“It is amazing what doctors say to women sometimes … The doctor told her that since she had no problem opening her legs to make the baby, she should open them again to get the baby out”
Photo: JGI/Tom Grill/Blend Images/Getty Images Doulas — non-medical professionals who help pregnant women before, during, and after childbirth — typically cost at least $1,000 and are not covered by insurance. While this makes them a luxury enjoyed by the lucky few, some doulas also work with low-income women — and specifically low-income women of color — often as volunteers, to help improve their odds of a healthy birth.
At the time I was a commodities broker and I had private insurance. After I was laid off during the recession in 2008 I became a doula full-time. Most doula trainings prepare you to have a private practice, which I did for a bit — but then I started to see how my Medicaid clients were treated differently from those who have private insurance. My clients who were women of color didn’t get the same attention as my white clients.
Some doulas say we should not be able to accept Medicaid. I would be in these doula chat rooms and there would be all this talk around having a business, about how much to charge people. Nobody was talking about people who can’t afford to pay. I believe everybody should be able to get equitable health care. You want to get paid, get paid. For me, I’m trying to serve the people who otherwise can’t afford it. Those folks need care.
New York City, where I moved in 2015, is saturated with doulas. Most are white. They can afford to focus more on the business aspects of being a doula. I assisted mostly low-income women of color. They couldn’t afford to pay, so I had to work as a volunteer. I supported myself with births with white clients and side jobs. I worked in a café in the mornings. A lot of time I was just as low-income as my clients. The majority of doulas who are black and brown are often burnt out.
It is amazing what doctors say to women sometimes. I was once assisting a mom from Sudan who didn’t want to do a vaginal exam because she was a victim of female genital mutilation. She didn’t want to endure the pain of a hand in her vagina. Really, this mom was very afraid. The doctor told her that since she had no problem opening her legs to make the baby, she should open them again to get the baby out.
In late 2016 I had a client give birth to a stillborn child. She wasn’t due for another month, but when she went to her prenatal appointment the doctor couldn’t hear a heartbeat, so she had to be induced. I was with her in labor. I asked her if she would like to hold her baby, name her, take pictures with her. I helped her arrange free funeral arrangements by connecting her with an infant-loss organization in Brooklyn.
Having a doula can cost upward of $1,000, which is not something a lot of young moms can afford. I trained to be a doula last year, and I work mostly with young clients who don’t have much support. If a woman having a child doesn’t have the support she needs to be the best mother she can be, then her child is at a huge disadvantage from the start. I have a client who hasn’t even had her child yet but already feels like a bad mom. It breaks my heart.
Women with private health insurance have more agency with their care. They can come in with a birth plan and talk about how they want their care to be. Women on Medicaid often spend three or four hours waiting at a clinic before their prenatal appointments. Whatever resident is on call will end up delivering the baby — and the woman probably has not had that provider before. They don’t have anyone to talk to about what they want their experience to be.
Even with white women, even in private hospitals, there are still problems with childbirth. Many women don’t realize they have a right to say no. But women who try to push back against interventions are often told, “You don’t want a dead baby, right?” How do you fight that if you’re not educated? There used to be communities around birth — now doulas create that sense of community. I’ve been a doula for 16 years. I wish we could serve more of these women. But as a doula we can only do so much. Medical professionals need to recognize that they are often biased in their care.
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