Rebecca Mzengi Corey wasn’t very familiar with doulas during her first pregnancy 10 years ago. Back then, she assumed their role was indistinguishable from that of a midwife—a common misconception. Still, her first home birth went smoothly. 

Fast forward to 2024, Corey, who is based in Brooklyn, New York, opted for another home birth for her second daughter, but with one key difference: She enlisted the support of a doula, Anjanette Silas. With Silas guiding her throughout the pregnancy and labor, Corey found the experience transformative. 

Corey said she felt more empowered and confident “in being able to not only give birth, but to give birth in the way that I wanted.” 

“That felt really meaningful to me,” the 37-year-old mother added. 

Unlike midwives or obstetricians, doulas focus on providing nonmedical support tailored to the needs of mothers and their families. They educate clients about the birthing process and provide physical comfort measures, like massages and breathing, to ease pain while also offering emotional support. 

Doulas also help pregnant people and their families navigate interactions with health care providers and make informed decisions about birth interventions. Their support does not stop after delivery—many assist with feeding newborns, promoting maternal self-care, and fostering bonding between mothers and babies. 

Evidence shows that doula support is linked to improved birth outcomes and a better labor and birth experience, including fewer cesarean deliveries, greater likelihood and duration of breastfeeding, improved mother-baby bonding, and reduced rates of postpartum depression. 

In the face of a growing maternal mortality crisis—particularly among Black women, who are disproportionately affected by substandard care and racial biases—doulas are increasingly seen as an important form of support for low-income and marginalized mothers in New York City. 

However, as the demand for their services grows, doulas in New York City told Prism they are encountering challenges such as exhaustion and inadequate compensation, raising concerns about the long-term sustainability of their work. 

“A lot of doulas are starting to burn out, and we’re not the band-aid for the deficiencies in the health care system—and that’s sometimes how we’re treated,” Silas said.

Balancing clients, paperwork

After experiencing two high-risk pregnancies and working as a registered nurse for over two decades, Silas transitioned to a full-time doula role in 2022. “I can see the correlation between how an unsupported pregnancy and postpartum experience can ultimately affect your life and potentially your children,” said the Staten Island-based doula. 

While there is an emphasis on patient-centered care, many health care environments fail to deliver it, she noted. 

“We have a lot of deficiencies within the health care system in terms of just the shortage of providers that are out there, the need to get people through appointments without really delving into what makes their situation unique,” Silas said. “So people are not really heard, and they don’t get supported based on their individual needs or the needs of their family.”

As part of the New York City government’s $34 million New Family Home Visits Initiative, the nation’s largest city aims to reduce Black maternal mortality by 10% in six years. Silas told Prism her personal goal is to make doula service more accessible for all populations, but especially people of color. 

In New York City, non-Hispanic Black women are 6 times more likely to die from pregnancy-related causes than non-Hispanic white women, according to city data. They are also 2.6 times more likely to experience serious pregnancy-related complications, and babies born to Black mothers are nearly 3 times more likely to die before turning 1 than infants born to white mothers. Hispanic or Latinx mothers face similar disparities; they are nearly twice as likely as white mothers to die from pregnancy-related causes or experience severe pregnancy complications. 

“They’re seeing the disparities and the maternal crisis that we’re currently in. So we’re not only helping them prepare for birth, but a lot of it is unpacking their own fears—of them experiencing something that impacts their life, whether it’s through illness or, worst case scenario, death,” Silas, 48, said. 

Silas provides a range of services, including prenatal visits, labor support, postpartum care, and lactation counseling. The cost of her services varies, but typically ranges from $1,800 to $2,000, spanning the prenatal, labor, and postpartum periods.

A typical day for Silas involves a mix of in-person and virtual appointments, serving three to five clients in Queens, Brooklyn, and Staten Island per month. Between these sessions, she juggles administrative tasks—a necessity she wryly referred to as the “fun stuff.” 

Silas accepts Medicaid, which covers doula care in New York State and covers 60% of all births in the city. Under Medicaid, a medical assistance program, doulas are reimbursed $1,500 for up to eight visits, though not all clients use all eight. When the number of visits decreases, doulas lose a portion of that payment—sometimes $500 to $600 per client.

