The city of Milwaukee and Milwaukee County are investing in doulas in hopes reducing the number of black babies who die before the age of one.
While doulas don’t have medical training, they do provide emotional, physical and mental support to families before, during and after the arrival of a baby.
Some studies have shown that when doulas are hired — especially early in pregnancy — the rates of C-sections are lower and people are more likely to attend prenatal visits.
WUWM’s LaToya Dennis explores how doulas of color are impacting birth outcomes for women of color in Milwaukee.
Before Precious Shropshire met her doula, she says she was scared.
Shropshire was a pregnant 24-year-old mom, who had to go from medical appointment to medical appointment because she was considered high risk. “I had lost two kids. I had a miscarriage and I had a stillbirth when I was five months with my son. His name was Zayden,” she shares.
Shropshire first met her doula Tiffany Scaife at a breastfeeding class put on by the African American Breastfeeding Network. She was almost five months pregnant at the time and already seeing doctors twice a week.
Shropshire says she wanted a doula for a couple of reasons — like support her at appointments and help her talk with her doctors. From the beginning, she says she made it clear she wanted to try for a vaginal birth, but doctors were pushing a C-section. Her son, born five years earlier, was delivered via cesarean.
As the doula, Tiffany Scaife’s job was to do everything she could to help Shropshire and her boyfriend have the positive outcome they wanted.
Scaife says she attended most of Sropshire’s doctor’s appointments. She gave Shropshire a birth ball and showed her different positions to try to help her get ready for labor.
Scaife says she also made herself available to answer whatever questions Shropshire had.
“It made me feel good that somebody care(d) about me,” Shropshire says.
After Shropshire's due date had come and gone, she had to be induced.
Before going to the hospital, Scaife went to the home Shropshire and her boyfriend share, and cooked them dinner.
They checked into the hospital on the day before Easter. They tried for the vaginal birth but after a doctor broke Shropshire's water to speed up the process, the baby’s heart rate rose.
The Monday after Easter, baby Violet Iva was born via cesarean.
Scaife says throughout the pregnancy and birth, she made sure Shropshire and her boyfriend had all the information they needed to make the best decisions. And she was still supporting Shropshire three days after the birth.
Tiffany Scaife says she thinks it’s great that so many people, especially women of color are becoming doulas these days.
But she says it’s important to know this isn’t something you do because you think it’s going to be fun.
“It’s definitely a calling,” Scaife says. “I think I was about 30 when I realized that there was a calling on my life to help hurting females, but I didn’t know what that meant … I was always that friend that had somebody on their couch or at her house. And just as time went on just the pieces started coming together.”
Scaife, who is also in the process of becoming a midwife, says she no longer refers to helping people through pregnancy and delivery as birth work, instead, she calls it heart work.
In fact, because Precious Shropshire and her boyfriend could not afford the $1,000 that Scaife charges for the initial consultation, at least two prenatal visits, and her time with them during labor. So, Scaife did it for free.
She says there was no way she would turn down Shropshire after hearing her story.
Precious Shropshire and her baby were lucky to have Tiffany Scaife’s help.
Doula services are too costly for many expectant parents. They aren’t covered by insurance, and many black parents in Milwaukee cannot afford the fees.
In order to help those most in need, Scaife and a lot of other doulas of color donate their time or lower their rates.
Lyanne Jordan, a doula and the cofounder of the Milwaukee-based reproductive justice organization called Maroon Calabash, says black doulas here are charging anywhere from $300 to $600 — much lower than what their services are worth.
“Black doulas have a bleeding heart. And so our rates are very low compared to the work that we are doing,” she says.
Jordan says no one becomes a doula for the money, but when you think about the time, the expertise, and the research that doulas go through — and the fact that they often have families of their own to support — making so little is difficult.
“You are navigating the world in this black body. And you are supporting someone and holding space for them as they navigate the world in their pregnant, black body and the trauma that they may be experiencing,” she explains.
Some states pay for doula services for people receiving Medicaid. But Jordan says there are concerns about those funding models, as well.
“We have five models of how it’s been done wrong,” she says.
Jordan says Oregon and Minnesota were the first and legislation has been introduced New York, New Jersey and Vermont. "Their efforts have been incomplete and have actually set back some of the work that community-based doulas in communities of color have been doing."
She says there are several serious problems for doulas in states where Medicaid pays for doulas, and for the families hiring them.
The doulas often have to be certified, Jordan explains, but many doulas of color are not. Another barrier is that payments are reimbursed, which means low income families have to pay out of pocket first.
She adds, the reimbursement rates are too low.
A state effort to provide doulas for women receiving Medicaid in Wisconsin appears to be going nowhere. Democratic Gov. Tony Evers included funding in his biennial budget, but Republicans on the joint finance committee stripped the proposal.
Meanwhile in Milwaukee, the city is working on a program that would employ four doulas and a doula manager for black women across the city. Milwaukee County has given the city an additional $52,000 in supplemental funds to target women in the 53206 zip code, where black infant mortality is the highest.
Becky Rowland, the interim director of family and community health for the Milwaukee Heath Department, says the city is trying something different to try and move the needle to lower the black infant mortality rate here.
"Some of the ideas proposed that we’re pushing forward include this concept of mothering the mother and providing prenatal and continuous labor support and postnatal care provided by doulas to the tune of three or four prenatal visits and three or four postnatal visits," she says.
The supplemental dollars for black women in 53206 would be used for things like acupuncture or massages or a meal service delivery for a couple of weeks. Rowland says the goal is to reduce the stress levels of the mother.
Editor’s note: This is part of our series about Milwaukee’s high infant mortality rate for black babies. Next, we hear from Wisconsin's only black midwife.