Community-based doulas’ work justifies higher reimbursement rates
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In order to address the rising costs of adequate reproductive care and disparate maternal outcomes for birthing people of color, the New York State Senate declared doula care eligible for Medicaid coverage.
Community-based birthwork refers to the unique, patient focused scope of care that has been practiced in communities of color for ages. Community-based doulas in particular possess an unparalleled skill set that centers around individuals’ needs concerning perinatal healthcare, but also involves transportation, housing security and food security. They are often on-call for health emergencies, but also for informational support, conflict mediation and resource attainment. They provide culturally congruent care, bridge language barriers and often come from the same background and hometown.
Birthwork can be an exhausting profession, particularly when the reimbursement for the hours worked is not commensurate with a livable wage. For example, childbirth can last several days, a massive commitment for caregivers like doulas. Clients may call their doulas throughout the night navigating stress, breastfeeding and other forms of childrearing support.
But these doulas’ reimbursement rates are not congruent with the amount of time, and effort that their work covers. Doula services are often accessed outside of regular business hours, which generally go unpaid. Community-based work happens between shift changes, after major establishments close and during burnout across birthworker circles.
In order for community-based doulas to continue providing life-saving services to those who need it, they must be adequately compensated for their work.
Following the NYS Doula Pilot Program and decades of demands for federal funding for doulas, a higher reimbursement rate was added to the agenda. According to NY state’s Maternal Mortality Review Board, doulas provide evidence-based care and can benefit under-sourced pregnant people. With resounding benefits from doula care, community-based doulas in particular have needs that lawmakers should account for.
Professor and reproductive justice scholar Dana Ain Davis, refers to this phenomenon as what doulas do “beyond birthing.” Davis asserts that modern, community-centered doula care is in accordance with a legacy of “African-American women, restrained by the hierarchical arrangements upheld by society, engage in work that sustains the communities of which they are a part.”
This encapsulates the essence of community-based doula work: the deployment of resources to resist institutionalized oppression and reproductive injustices.
Community-centered birthwork has transformative potential. For birthing people facing reproductive injustice in their communities, having an empowered pregnancy and finding resources from someone in their community can shape powerful future realities. The birth workers who engage in this imperative work deserve to be recognized and reimbursed for the level of care, work and expertise that they contribute.
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Doulas in community-based organizations often work collectively and support one another, to ease the workload and offset costs. Sequoia Kemp, the founder of Doula 4 a Queen, explained how she avoids burnout, “We help each other out a lot. Being able to refer to your sister…that also helps.”
Kemp also noted how collective protest is a testament to her doula work. “I organize with Black Lives Matter Syracuse,” Kemp said. “So when I do my doula work, I don’t only care about their pregnancy. I care about their interactions with police and their kids.” Her engagement with local protest demonstrates the inextricable link between community-based care and collective justice.
Community-based doulas are tasked with looking at their client’s circumstances overall, and determining client needs beyond birth is a form of reproductive justice.
“I’ve had one client who had severe anxiety,” Kemp said. “So we had to do goal setting. The baby was here and she needed an apartment. She needed someone to push her. So it’s not birth-related, but it is reproductive justice.”
Community-based doulas also do the necessary work of breaking harmful generational cycles. Liessa Rudolph, one of the doulas at the Sankofa Reproductive Health and Healing Center, spoke about breaking the stigma surrounding postpartum depression in Black communities.
“I work with Upstate in a group for postpartum depression. It’s so prevalent and it gets overlooked,” Liessa said, “And we all have that stigma, that Black folks don’t go to counseling. Black folks don’t see psychologists. So we’re trying to make it normalized that if you got an issue, to talk about it.”
Leeandra Torrence, another doula at Sankofa and full-time staff member, said she has to wear many hats to meet her clients’ needs.
“You look at the whole family and give them resources,” Leeandra said. “I had to help her set up her food stamps. Sign up for housing. Things like that. (We’re) not just doulas, but therapists and care managers and social workers, everything. We do a lot.”
As doula care becomes integrated into hospitals and accessible through affordable healthcare, more communities will benefit from this breadth of resources. But this effort will only be sustainable if doulas are paid a fair wage for their work.
The expansive nature of BIPOC-led and community-based doula work goes beyond these few examples. This year, as we prepare for the finalization of Medicaid reimbursement rates for doulas in New York state, we must keep these efforts “beyond birthing” in mind.
Mayannah Beauvoir, Program Assistant at Village Birth International
Village Birth International is the founding organization for the Sankofa Reproductive Health and Healing Center located in Onondaga County. VBI is a policy, training and advocacy organization.
