Medical providers and policymakers have already recognized that birth doulas improve such health outcomes. Two states, Minnesota and Oregon, now include birth doula services in their Medicaid coverage, and in the spring of this year, Gov. Andrew Cuomo announced a pilot program to expand Medicaid coverage for doulas in New York. The idea of hiring such doulas has gotten a lot more mainstream.
Still, even as postpartum doulas multiply, the care they provide remains largely unsubsidized and expensive. (The majority of Ms. Spadola’s clients are white, upper middle class and can pay out of pocket, though she does offer a sliding scale.) And though the care aims to be non-judgmental, it often comes along with white, middle-class assumptions about parenting, said Christine Morton, the author of the book “Birth Ambassadors,” which chronicles the rise of doulas in the United States.
Some birth activists and nonprofits are working to change that, and to make postpartum doula care more democratic and widepread. Ancient Song Doula Services in Brooklyn, a low-cost doula collective for women who couldn’t otherwise afford one, is one such place. The majority of the organization’s clients are women of color, and more than half of the doulas are low-income themselves, volunteering to help other women through labor and after birth. The collective is fighting abysmal maternal mortality rates among black and brown women, in addition to well-founded fears among women of color, said Chanel Porchia-Albert, its founder.
“A lot of times women of color won’t express what they’re going through, or seek out help, because they don’t want to be criminalized for the choices they make,” Ms. Porchia-Albert said, adding that a black woman might fear losing custody of her children if she admits to being overwhelmed or exhausted.
One client, Aisha Crawford, 33, wanted to be prepared for anything that might come up when she gave birth, so, six months pregnant, she arrived at Ancient Song to get matched with a postpartum doula free-of-charge. She took a seat in the intake room, a comfortable space outfitted with yoga pillows and a baby crib, and explained her situation to the intake coordinator. She and the father of the baby had a fine relationship, and she wanted him to be involved when the baby arrived. But she wasn’t sure she could depend on him.
“I don’t want to say I’m scared to have the baby by myself, but just in case, I need someone there with me,” Ms. Crawford said.