‘You don’t know what you don’t know’: A Q&A with a NC doula on making maternal care affordable and accessible

It can be difficult and expensive to be a pregnant person in NC, especially if you’re Black or live in a rural community. We talked with a local doula about the gaps in care and making doulas more accessible to all. 

[The following is part of an ongoing series on Black maternal health disparities in North Carolina. For more of this project, click here.]

Pregnancy and childbirth are not straightforward.

I can’t have a baby, but my wife and I have had three children. There are amazing moments and a big, beautiful payoff. But for many folks, pregnancy is a winding road, filled with anxiety, pain, excitement, and expensive appointments.

Which is why it’s important to take care of the body and the mind before, during and after a pregnancy. Doulas can help with that. A doula is a person—typically without formal obstetrics training—who helps people with guidance and support during their pregnancy. They can be an approachable, often more holistic source of support and advocacy during a pregnancy, and as any parent will tell you, you can’t have enough of those. 

In fact, studies show that moms who have doulas helping them have less medically complicated labors, shorter labors, lower rates of C-sections, and fewer complications after delivery.

Some health care advocates think doulas can be especially helpful for rural communities and colors of color.

Related: NC’s midwives might be the key to the Black maternal health crisis

As we’ve reported at Cardinal & Pine, there are major differences between the experience of Black women and white women in America. Those differences are even more pronounced in North Carolina, which has dozens of rural counties with limited health care options and few birthing centers in range.  

More than 20% of North Carolina’s 100 counties are “maternity care deserts,” the March of Dimes says, and 13% of women statewide live more than a half hour’s drive away from the closest birthing center. That’s higher than the national average. It’s such a big deal because access saves lives, the research shows.

Doulas don’t have the same kind of training and education as doctors or nurse practitioners (which is expensive). But they do have some training—roughly 16 hours of classroom work with a trainer, and assisting with a number of in-person births before they’re considered a professional doula. And that means becoming a doula is more accessible for folks who have a knack or a passion for the work.   

The problem is that many insurance carriers don’t cover the cost of doulas. And in NC—despite research that shows doulas decrease medical complications during and after childbirth—Medicaid isn’t required to cover them. That’s significant because Medicaid, which provides health insurance for lower income people, covers more than half of all births in the state, according to the nonprofit NC Child.

Last week, Democrats from NC filed federal legislation to cover doulas under Medicaid. They’ve tried at the state level too. A 2023 bill filed by Democrats in the NC General Assembly didn’t move in the Republican-controlled state legislature. 

We talked to LaToshia Rouse, a certified doula who owns Birth Sisters Doula Services in the Triangle, about the gaps in NC’s maternal health care. Here’s what she had to say.

LaToshia Rouse of Birth Sisters Doula Services says that while many insurance plans don’t cover doulas, there are nonprofits that can help, and some plans have begun covering them. (Photo via Birth Sisters Doula Services)

Cardinal & Pine:

Tell me a little bit about yourself and how you got into the work.

LaToshia Rouse:

I had my children and that was my kickoff into the maternal work. I have a 14-year-old and triplets that are 11. And once I went through the process of having my own children, I started to recognize that there were gaps. 

There were gaps in care, information that I wish I could have had and understood better. Being able to make a connection between who was going to be there with me during delivery and just having that emotional support that doulas provide. 

And so learning about doulas through the work that I was doing, it made me want to be one, and so I became a doula so that I could fill the gaps that exist in healthcare.

C&P: 

How long have you been working as a doula?

Rouse:

Almost five years. I started right before the pandemic.

C&P:

If you can, for folks who don’t really know what doulas are, why is the doula role so important?

Rouse:

So a doula is a non-medically trained professional that provides informational, physical, and emotional support to mothers and their families. So we don’t want to forget about the fathers. We have interaction with the whole family to make sure that they get the care experience that they were hoping for as much of it as possible and feel good about being able to make informed decisions.

And I think the difference is because we’re not doing the clinical piece, we’re not doing the blood work, we’re not doing the checking that the clinicians do, the midwives and the doctors do, we’re able to focus in on their whole life and the issues that might come up that might not be related clinically to their pregnancy or to their postpartum, but it does impact it.

C&P:

I can’t have a child, but my wife has, we had three. So I know what you mean. And I think anyone who’s had a child can see exactly what you mean, why the whole life needs to be taken into account. 

It’s not just going and sitting in an OB’s office and doing the routines. Your emotional wellbeing, your physical wellbeing, it’s all part of it. So I guess that’s something that is such an important part of what you do, right?

Rouse:

It absolutely is. And also getting people to services. So many people don’t know how to find resources that exist in a community. It could have everything they need, could be in the community, but they don’t know where to find it. They don’t know how to access it. 

And so helping them with that, sometimes it is literally taking someone and showing them where the website is and helping them through it because it’s so stressful to be able to figure it out with everything that’s going on. 

So yes, I love that work. I love making those connections for people because it is difficult during this time to have a new baby or even if it’s not your first one, it’s difficult. It’s so many things that come up.

C&P:

No doubt. There is an emerging public knowledge about the gaps in Black maternal health outcomes and the lack of access that so many communities have and the problems that it’s caused for people. 

Why do you think it’s so important for folks to know about people like you who are out there providing these services, that are going to help people not only be healthy as they’re having the baby but help them have a baby that’s healthy and that goes on to be healthy and to prosper?

Rouse:

I think it’s important because you don’t know what you don’t know. And oftentimes people find out when it’s too late and they wish they had known. And you don’t get those days back. 

You don’t get the first time you had that baby back, you don’t get the birth of that next baby back. You get those shots one good time. 

And so you want to make sure that you have the information, the resources, and the support you need to go through that process and make sure that if it’s not happening and something’s not going right, you have someone that can guide you through how to get to better care, how to get to the resources you need. Even for emotional support. 

What do I do to find the therapist? What do I find? The support groups and being able to just talk it out with someone who’s not going to judge them for what they’re saying in that moment and how they’re feeling.

C&P:

Absolutely. What do you think is the biggest thing that Black communities in North Carolina really need right now from the healthcare community on this?

Rouse:

Compassion, support, and really centering them in the care and not what they are choosing that that person should need and want in a moment. 

I think that is difficult to do, and I’m finding that even when people are trying, sometimes they miss the mark. 

So I think making sure that in this system that runs so fast and everything has to go, go, go, when people do make it to the appointment, that’s a chore in and of itself to get to the appointment. When they actually make it to the appointment, (I want them to leave) better than how they came, they felt supported. They got resources, they were seen and heard in those appointments.

C&P:

Is there anything that I haven’t asked that you wanted to say?

Rouse:

So I think oftentimes when people talk about doulas, the first thing is they’re too expensive and I can’t have one. And I want people to know that there are so many programs piloted throughout the state that offer doula services. Some Medicaid plans. Tricare is starting to offer doulas through their plan. You also have United (Healthcare). 

So just because we don’t have a state law that says doulas are in the law to be paid for, doesn’t mean that there aren’t programs out there that also can support you. There are nonprofits that cover doulas. I get clients from nonprofits that will cover a doula for a family. 

So don’t be discouraged because you already are thinking that you can’t have a doula. No, there are options and opportunities out there. So make the connection, talk to people, ask the question. Don’t just settle and say I can’t have it.