine to help clients advocate for themselves. Black women frequently report that when they try to raise or discuss a medical problem during or after birth, providers are less likely to believe them than white women.

Indeed, Black women are the least likely to be listened to when they raise an issue about their birth concerns, increasing the risk of death and complications for mothers and babies, according to a 2018 survey in California Health Reports – a finding echoed in a study published in 2022 in Women’s Health Reports. Research on U.S. pregnancy and childbirth by the World Health Organization backs up these reports.

“Sometimes I'm the only other person who looks like my client,” says Brianna Betton, chief operating officer of The Doula Network. “I've been in hospital rooms where I've had to repeat myself multiple times to the provider. Imagine what that would look like for my client if they were alone.”

Care with a doula is also more holistic, involving multiple prenatal and postpartum visits as well as connections to community resources for food, diapers, transportation, or mental health. 

Through its GROW Doula program, the Florida Association of Healthy Start Coalitions has trained over 200 doulas. Brittney Palmer reached out for help after providers suggested she try birth control instead of  trying to get pregnant. Of her doula, Palmer said, “She made me feel seen and heard.”

'I never want any woman to feel unimportant'

Renois, a nurse who trained as a doula through the Southern Birth Justice Network, sees her work as a calling. “I've experienced being pregnant and feeling shame. I’ve been to the E.R. and the doctor has put me down. I've had postpartum depression. I've dealt with all of that and it doesn't feel good at all,” Renois  says. “I never want somebody to feel the way I felt.”  

Michel’s pregnancy was a lonely experience in the beginning, and she knew she wanted more support. She’d dealt with morning sickness and couldn’t stand the smell of grass, which was especially challenging because she loved nature.

She also was aware of the high mortality rate for mothers like herself and was fearful of not getting the right care. But instead of calming her fears, Michel said her OB-GYN told her giving birth was going to be the worst pain she’d ever experienced and dismissed her request for a birth plan.

Ezra was born early at 28 weeks and remained in the NICU, or neo-natal intensive care unit, for nearly three months for help with his breathing, getting stronger each day. Michel worried about him but she was hopeful. She went  to the hospital daily, held Ezra skin-to-skin, and read a book of affirmations called “I’m a Little King.” Renois continues to check in regularly by phone. And three weeks ago – a glorious day  – baby Ezra came home.

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