Annual Report: Changing the statewide conversation about doulas

Doula and birthing parent

This story was first published in our 2023 annual report, Reframing the Big Picture.

Data show us that doulas can contribute to better maternal health outcomes, including fewer premature births and cesareans, and yet these professionals have traditionally been ignored by health care systems. The Health Foundation has funded programs in both western and central New York to help doula access for low-income parents. Thanks in part to the outcomes from those programs, along with ongoing work by advocates, New York State recently enacted policy changes that will make it easier for low-income people to access doulas.

New York State’s doula pilot program

In 2018, New York State’s Department of Health launched a pilot program for doula services in Erie County to expand maternal support for Medicaid-insured patients. At the time, doulas weren’t being compensated through Medicaid for their services.

The pilot was a resounding success. Doulas reported that the program allowed them to expand their capacity to serve more Medicaid members. They could support clients by advocating for a childbirth experience that considered their clients’ preferences.
The number of families on Medicaid who used doulas increased. The number of vaginal births increased, resulting in lower insurance costs. Previously ineligible for Medicaid reimbursements, doulas could now receive $600 per pregnancy (eight visits, labor, and delivery). The pilot was expanded statewide, and in 2023, under the leadership of Governor Kathy Hochul, Medicaid reimbursements for doulas more than doubled: $1,500 in New York City and $1,350 in upstate New York.

“A lot of people still don’t know what doulas are or that it’s an option for them.”
Kalia McCray, Birth Equity Project Manager, Erie Niagara Area Health Education Center

How doulas provide comfort and build trust
A doula is a trained, nonclinical professional whose services can improve pregnancy, birth, and postpartum outcomes. A doula isn’t the same as a midwife, who is clinically trained to deliver a baby. Instead, a doula is wholly focused on the physical, emotional, and
psychological needs of the birthing parent.

As an extension of the care team, the doula becomes the person in the delivery room to provide moral support and advocate for the birthing person. Doulas can’t make any clinical decisions, but they can facilitate communication between the patient and the medical team and help navigate the emotional roller coaster of labor.

A 2017 study showed that patients with access to a doula had a 39% reduction in the likelihood of cesarean birth and 31% reduction in reporting a negative birth experience.*
*Source: Cochrane Database of Systematic Reviews, 2017

Training doulas in Erie County
After New York State’s doula pilot program began in Erie County in 2018, the Health Foundation awarded a grant to a local coalition that included March of Dimes NY and United Way of Buffalo and Erie County to help facilitate the program. The funds enabled the Erie Niagara Area Health Education Center (ENAHEC) to project-manage the county’s participation in the new pilot program. ENAHEC’s doula work continued to grow, and two years later, the organization established a doula training program within their Birth Equity Project to focus on training more Black women as doulas.

Other goals include helping doulas navigate the complex Medicaid system and educating both health care providers and the community about the role and value of doula services. Once they’ve been trained and certified, the doulas can work independently or through the ENAHEC network as a Medicaid provider.

Jericho Road Community Health Center, a Health Foundation grantee-partner, which had already begun training doulas through the Priscilla Project, was also a participant in the NYS pilot program. Jericho Road caters to the unique cultural needs of immigrants and refugees. The Priscilla Project offers maternal support such as prenatal education, mental health screenings, mentoring, and language interpretation services.

Doulas are paired with clients who speak the same language, and when that’s not possible, an on-demand language interpretation service is used.

“I’d like to see us continue to grow the doula movement through these collaborations and partnerships.”
Shari Weiss, Ph.D., Executive Director of the Cayuga Community Health Network

Central New York doula network
While the Erie County pilot project was underway, central New York groups focused on their own maternal health needs. A 2018 grant from the Health Foundation laid the groundwork for a new program in Cayuga County.

The program focused on training doulas to serve the unique needs of residents in Cayuga’s communities. Shari Weiss, Ph.D., Executive Director of the Cayuga Community Health Network, soon invited groups from Cortland, Madison, and Herkimer counties to collaborate. Cohorts of doulas were trained and began helping with births through referrals from local health care providers and community organizations.

Today, the multi-county doula network continues to educate central New Yorkers about the value of doulas. In Cortland County, meet and greets have helped build strong working relationships with health professionals and community groups.

Gabrielle DiDomenico, who manages the Cortland doula network, explains that a key priority is to help OB/GYN staff members at the local hospital and clinic understand the value of doula services for their patients.

“Knocking down myths and misconceptions about what doulas do or don’t do was a big reason to create our referral network,” she says.

Medicaid recognition and reimbursement
In November 2023, Governor Kathy Hochul signed a law to create a statewide doula directory. In her 2024 State of the State address, Governor Hochul introduced a six-point plan to reduce the risks of maternal and infant mortality, including the continued expansion of doula services for low-income New Yorkers. Much of the plan builds on the groundwork laid by the 2018 pilot program that we helped fund. The ongoing work and advocacy of our grantee-partners has also raised awareness of doulas.

The newly increased Medicaid reimbursement rates are a significant first step in changing the statewide conversation around doula services. The rates should be even higher to help those who want to work full time and keep up with the cost of living.

While more work needs to be done to reimagine reproductive health, for now, the growing doula movement gets us closer to the goal of making pregnancies as safe and healthy as possible for everyone—regardless of race or socioeconomic status.