This, she explained, makes it hard for doulas to accept Medicaid clients without taking a financial hit. “I jumped at Medicaid because I believe everyone should have access to doula services. But in all honesty, I have seen the loss of income in my business,” Silas said.

Medicaid reimbursement rates underscore a larger issue: the financial sustainability of doula work. “It does not really give us wiggle room to pay for our own healthcare insurance or really consider the long term, like retirement benefits,” Silas said. 

“For a lot of doulas, this is the second career, so we’re walking in with experience, but then we’re taking a significant cut in income from our prior profession. And then on top of that, we’re taking another cut within our own system, and that just makes it difficult,” she added.

In its report, the city health department acknowledged that the Medicaid rate of $1,500 is “low” for New York City, one of the most expensive urban areas in the world. “This can result in less-experienced doulas serving Medicaid members, which risks creating a two-tier system of support,” the report noted.

Another challenge is the complex paperwork and time-consuming requirements needed to become a Medicaid provider. In 2024, when New Yorkers could first use Medicaid to cover doula services, the state paid all claims directly. But since most Medicaid members use managed care organizations (MCOs), doulas must also enroll as contractors with each MCO to serve clients—a change that took effect April 1. 

“It has been very difficult to navigate,” said Charlotte Johnson, a doula based in Queens. “You feel bad telling people that you have to turn them away because the process is not completed yet, but also you’re not going to work for free.”

In an email, the New York City Department of Health told Prism that one-on-one support and informational sessions are offered to doulas to make the enrollment smoother.

Financial struggles, burnout

New York City offers free doula services to low-income residents in neighborhoods identified as having poor health outcomes, and services are also available for asylum seekers and residents of homeless shelters and foster homes. According to the city government, infant mortality and life-threatening maternal complications are especially high in neighborhoods with a large Black and Latinx population. 

Since its launch in March 2022, the Citywide Doula Initiative (CDI) has served 3,245  mothers and their families. In 2024, CDI provided free doula services to 1,128 new clients, 61% of whom were Black and 41% of whom were Latinx (clients could identify as more than one category). 

CDI grew out of the city health department’s By My Side Birth Support Program, launched in 2010 to provide doula support in central and eastern Brooklyn under the federally funded Healthy Start Brooklyn grant.

When the By My Side Birth Support Program first launched, some of the people seeking doula services explained their motivation by sharing personal stories, such as how their grandmother died in childbirth, said CDI Director Mary-Powel Thomas. 

“[They said] ‘I know it’s silly, but I just kind of worry about the same thing happening to me.’ And now, nobody thinks it’s silly because we know how many people this has happened to,” Thomas said.

A May report from the city comptroller found that Black and Hispanic CDI clients fared better than their citywide counterparts when it came to rates of C-sections, low birth weight, and preterm births. White CDI clients did not see the same level of improvement, and Asian American and Pacific Islander clients had worse outcomes, though participation for these groups was low. 

But doulas interviewed by Prism expressed frustration over the government-funded program’s slow payments for their services. According to Thomas, a little over 200 doulas who are contracted by various organizations are participating in CDI.

How are we out here trying to affect and change Black maternal health when you’re not supporting the Black providers who are providing this assistance to these families that we say are most vulnerable?

Charline Ogbeni

While Medicaid reimbursement rates remain a challenge, payments from the insurance program are generally relatively fast, taking three to four weeks. In contrast, the community-based organizations that make up the city’s doula program can take months to process payments, said Charline Ogbeni, a doula based in Queens.

Before founding her own organization, Supporting Our Mothers Initiative, Ogbeni worked with a community organization that partnered with the city government. She recalled the frustration of repeatedly following up on payments without receiving updates. Fortunately, she had a job as a school counselor alongside her doula work.

“I had a steady income, but not everybody has that capacity,” Ogbeni said. “If you are counting on your doula work to pay your bills, and your doula payments are not coming in, you can’t get your basic needs met.” 

“How are we out here trying to affect and change Black maternal health when you’re not supporting the Black providers who are providing this assistance to these families that we say are most vulnerable?” she added.  

