The first time I heard of a doula was my first week as an intern at WFRI. I attended an event celebrating the passage of the Reproductive Privacy Act in Rhode Island. While everyone was incredibly proud that the RPA had passed, many felt disappointed that Bill H5609 did not. Known as the Doula Bill, it would have allowed care by a doula to be covered by Medicaid. I didn’t recognize how instrumental doulas are in the lives of pregnant women until I read Dr. Ayana Moore’s story in the Washington Post. In February 2019, Dr. Moore spoke to the newspaper and discussed her first delivery by Cesarean section, describing it as “extremely traumatic” when her doctor refused to listen to her when she said she could feel pain during the procedure. For her second pregnancy, Dr. Moore hired a doula.
Over 50,000 women each year suffer life-threatening complications during childbirth. Black women are three to four times more likely to endure these complications, a statistic highlighting the maternal mortality crisis in this country. In Rhode Island, the maternal mortality rate was 11 out of 100,000 women between 2013 and 2017. High maternal mortality transcends socioeconomic status and educational achievement among black women. Despite Dr. Moore having the necessary access to health care and a relatively uncomplicated pregnancy, it didn’t prevent her from facing an issue many black women face in the delivery room — their pain being dismissed by healthcare professionals.
Dr. Moore’s story is just one example of the pervasive racial bias against black women in the healthcare system, showing that there is inadequate treatment for pain and often dismissal of black women by healthcare professionals. A study done in 2016 by the University of Virginia showed that white medical students and residents believed in biological myths about racial differences in patients, which affected how they assess and treat pain in black patients.
Doulas are trained professionals who provide physical, emotional, and informational support during pregnancy, birth, and postpartum. Doulas also act as advocates for their patients, which is particularly essential for people of color who may face harmful bias by healthcare professionals. Research suggests that providing doula support through Medicaid is likely to reduce significant racial health disparities that are also tied to social factors, including poverty and lack of necessary access to prenatal and postnatal care.
The Doula Bill is an incredibly important piece of legislation that will improve overall health outcomes, set industry standards, create a statewide registry of doulas to assist women in connecting with these professionals and ensure that doulas are paid fairly. Maternal mortality in the US is both a women’s health and a public health issue. While RI has come far in creating a gender-equitable state, there is more work to be done to ensure all women of every background are reaping those benefits. Please support the Doula Bill this year.