How Doula Access is Transforming Maternal Health in New York

Shantel Destra: Thank you so much for being here, Senator.

Senator Samra Brouk: Thanks for coming.

SD: Now last year, you released a report that really spelled out the state of doula care in New York. Coming out of that, there were a lot of revelations and some policy recommendations. So I wanted to get your perspective on why doula care and maternal health has continued to be one of your top priorities as a lawmaker.

SB: Absolutely. Well, it was something that I obviously was interested in as a legislator. In general, just being a woman in New York, but I have to say the big moment for me came in 2022 when I became a mother and went through the birthing process, and I really credit my doula for helping me have a healthy outcome for me and my daughter. Having that informational, physical, emotional support that the doula provided allowed me to actually enjoy that process. Even following the birth, a lot of folks don't realize that doulas provide support postpartum as well. After having that experience, it became clear to me it was going to be my mission to make sure every New Yorker who has a baby has at least the option to have a doula. That has really been a driving motivation to get this work done, but then the other piece of it is simply being a Black woman in New York State, right? So really, the United States is actually the most dangerous place for someone to give birth in the developed world. But on top of that, Black women, especially here in New York, are five times more likely to die in childbirth or related to pregnancy. So when you look at statistics like that, it's really, really scary and what we know is that doula care—again, these are non-clinical professionals that offer emotional, informational, physical support, are actually able to help intercept some of the negative outcomes that happen specifically for women of color. So when you look at that and you see this could be a really huge help to fighting the maternal mortality crisis, it's a no-brainer that it's something I want to continue to support here in New York.

SD: And the good thing is you're not alone in trying to expand access to doula care. The governor signed one of your bills that you sponsored to create a directory of doulas in the state. So can you tell me about your conversations with the governor to expand doula care in the state?

SB: The Governor has been a tremendous partner on this, as we saw in her State of the State even this year in 2024, she's prioritizing maternal health, maternal mental health. So the bill that was passed last year was our Community Doula Directory and the whole point of that is that we were aware that starting January 1st of this year there was going to be Medicaid reimbursement rollout for doula care. That means that any person who's covered with Medicaid, who gives birth in New York State can now be reimbursed should they choose to hire a doula. And just to put a finer point on that, nearly 50% of births in New York State are covered under Medicaid. So when we think about changing the trajectory of New York State, we are literally affecting potentially nearly half of the births in New York State, which is so huge. And so after having that Medicaid rollout, now we think about, okay, how do we make it accessible, how do we make sure people know about it, right? That's why the Community Doula Directory was so important because DOH needs to take the responsibility for having the information so anyone searching for a doula on Medicaid can go on the DOH website and know they can find vetted doulas in their area. That's what that bill was about. Because at the end of the day, if you have, you know, you can have all the doulas in the world accepting Medicaid and being enrolled, but if mothers and birthing people can't find that information, what good is it? That's where we need the information to get. So the Community Doula Directory is a huge step in that. So was very, very proud to be able to stand with the Governor in November and have her sign that bill.

SD: So expectant mothers enrolled in Medicaid will be reimbursed if they choose to utilize the doula, but what about mothers that aren't enrolled in Medicaid? Is there any thinking that, you know, you'll expand to have statewide mandates for private insurance companies to cover that cost as well?

SB: Yeah. I mean, for me, yes. My goal is yes. My goal is, again, everybody in New York who wants a doula should be able to have one. What I will say is that usually we start with the Medicaid reimbursement, right, because we know so many people are served through Medicaid, but a lot of times what happens and has happened in other states as well, private insurance companies see what is happening through Medicaid and a lot of times follow suit. So I'm really, really happy to say that I have even in the last couple of weeks conversations with commercial insurance providers who have said they intend on starting the reimbursement process for doula care. So you know, I hope more insurance providers will take note and realize that at the end of the day, it can be a cost saving measure for an insurance provider, right? So if you look at some of the data of using a doula, doulas actually decrease the amount of time during birth by up to 25%. So if you think about that, that's less time in a hospital, right, less time insurance has to pay. They decrease the number of emergency C-sections which are incredibly expensive and somewhat dangerous procedures so if you're looking at it from an insurance provider's perspective, spending 1,500 or $2,000 for reimbursement on doula care could save you tens of thousands of dollars if it's improving the outcomes at the end of the day for the mother and the baby. Right now, it is not mandated in state law, but my hope is that we can work with provider to see that there is tremendous value in doing this.

