When Fantasy Lozada-Smith became pregnant she had a fear. A fear she didn’t immediately voice out loud, but was still there, in the back of her mind. She was afraid of dying.
“I remember so vividly making a grilled cheese sandwich one day,” Lozada-Smith recalls. “I was just really hungry and just started crying while I was making it, because I just thought to myself, 'I'm so happy to be pregnant. I'm so terrified about what's going to happen,’.”
Her fear wasn’t unfounded.
Giving birth is the most common reason for a woman in the U.S. to be hospitalized, and according to the Department of Health black women in Virginia are three times more likely than white women to die during or after childbirth.
“I needed to have someone who was going to be in the room with me who understood my perspective as a black person in a predominantly white health care space,” says Lozada-Smith.
So she hired a doula.
Doulas are like birth coaches, not medical professionals. In addition to helping women through labor, they also provide support long before, and even after, a baby is born.
For some Virginians, getting help from a doula may mean the difference between life and death. That’s why lawmakers are pushing for their services to be covered by Medicaid.
Lozada-Smith hired doula Kenda Sutton-El, who helped probe her fears. For instance, doctors had told Lozada-Smith her high body mass index was a risk factor for her pregnancy. Sutton-El made her walk daily, and prepare her body with exercises. She provided facts, figures and data -- all in an effort to empower her client.
“I provide information to help them tackle all of their fears,” Sutton-El explains. “I make sure that they know that I'm there every step of the way and I will help them advocate for themselves and I will also advocate for them.”
Sutton-El says going into birth with fear can have physical consequences. For instance, a mother's cervix won’t dilate. Often a doctor will jump straight to a C-section, a surgical alternative to a vaginal birth.
“Whereas if you have a doula, they're going to say, ‘Okay, hold on, wait a minute, give me a second.’ and talk to the mom,” says Sutton-El. Often that communication and trust will help resolve the issue without surgery.
Research does show women who have doulas are less likely to get C-sections, and they’re more likely to give birth to healthier babies.
And yet using a doula is still rare, especially among black women.
Part of the reason might be expense. A doula’s services can range anywhere from hundreds to thousands of dollars, and they’re often not covered by insurance.
Legislation being proposed in Virginia would change that for people with Medicaid, often low-income individuals. The bill would require Medicaid cover doula services, pre and post birth. In Virginia, Medicaid covers one in every three births. A study in the journal ‘Birth’ shows that when Medicaid covers doula services it can actually save the state money.
A separate piece of legislation would help establish a reimbursement rate, and another would create a licensure process run through the Virginia Department of Health. A doula would have to get certified in order to be reimbursed by Medicaid.
Vallin Bingley is a doula who specializes in taking care of women once they’re home, when they’re still susceptible to depression or medical complications. She says mothers are focused on their baby, but she’s able to focus on the mother.
“If she doesn't have that... it's a matter of life and death for herself and for her baby,” says Bingley.
Virginia isn’t alone in seeking to expand access to doulas. Minnesota, Oregon, New Jersey, and other states, have all taken similar steps. It’s often cited as an approach to reducing racial disparities in maternal mortality rates.
Delegate Jennifer Carroll Foy knows firsthand how those disparities play out. Her own complicated pregnancy with twins threatened her life. She says her pain wasn’t taken seriously.
“I have a law degree, a master's degree, I'm a legislator -- and none of those things matter because often times people think it's just people have a social economic status. This happens to... African American women across the spectrum,” says Carroll Foy.
She insists she could have had a safer pregnancy if she had a doula advocating for her. That's why she’s sponsoring the legislation.
Fantasy Lozada-Smith credits her doula for helping the birth of her son go smoothly. She says she never had an epidural, and before she knew it her son Jaxxon was born.
“I remember crying because I made it. I survived and I didn't just survive. I had this amazing birth,” she says.