Austin-area doulas lead the way as profession eyes future advocacy efforts

From KUT News:

When Josephine Adegbite had her second baby last spring, all the stars seemed to align. At a midwife-led birthing center in Manor, she labored in a tub of water as music played. Just when it was time to push, she heard the opening notes of “Akikitan” — one of her Nigerian grandmother’s favorite Yoruba gospel songs.

“I was like, ‘Oh my gosh. Like, what are the odds?’” Adegbite said. “I think that’s what gave me so much more power and strength to give birth.”

While the timing may have been perfect, the playlist was planned with this day in mind. By Adegbite’s side the whole time — supporting her with water, towels and massages and keeping the music rolling — was her doula, Alicia Rivera-Clemente.

“I was happy to be there and happy to see that she was so comfortable and felt safe,” Rivera-Clemente said.

Adegbite’s first experience giving birth just a couple of years earlier was different. The memory of the difficult emergency c-section she underwent with her toddler-aged eldest daughter was still fresh when she found out she was pregnant again.

“I did not like it,” Adegbite said. “I did not like the recovery. I didn’t like the way I was treated in the hospital. I felt like I didn’t really have a voice.”

That’s why, this time, she sought out a doula — a non-medical support person to be her advocate during pregnancy and childbirth.

A growing body of research shows that doulas are associated with better birth outcomes. That includes reduced rates of preterm labor and fewer c-sections — which can be lifesaving but come with increased risks when performed unnecessarily. These benefits have been especially noted for Black women, who have a maternal mortality rate 2.5 times higher than white women in Texas, per data from the Texas Mortality and Morbidity Review Committee.

Legislators and health leaders in states including Texas have begun to take note in recent years, introducing bills that support furthering access to doula care. As this heightened attention motivates many doulas in Texas to advocate for their interests as a profession, a robust network of birth workers in the Austin area appears poised to set the standard for advocacy and practice in the state.

Making services accessible

Despite the noted benefits of doula services, this care is not always accessible. Doula services historically have rarely been covered by insurance, meaning they have often been limited to people who can pay out of pocket.

However, in the Austin area, there’s a network of doula organizations that offer free services for local families, aiming to make birth safer for Black and brown women in particular. It’s called the Maternal Health Equity Collaborative. Rivera-Clemente connected with Adegbite through one of the organizations in the group, Healing Hands Community Birthing Project.

“If one organization doesn’t have the capacity, we’re not just telling you no or saying, ‘Better luck next time,’” Rivera-Clemente said. “We can refer you to somewhere else … we’re getting you in touch with somebody directly.”

It’s an example of the kind of coalition-building Texas doula leaders want to see more of.

Texas Doula Association Vice President DeAnna Vonbartheld said Austin’s proximity to the Capitol has bolstered the local doula community and motivated them to take an advocacy-focused approach to their work.

“You have a freeing environment to provide the services that you need. You have local representatives who support and have a better understanding of the doula work,” she said. “We would want to see what’s happening in Travis County multiplied across the state.”

The TDA recently released the results of a first-of-its-kind survey of the Texas doula workforce — an attempt to get a picture of a profession that largely operates outside of the traditional medical establishment, with no one single credentialing agency and many training pathways.

“We wanted to reflect the reality of our community-based work,” Vonbartheld said. “[That includes] informal care, unpaid labor, cultural responsiveness, and, of course, the emotional and financial toll of supporting families in an under-resourced system.”

The survey confirmed that Austin is a hotspot for birth workers, with almost 30% of doulas who responded saying they worked in Travis County. Rural doulas were more isolated, and indicated they could use more support. Across the board, doulas said they still encounter a lack of understanding from the public about what their job is and why it’s important.

Vonbartheld said the TDA wants to ensure state policymakers are educated about this, too, especially as several bills related to doula services have been filed in the past two legislative sessions.

“Having to sit across a policymaker that’s going to say, ‘OK, I’m going to vote on this bill, but I still don’t know what you do,’ is alarming,” she said.

Increasing advocacy

The push to cover more doula services through Medicaid has gained momentum in recent years. Around half of U.S. states now offer reimbursement through their Medicaid programs, but bills in Texas that would have introduced a Medicaid pilot program have stalled in committee.

In 2023, Texas legislators did pass an adjacent law that allows doulas to be reimbursed for a narrow scope of work — conducting assessments of non-medical drivers of health, like transportation and housing needs. It’s case management work, not straightforward birth support.

Vonbartheld and many others see this as a step in the right direction. But many doulas also feel it’s a laborious process to get qualified for a small amount of reimbursement that doesn’t cover the core parts of their work.

“I personally want to see more doula slash birth work covered before I really make the push to do the case management,” said Darline Turner, executive director of Healing Hands.

The TDA is already looking ahead to the next Texas legislative session, and is hoping to get more individual doulas involved in advocacy efforts moving forward. That’s something Rivera-Clemente said she’s interested in.

“I’d like to get more involved and become more knowledgeable about how these things can change and why they’re remaining the same,” she said. “The compensation, to me, doesn’t equate to the work that’s being done and the impact that’s being made. So I’d like to see change there, for sure.”

In the meantime, she loves the work she’s doing. That work has also been motivating for her client, Adegbite, who hopes to work towards becoming a labor and delivery nurse. She wants to help other women to have positive experiences with childbirth.

“Because it was so good,” Adegbite said. “It felt like I could do it. I knew what I was doing, I had support, I felt heard, I felt seen — and that’s really what every woman deserves during labor.”

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