This story is published in partnership with MindSite Newsa nonprofit news site reporting on mental health.
Jacquesta Michel’s baby shower was supposed to be themed after her favorite Disney movie, “The Lion King.” Then his 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, fearing that she and her baby would not survive.
During these stressful weeks, her lifeline was Sabine Renois, a birth doula. Renois showed up at the hospital in Fort Lauderdale, Florida, every day for hours. Michel had a midwife, but it was Renois who translated and softened the alarming language of the nurses and doctors. She massaged Michel’s neck and ears with essential oils and assured him that whatever happened, she could handle it.
With Renois’ help, Michel fell back to sleep, lowering his blood pressure. But over time, it returned and she eventually had to have an emergency C-section. Even though it wasn’t part of his dream birth plan, Renois had already given baby Ezra more time to grow and eased Michel’s anxiety, making everything more bearable.
“It’s the most traumatic thing I’ve ever experienced in my life,” Michel said. “And I’m so glad Sabine is here.” Her whole presence – her voice, the words she used – it was all very calming.
Doulas like Renois are non-clinical health workers trained to meet the physical and emotional needs of women during pregnancy, childbirth and beyond.
They have been around for centuries – the word comes from ancient Greek and today means “one who mothers the mother”. In the United States, they are increasingly used, in part to address long-standing inequities that lead to higher rates of premature births, pregnancy complications and maternal deaths among mothers of color.
If the first year after the birth of a child is a period of joy and bonding, it can also be a period of risk: the suicidal tendency is now considered a leading cause of maternal mortality for women in the year following childbirth. Postpartum mood disorders, although usually mild and short-lived, affect up to 85% of womenwith 10-15% experiencing depression and anxiety and 1-2 in 1,000 women developing postpartum psychosis.
But the support of doulas does not only lead to reduction of childbirth complications and higher rates of breastfeeding, it also improves the mental health of new mothers. A recent study found that women using doulas had a nearly 65% reduction in risk of developing postpartum depression and/or postpartum anxiety, provided doulas were present during labor and delivery.
Yet doula care is often unaffordable for low-income Black women and other women of color, who are at the highest risk for childbirth complications and postpartum mental health issues. This is starting to change, as doulas become available in more communities. The Doula networkan Orlando-based company that provides health plans with credentialed doulas, has expanded doula services and pilot projects in 11 states.
While most women give birth without a doula, more insurers now offer coverage. Bills passed, introduced or under consideration in California, Massachusetts, Missouri, Virginia and New York encourage private insurance plans to pay for doula careand Rhode Island requires it.
Today, at least 12 states fund doula care through Medicaid, the joint federal-state health insurance program for low-income people, and eight are in the process of doing so, according to the National Health Law Center Medicaid Doula Project. In Florida, where about 100,000 Medicaid births take place each year, only people enrolled in Medicaid in managed care plans have access to a doula. Recently, the Biden administration approved Florida’s extension request postpartum covere from 60 days to 12 months.
“Doulas bring back humanity”
From its base in Miami, the nonprofit Southern Birth Justice Network trains and matches community doulas across the country and operates a mobile midwifery clinic that travels to Miami’s historically black neighborhoods. Nadirah Sabir, a newly certified doula, sees her job as providing care that once came from grandmothers and aunts.
“Everything about pregnancy and childbirth is a ritual that requires community,” says Sabir. “Doulas bring back humanity and put clients at the center.”
Black women are three to four times more likely than white women to die during or after childbirth, regardless of income or education level. They are also more likely to suffer life-threatening postpartum complications.
Doulas at organizations like Justice Network combine tradition with Western medicine to help clients advocate for themselves. Black women frequently report that when they try to bring up or discuss a medical problem during or after childbirth, 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, which increases the risk of death and complications for mothers and babies, according to a 2018 California Health Reports survey – an observation taken up in a study published in 2022 in Women’s Health Reports. Research on pregnancy and childbirth in the United States by the World Health Organization save 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 have been in hospital rooms where I have had to repeat myself several times to the provider. Imagine what it would be like for my client if he 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 more than 200 doulas. Brittney Palmer sought 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 a woman to feel unimportant.”
Renois, a nurse trained as a doula through the Southern Birth Justice Network, considers her work a calling. “I went through the experience of being pregnant and being ashamed. I went to the emergency room and the doctor put me down. I suffered from postpartum depression. I’ve been through all that and it doesn’t make me feel good at all,” says Renois. “I never want anyone to feel the way I felt.”
Michel’s pregnancy was a lonely experience at first and she knew she needed more support. She suffered from morning sickness and couldn’t stand the smell of weed, which was especially difficult because she loved nature.
She was also aware of the high mortality rate for mothers like her and worried about not receiving proper care. But instead of calming her fears, Michel said her obstetrician-gynecologist told her childbirth was going to be the worst pain she had ever felt and denied her request for a birth plan.
Ezra was born prematurely at 28 weeks and remained in the NICU, or in the neonatal intensive care unit, for almost three months to help him breathe, harder and harder every day. Michel was worried about him but she remained hopeful. She visited the hospital daily, held Ezra skin to skin, and read a book of affirmations called “I Am a Little King.” Renois continues to check in regularly by phone. And three weeks ago – one glorious day – baby Ezra came home.
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