WEIGHING IN – My wife and I recently reflected that only one other person witnessed the birth of both our children: our doula.
Before Kathleen became pregnant with our daughter, I didn’t really know what a doula was or what services the profession provides.
In part, that’s because doulas do so much it can be hard to aptly describe. Part cheerleader, part planner and part advocate, our doula, Kira, who was present for both of our kids’ births in Seattle, said her role was to handle everything happening above the waist. Christine Hernandez, a Saratoga Springs-based doula who testified Tuesday at a New York state Senate hearing about how to best implement doulas into the state’s standard maternal health care, likened doulas — who are not medical professionals — to expedition guides.
“Say you’re packing for a trip to the Andes. What do you need to pack on that trip? What do you need to be aware of as far as the weather, the climate, the atmospheric pressure,” Hernandez said ahead of her testimony. “And once you’re there, it’s unknown territory for you. We help walk alongside you through this journey to get you to the other side safely and feeling good about what you’ve done.”
Now, some New York leaders are pushing to make the state one of the most supportive of doulas in the country. A major part of this push is to include funds for at least $1,500 of state Medicaid reimbursement for doula services in the state budget. Gov. Kathy Hochul’s initial budget proposal for the coming year called for expanding Medicaid coverage for doula services.
We should encourage these initiatives. That’s because doula services aren’t just nice to have. Their work can lead to drastically improved outcomes at a time when our country and state face a maternal mortality crisis.
As noted Tuesday by Dr. Ursula Bauer, the deputy commissioner for Public Health for the state’s Department of Health, New York state’s maternal mortality rate, according to 2017-2019 data, is 19.3 deaths per 100,000 live births.
“And while this statistic is already high — and worse than the national Healthy People 2030 target of 15.7 — the mortality rate for Black women is far higher,” Bauer said.
The maternal mortality rate for Black New Yorkers is 59 deaths per 100,000 live births — more than four times the rate for white women (12.9 deaths/100,000 live births), Bauer testified.
“Although they account for only 14.3% of all live births in the state, Black, non-Hispanic women comprise 32.5% of all pregnancy-associated deaths,” Bauer said.
Agencies including the American College of Obstetricians and Gynecologists note that continued doula support during pregnancy, birth and postpartum care can save lives.
In fact, 78% of all maternal deaths in New York could have been avoided, according to state analysis, and doulas can play a critical role.
It’s time New Yorkers have greater access to doulas’ care.
At the moment, several other state Medicaid programs reimburse for doula services, including Florida, Maryland, Minnesota, New Jersey, Oregon and Rhode Island. Meanwhile, Medicaid reimbursement models are being developed in California, the District of Columbia, Michigan, Nevada and Virginia, according to Bauer.
New York launched a Medicaid Doula Pilot program in 2019 in Erie County.
Advocates want this to be rolled out statewide with sufficient reimbursement granted.
As state Sen. Gustavo Rivera, D-Bronx, chair of the Senate Standing Committee on Health, noted during Tuesday’s hearing, we should think of financial backing for doulas not just as expenditures, but as investments.
The Capital District Physicians’ Health Plan (CDPHP), which has more than 400,000 customers in 36 New York counties, has already made this calculation. Beginning in January, the health plan began reimbursing up to $1,500 for out-of-pocket costs related to in-person or virtual doula services provided by a certified and/or trained doula. (There is no national or state standard doula certification, but a bill that passed the state senate lays out criteria that would need to be met for a doula to be included on the community doula directory, which is designed to be a tool for Medicaid enrollees.)
CDPHP began offering this reimbursement because its leaders are alarmed by the maternal morbidity crisis in the United States, and its own research team concluded that doulas can improve outcomes, according to Dr. Elizabeth Warner, CDPHP’s chief medical officer.
For instance, evidence shows that doulas can drop the risk of Cesarean birth by 39%, a preterm birth by 22%, requests for an epidural by 60% and can make a patient twice as unlikely to have a birth complication, Warner testified.
In addition, doulas increase a mother’s and baby’s chance at breastfeeding and lower the odds of postpartum depression.
Our doula, Kira, helped us plan for our children’s births but also helped my wife and I adjust on the fly when things didn’t go according to plan. Kira had strategies for natural pain- and pressure-relief, and helped my wife decide when it felt right to get in the hospital room’s bathtub or walk around.
While the nurse and doctor were helpful, they were in and out of the room, checking in on other patients. Our doula was focused solely on us, and she stayed with us throughout the entirety of both our children’s births and then visited our home after our kids were born to check in on everything from breastfeeding to my wife’s mental health.
Making doula services available to Medicaid recipients would ensure this kind of care is offered to the very populations who stand to benefit the most.
Throughout Tuesday’s hearing, several doulas explained how their role is often to serve as a buffer against the institutional racism that many mothers who are Black, Indigenous or other people of color experience while giving birth.
“Black and brown birthing people report being disrespected, not seen or heard, their plans or preferences for birth ignored, having their experiences of pain often disregarded, their symptoms of life-threatening complications dismissed,” said Esther Patterson, co-chair of the Leadership Council of BirthNet NY, which trains and advocates for doulas in the Capital Region. “Doulas are a part of the solution to this health care crisis.”
This troubling reality entered the national spotlight after tennis great Serena Williams revealed that signs of what turned out to be potentially life-threatening blood clots were originally ignored by health care providers during the birth of her daughter in 2017.
I could tell you more about how Kira helped us — how she helped my wife and I remain calm when our daughter was born with mustardy meconium present in the amniotic sac and first emerged quiet and purple rather than screaming with life.
But, really, it’s not our story that matters most here. What matters most is the fact that in New York, Black mothers have shown to be at least four times more likely than white women to die during childbirth.
During the hearing, Rochester-area state Sen. Samra Brouk, chair of the Senate Standing Committee on Mental Health and the pioneer of the senate’s efforts to support doulas, read the names of several women who had fallen through the cracks and died as a result of childbirth complications.
There was 27-year-old Jeiza Torres, who died suddenly post-delivery after staff informed her family that she was in stable condition. There was 26-year-old Amber Rose Isaac, who died due to complications of an emergency C-section. There was 29-year-old Denise Williams, who died days after seeking postpartum care for a pulmonary embolism.
These are the stories that matter. These are the stories that need different endings.
Columnist Andrew Waite can be reached at [email protected] and at 518-417-9338. Follow him on Twitter @UpstateWaite.
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