Jezreel “Jazz” De Cohen had never considered becoming a doula: a trained professional in providing physical, emotional, and informational support to expecting mothers through the birthing process (including the prenatal, perinatal, and post-partum periods). As someone who had experienced domestic violence and homelessness, living out of her car and shelters, it took enough to survive, let alone try to help others. But after she delivered her third child at a birthing center with a midwife, following two hospital deliveries that she calls traumatic, she realized that helping other women navigate their pregnancies and births with this type of care and support was her calling.
“During my first delivery, I knew what I wanted and how to advocate for myself, but the color of my skin was a hindrance for others,” says De Cohen. Like many other Black women, De Cohen says that she was mistreated at the hospital, and her wishes ignored, because of her race. “I didn’t have care and support,” she says.
During her third delivery at the birthing center in Arcadia, California, the staff listened to her. The director of the center, Chemin Pérez, recognized that De Cohen had the intelligence, compassion, and other qualities to succeed in the maternal care field, and suggested she consider becoming a midwife. De Cohen eventually enrolled in a six-week doula training program offered by Happy Mama Healthy Baby Alliance (HMHBA), a Los Angeles-area doula provider and one of Heluna Health’s partner programs. Its executive director, Cordelia Hanna, was impressed by De Cohen and offered her a scholarship, later hiring her as a doula. De Cohen recently launched a doula business called Wisdoms Doula Services. She is currently enrolled in a midwifery school, will be working soon at New Life Midwifery, the Arcadia birthing center, and hopes to become a licensed midwife and International Board Certified Lactation Consultant (IBCLC).
“Look at where Jazz is now,” says Hanna. “She’s going to touch so many lives.”
Data from the National Vital Statistics System showed that in 2020, the maternal mortality rate for non-Hispanic Black women was 2.9 times the rate for non-Hispanic White women.¹ Doulas have been shown to improve birth outcomes, including reducing the chances of preterm births.² Until recently, few health plans have covered doula services, shutting out many low-income people. But that lack of coverage recently changed in California, when a state law known as the “Momnibus Act” took effect. As of January 1, 2023, doula services are now covered under Medi-Cal, the state’s version of Medicaid.
“There has been a flourishing of doula programs, which provided a different energy that applied pressure” on the legislature, says Dr. Zea Malawa, one of the experts who advocated for Momnibus, and Director of Expecting Justice, a San Francisco-based, Black-led collaborative and partner program of Heluna Health that offers doula training. “There’s so much racism toward birthing people in hospitals,” Malawa says. “The state responded to research that shows that doulas save Black mothers’ lives, Black mothers want it, and because of economic racism, many families can’t afford it.”
One outcome from the Momnibus law is that the need for trained doulas from Black, Brown, and Native American/Pacific Islander communities, where birth disparities are greatest, is certain to increase. Patients often report that they relate best to doulas who share their ethnic and racial background. So organizations that train doulas, such as Expecting Justice, HMHBA, and SisterWeb, a San Francisco-based doula service that is also a Heluna Health partner, focus on training doulas from the communities they serve, typically Black, Latina/o/x, and/or Pacific Islander communities.
While all doula training programs differ, most cover anatomy; stages of labor in the birth process; psychological aspects of pregnancy; birth and postpartum; and how to provide comfort, nutrition advice, and lactation guidance. SisterWeb is also piloting a trainee program with a stipend that Executive Director Marna Armstead says is like an apprenticeship. When students have completed the six-month course, Armstead says they will be better prepared to begin working as a doula, potentially with SisterWeb, which plans in the next year to increase the number of its doulas from eight to 15.
Expecting Justice, which has offered two free doula training programs since 2021, recently launched a free Workforce Development Program, which provides mentoring with seasoned doulas and teaches new doulas how to launch a practice. Both their doula trainees and those who go on to the Workforce Development Program are paid a barrier-removal stipend.
Through Heluna Health, both SisterWeb and HMHBA are able to offer their doulas full-time employment with a health plan and retirement benefits, something that’s almost unheard of in the burgeoning industry. SisterWeb also offers mental health counseling for its doulas and also supports Ubers for doulas who are attending births. Vanessa Castro, a former doula with SisterWeb who was recently promoted to Doula Program Coordinator, appreciates that she doesn’t have to work extraordinarily long hours. Before she was hired by SisterWeb, Castro once assisted on a birth that lasted 33 hours. She couldn’t leave the hospital because she was the only support for the parents. At SisterWeb, doulas must be relieved if they work 12 hours straight. “I get healthcare and support from a team that I wouldn’t necessarily get if I was working privately,” Castro says. “I feel comfortable with SisterWeb, and want to be here for a while.”