The Community Health Workforce provides tremendous and often unseen value to the communities they serve. In this three-part series, CHAP introduces a peer recovery specialist, a community-based doula, and a community health worker, and shares what sets them apart from other healthcare professionals.
On any given day, you can find Ashli buzzing around Detroit, meeting with expecting parents, attending births, and advocating for healthier pregnancies. Ashli is a community-based doula. She’s an expert in caring for and connecting with her community: “It’s all about getting our moms to advocate for themselves, ask questions, and make informed decisions.”
As the mother of four boys, she knows the ins and outs of pregnancy intimately. She had a freshman counselor in college who first told her about doulas, though she didn’t come around to doula training until later in life. After her own birth experiences, including her fourth son who was a planned home birth, she knew she wanted to become a doula to help other birthing people advocate for their care.
“Community-based doulas are trained community birth workers that provide culturally appropriate and kindred spirited, non-clinical, emotional, physical and informational support before, during and after birth,” says Ashli. She offers pregnant people physical, emotional, informational, and breastfeeding support. She connects her patients to resources like free car seats, pack ‘n plays, and labor and delivery classes. While doulas have existed in various forms for millenia, they’ve been gaining in popularity over the last decade thanks to increasing evidence of their role in improving health outcomes. Women who give birth with a doula present are two times less likely to experience birth complications and significantly more likely to initiate breastfeeding (Gruber et. al, 2013). Doulas also have crucial roles to play in improving outcomes and experiences for communities most affected by discrimination and disparities in health outcomes.
A typical day for Ashli includes visiting three to four birthing people and assisting them in labor and delivery preparations, offering breastfeeding support, or helping pregnant individuals brainstorm questions to ask their providers. And of course, there are the exciting moments when she gets the call—a client is in labor, and it’s time to put all of the preparations into practice. Ashli will typically attend two to three births per month, assisting in around 25 births per year. She also provides care for up to three months after birth, to help babies and their parents meet developmental milestones.
When she gets the call, Ashli makes herself a cup of tea, puts on inspirational music, and gets in her car. It could be noon or midnight. It doesn’t matter, because this is Ashli’s favorite part of the job: showing up for birthing people and helping them meet their goals for their own delivery. Her role as a doula is really about advocacy—advocating for birthing people, but also giving them the tools to advocate for themselves during delivery.
Her most rewarding work experience during the COVID-19 pandemic was assisting birth virtually while the mother was delivering in the hospital. For many hospitals, doulas weren’t considered essential medical staff with floor privileges, so they counted against the birthing person’s “plus one.” Despite having to tend to patients virtually instead of in-person, Ashli was still able to be a voice for mothers in the delivery room—getting a mom through her contractions and coaching a dad through various birthing positions. A hallmark of a doula’s care and support is that it’s continuous, even during a pandemic. While nurses, doctors, and residents come and go, doulas are side by side with a birthing person from the first moment they call, to the first few hours after delivery. This level of attention is not something most people get from medical providers.
While the job is full of the joyful moments of bringing new life into the world, there are challenges too. Getting those who work in medical positions at the hospital to respect doulas is a challenge. Some medical providers feel that doulas are stepping on their toes. At the end of the day, Ashli is there to make the family feel comfortable and amplify their voices, and she takes a lot of pride in that. Medicaid reimbursement is also a challenge for the workforce across the state. Even in the few states that provide reimbursement, complex regulations and staff capacity can make billing for services a slow process. Ashli has taken part in statewide policy efforts to help make Medicaid reimbursement smoother through her employer, Black Mothers’ Breastfeeding Association. When she’s not with her boys or at deliveries, she finds time to contact senators and meet with regional hospitals as part of the Healthcare Improvement Detroit Equity Action Lab.
When asked what advice she would give to someone just starting out as a community doula, she said, “Check your emotions at the door, show up for your families, and make sure you pour into yourself the same energy you pour into others.” Ultimately, she does this for her family, showing her sons how to navigate pregnancy in a way that is centered in care, community, and a family’s desires. She hopes to be a midwife someday so she can keep helping birthing people in Detroit have healthier pregnancies, healthier deliveries, and healthier babies.
Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth outcomes. J Perinat Educ. 2013;22(1):49-58. doi:10.1891/1058-1243.22.1.49