How Democrats’ ‘Mamas First Act’ could save lives by funding doula and midwife services

Funding doula and midwife services

U.S. Representatives Alma Adams (D-NC) and Lauren Underwood (D-IL) at a Black Maternal Health Caucus Stakeholder meeting in 2019. They are each co-sponsors of the Mamas First Act. (Photo by Michael Brochstein/SOPA Images/LightRocket via Getty Images)

By Michael McElroy

May 11, 2024

A bill co-sponsored by Rep. Alma Adams of North Carolina would expand access to a vital tool in the fight to address the nation’s Black maternal health crisis.

[Editor’s Note: The following is part of an ongoing Cardinal & Pine series on NC’s Black maternal health crisis. For more of the series, click here.]

This week, a few days before Mother’s Day, Rep. Alma Adams of North Carolina and several other Democrats reintroduced a bill in the US House that would allow Medicaid to pay for doula and midwife services, a vital service that can help bring down the country’s staggering Black maternal death rates.

The bill, the Mamas First Act, would expand access to midwives and doulas for many women who already live in communities with scant health care services. The bill would also improve resources through all levels of pregnancy, including the postpartum stage, especially in under-served communities.

Few industrialized countries have as high a maternal death rate as the US, and Black women are three times more likely to die from pregnancy-related complications than white women.

Midwives and doulas are an important tool to fighting the Black maternal health crisis, advocates say, because many hospitals and birthing centers lack health care workers of color and several studies show that doctors are more likely to doubt their Black patients than their white patients. There’s often a huge culture and/or trust gap toward medical professionals as a result: Midwives and doulas can help fill it.

And since North Carolina expanded Medicaid last year, which has helped bring healthcare to more than 440,000 low-income North Carolinians, even more mothers-to-be could benefit from the Mamas First Act.

“As we’re seeing today at the state level in North Carolina, Medicaid expansion continues to improve outcomes for mothers, babies, and all Americans,” Adams said in a news release on Thursday, the day lawmakers officially reintroduced it.

“Having trusted partners in the birthing process saves lives,” Adams said.

“Mothers are less than half of the population, but we give birth to 100% of it – Congress needs to put Mamas First because our Mamas can’t wait.”

Midwives and doulas save lives

Doulas and midwives, the lawmakers point out, have been “proven to reduce C-sections, decrease maternal anxiety, and improve communication between pregnant women and their health care providers.”

Expanding access to these services will save lives, several studies show.

Since Republicans have a slight majority in the House, it is unclear if the bill will get a vote.

Adams is a co-sponsor of the bill, which was filed in both House and Senate versions by Representatives Gwen Moore of Wisconsin and Debbie Dingell of Michigan, and Sen. Elizabeth Warren of Massachusetts, among others.

Midwifery’s roots are in Black, Indigenous, and immigrant communities, and the profession has a history of providing a more welcoming, culturally affirming alternative to traditional medical providers, advocates say.

‘I think a lot about my daughter’

More than 20% of North Carolina’s 100 counties are considered “maternity care deserts,” according to the March of Dimes, and 13% of women statewide live more than 30 minutes away from the closest birthing center, a figure higher than the national average.

Adams is also a co-leader of the Black Maternal Health Caucus, a group of lawmakers intent on educating the public about the ongoing crisis and pushing for legislation to do something about it.

“In Congress, I think a lot about my daughter Jeanelle,” Adams writes on her Congressional website.

“She is an educator and mother herself, but she also faced numerous challenges, including a crisis during her pregnancy.”

She added: “Despite all our progress, women are still fighting for equal health care, equal pay, equal representation, equal respect, and equal rights.”


  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.


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