PROVIDENCE – In 2018, the United States reported that 658 women died during pregnancy, birth, or 42 days after delivery. Our maternal mortality rate puts the U.S. last among similarly wealthy countries and, to make matters worse, according to the Centers for Disease Control and Prevention’s National Vital Statistics System, black women are more than two times more likely to die during childbirth than their white counterparts.

To help to address those disparities locally, the Healthy Communities Office of the City of Providence recently awarded five grants totaling $20,000 to support the provision of doula services and training to improve maternal health outcomes. The recipients included: Quatia Osorio [OurJourn3i], Aida Johnson [Hawthorn Grief Care], Lastisha Michael [Ready Set Latch Go] and Emerald Ortiz [Sacred Wombanhood Birth Support Services].

The goal is to increase the number of local doulas of color, expand access to doula services for people of color in Providence, and to provide business development to other doulas, according to a news release issued by the city. In particular, the funding will also pay for stipends for 12 doulas to help guide the development of a statewide doula certification process through the Rhode Island Licensing Board. Currently, there is no state certification process for doulas, which is a barrier to doula services being reimbursed through private or state-funded medical insurance programs.

Doulas provide perinatal care, helping to educate and advocate for families through pregnancy, breastfeeding and into the early months of childhood, according to Emerald Ortiz, a doula, and one of the grant recipients.

On Tuesday, March 10, [also now known as Doula Day in Rhode Island], Providence Mayor Jorge Elorza hosted a news conference at City Hall to announce the awards and to lend support for the proposed Doula legislation, H5609, which aims to improve access to maternal health care for all women in the state, and for the proposed budget item [HB7587] that will establish medical assistance coverage and reimbursement rates for perinatal doula services.

The setting was grand; the people attending were low-key but formal in their commitment to making change. There was a great showing from Doulas of RI, a local organization that supports doulas and their businesses. Susie Finnerty, the co-president of Doulas of RI, was the first person I spoke with.

Finnerty is pregnant with her fourth child and due in the very near future [“Today. Or Friday.”] according to her doula colleague, Rachelle Friesen, who was sitting next to her.

Both women had that doula way about them. They were approachable but determined, sitting on the edge of their seats, and clearly poised for any challenge.

I asked Susie whether doulas within the community had been consulted about the doula bill. “When the bill was originally introduced, I found out about it the day after and I quickly butted my nose in, and I have been collaborating with them ever since,” she said.

Susie said she has been trying to increase the reimbursement rate for doulas to $1,500 [per client], and that the problem with similar bills in Oregon and Minnesota was that the average reimbursement rate of $350 was not enough for doulas to live on.

To this point, the first thing I heard on my way into the press conference was: “I am not working for $850,” the rate as it currently stands in the pending Rhode Island doula legislation.

When I told Susie that I have been a doula in New York for 15 years and that I had just moved back to Rhode Island six weeks ago, she said: “Oh, well, the New York doula bill has been the framework for how we are hoping NOT to do the bill.”

I laughed in recognition of the mess the New York bill has been. It had passed quickly, and without the consultation of the community it was aiming to employ and help, namely doulas of color.

According to a report compiled by Every Mother Counts [an organization that works to make pregnancy and childbirth safe for everyone, everywhere], in analyzing the demise of a doula pilot program in Brooklyn in New York City last year, they suggested that the emphasis needed to be on working together with community-based doula programs.

“Situated in the communities they serve, community-based doula programs generally encompass all of the services that private doulas offer, and add additional home visits and a wider array of services and referrals for individuals who need more comprehensive support. Most community-based doulas are members of the community they serve, sharing the same background, culture, and/or language with their clients,” the Every Mother Counts report said.

Rep. Marcia Ranglin-Vassell, who has helped to advocate for the doula legislation at the R.I. General Assembly, spoke at the news conference, seeming to echo the findings of the Every Mother Counts report.

“We need doulas who are women of color,” Ranglin-Vassell said. “Having a doula who can respond culturally, racially and linguistically is a win-win for all. This is reproductive justice.”

The maternal death rate for black women is more than double that of white women: 37.1 deaths per 100,000 live births, compared to 14.7 deaths per 100,000 live births. While doulas won’t solve the problem outright, the benefits of doula care are supported by consistent, high-quality research.

Evidence-based reviews
Cochrane Reviews have reported on the positive effects of continuous labor support from doulas since 1995. The most recent review analyzed data from 26 individual studies involving more than 15,000 women and identified numerous benefits to continuous labor support. The positive benefits included:

• 39 percent reduction in the likelihood of cesarean births

• 15 percent greater likelihood of a spontaneous vaginal birth

• 10 percent reduction in the use of pain medications

• Shorter labor by an average of 41 minutes

• 31 percent reduction in reporting a negative birth experience

The proposed legislation is a proactive way to give more women of color access to the support they deserve, according to advocates.

I asked Susie, who is white, whether she saw a need for more doulas of color in Rhode Island. The answer was a quick, “Yes.”

Emerald Ortiz, who was one of the recipients of a grant through the Healthy Communities Office, spoke about the importance of providing quality health care to women of color, based on her own experiences. “I didn’t have what I now provide,” she said. “I hope to be the support I didn’t have.”

On to the State House
Following the news conference at City Hall, I accompanied a number of doulas to witness an expected vote by the Senate on the proposed doula legislation, but the bill did not come up for a vote.

The cadre of doulas then wound their way down to the basement where the House Finance Committee was reviewing the bill for Medicaid reimbursement for doulas. One of the representatives on the committee asked: “How many doulas are there in Rhode Island? And what is the breakdown by race?” According to the Doulas of RI’s website, there are approximately 50 doulas practicing in Rhode Island and that about 20 percent of them were women of color.

From my perspective, the legislation is about equal health care access for women of color. It’s about improving the maternal mortality rate here in Rhode Island. It’s about fair wage reimbursement for services.

The next step will be implementing a plan to recruit and train doulas of color; doulas who will improve outcomes and lower medical costs through fewer interventions.

At the end of the House hearing I appreciated seeing Mayor Elorza giving testimony with his toddler son on his lap, in support of having doulas around you during the perinatal period. Elorza said: “It is so difficult to be a parent. It’s so stressful.”

In my experience working as a doula, I have found that women need someone who they trust deeply, whose expertise they believe in and [often, but not always] whose background is similar to theirs. I hope the Rhode Island doula legislation is enacted in order to provide more support for all women, pushing our state and our nation to make childbirth a healthy passage rather than a deadly risk.

Sarah Moore has worked in the birth world for 15 years. She just returned to Providence after 24 years in Brooklyn and is so happy to be back.

You can find more information about her work as a doula on her website, figtreechildbirth.com.