As a full-spectrum doula, Ogbeni supports families from pregnancy all the way through the empty-nest syndrome that parents often experience when their kids go away to college. “We prepare families at the beginning and also during those transitions that they might not necessarily be prepared for,” she said. 

Ogbeni works flexible hours, usually until 7 p.m. on most days, and some weekends. She also supports families through prenatal visits, births, and postpartum care. Each Wednesday, she leads a weekly support group for first-time parents experiencing pregnancy and childbirth. Other days, she might be at a community baby shower or training other doulas.

The city’s doula program has a “complicated” payment process, acknowledged Thomas. Doulas must wait for partner organizations that contract doulas to be paid by the city before they can receive payment.  “Doulas have to enter data in the database before they can invoice. Some of the doulas are really good and prompt. For others, it’s more of a challenge,” said Thomas, who also heads Healthy Start Brooklyn, which provides support programs for expecting and new parents.

The New York City Department of Health and Mental Hygiene, in a separate email, told Prism it has hired more staff to address delayed payments, resulting in “considerable improvements.” Thomas also said the city has raised rates for doulas in the program and is pushing for higher Medicaid reimbursement rates.

Training gaps

Beyond the problems of low reimbursement rates and delayed payments, some doulas also grapple with feeling underprepared to meet the needs of their clients, citing gaps in hands-on skill development despite months of training.

According to Johnson, her program leaned heavily on what she described as “fear-based” and “fear-focused” narratives and training—such as emphasizing the higher C-section rates among Black and Hispanic women—without enough focus on practical skills, such as comfort measures and newborn care basics. Johnson declined to name the organization in charge of her program, but she noted it is one of the partner groups associated with the CDI. 

“When we were nearing our last class, you could hear some of the doulas in training that they were not confident. They said, ‘Oh man, I don’t feel like I should charge people when I start doing the work at first. I don’t feel like I really know what I’m doing,’” she said.

Before joining CDI, doulas must complete an eight-hour training covering the program’s mission, service model, client care, and needs assessments. Newer doulas with fewer than 10 births need to enter a six-month apprenticeship with their community doula organization to gain hands-on experience and mentorship.

Frustrated by the lack of comprehensive instruction, Johnson took it upon herself to pursue additional learning to bridge the educational gaps. Still, she believes training programs should fulfill their promise of providing full-spectrum preparation across prenatal, labor, birth, and postpartum care.

“At a training program, you don’t have to know everything,” she said. “But it’s important to give people the tools to feel empowered.”

The ‘transformative’ power of doula care 

Despite the challenges, the doulas who spoke to Prism remained deeply motivated by their clients and their visions of making maternal health more accessible and equitable. Ogbeni has major plans to better serve her community.

“One of my big goals is to open a birth center here in Queens, and I think that has not been properly addressed as a safe alternative for our families,” Ogbeni said. She added that while this would take a lot of work, she has strong advocates and an eager community “not only seeing what’s possible, but also understanding that they can be a part of the change.”

She also shared her aspiration to mentor new doulas. “I would like to see doulas be prepared in a way that they are positioned for success for births and for working with their families. Because while we’re producing a lot of doulas, the doulas are not receiving appropriate mentorship, and sometimes they are kind of winging it,” Ogbeni said.

To cope with the emotional and physical demands of her work, Silas prioritizes self-care by being mindful of her own needs and taking time off when necessary. “There’s some days I would go into the shower and just cry. But for the most part, I can tell you that my family, other doulas, other birth workers, they make a huge difference.”

Like Ogbeni, Silas envisions a larger role for herself in supporting other doulas and expanding services to uplift her community. “For every one person we touch, that just kind of trickles into the entire community,” she said.

Corey, who enlisted Silas’ doula service, expressed gratitude for the support she received, saying her doula played a key role in shaping her positive outlook on pregnancy and delivery.

“Even though I have great family and friends and a great partner, there’s something about this role of someone who’s so focused on seeing the experience in that kind of light, like, ‘Oh wow, this is such a transformative and beautiful life experience,’” Corey said. 

“It’s something that I really wish all people who are giving birth and having babies could experience,” she added.

Editorial Team:
Tina Vasquez, Lead Editor
Carolyn Copeland, Top Editor
Stephanie Harris, Copy Editor