SD: As Chair of the Senate Mental Health Committee, in what ways does support and resources for expectant mothers really help them through their pregnancy? Can you speak to that?

SB: Yeah. You know, I will say doulas help with a lot of the physical labor, if you will, but they also help on the mental health side. So I've shared with several folks that one of the most powerful moments I had with my doula was the first day I was sent back from the hospital, sent home, new mom, no idea what I'm doing. Very confused. I have this beautiful little being in my arms and just so focused on her, so focused on everything that I need to do for her and my doula asked me a very simple question and looked at me and said, how are you? It was just life-changing because I haven't checked in on myself. Just giving me that space to say, am I okay? Do I feel emotionally and psychologically okay? Luckily I did and I felt look I had a lot of support.

Even having someone to ask those questions of new mothers is so, so important and actually, maternal mental health conditions are the number one most common pregnancy complications. 1 in 5 birthing people will have face some type of maternal mental health condition, and it's more than just postpartum depression, right? It can be the onset of anxiety, of OCD in the postpartum time period. We've done a lot when it comes to maternal mental health as well. We got the maternal health workgroup passed in last year's budget and funded. Yeah. I want to make sure folks understand, too, that's one of the only workgroups that will reimburse for child care, and that was a really big component for any to have in that legislation because if we truly want affected individuals, which are parents or mothers, on this workgroup to be able to speak to their experience, we can't say, oh, come do this workgroup. It's a voluntary body. You are going to volunteer your time but we're not going to take care of your kid for you, and they will reimburse for child care and they have started to meet. That is incredible. Also last year, we passed a bill to study the depression screenings that were done and this actually came out of my own personal experience of going through these screenings at my child's pediatric appointments and we realize that there was some space there to perhaps expand which providers are giving these screenings, and so the bill that we passed in the legislature, this year we're hoping to get signed by the Governor, actually will expand which provider are encouraged to give these screenings so for example, like I think a lot of parents put their own health on the back burner when their child is in need and so, you know, I didn't miss any of those pediatric appointments. It was two days. It was two weeks, right, you are going there so often. Now DOH will put out recommendations that at pediatric appointments, they're supplying these depression screenings to new parents and I think that's really important because you know that they're more likely to go to these appointments and now there's a chance to really hopefully intercept and perhaps even start treatment plans for anyone who needs it.

SD: As you continue to focus on doula care and maternal health in the years ahead, what are the implications of not expanding access to doula care and focusing on, for example, postpartum, anxiety disorders and really pushing forward that workgroup that you mentioned?

SB: I mean, if we don't do this work, we already see what happens. It's the moment we're in, right? So when we didn't have people in positions, policymaker positions, when we didn't have mothers, you know, in the legislature, we were failing mothers throughout New York State because our maternal mortality crisis is getting worse. I don't think a lot of people understand that. A lot of things in this country have gotten better, sure. The truth is when it comes to maternal health, we are worse off today than we were years ago. If we don't continue to make these investments and really put in the work that is going to reach the end user, reach the New Yorker who needs the help, we will see it continue to get worse. When I say get worse, I'm talking about literally losing lives, losing lives of mothers, losing lives of our children and that is 100% unacceptable. That's why I call it beating the drum. We're going to keep beating the drum, you know, and I can't stress enough that we can see and feel the difference when we have people who understand these issues in these positions and who are willing to use that and have the courage to move these things forward, right. The governor could have just as easily not included maternal mental health in her priorities, but she did. So what we're doing is working and I don't think anyone in this sector is anywhere close to stopping. So we're going to keep—keep beating the drum and keep going, really, until we solve this crisis.

SD: We're two months into the legislative session. We're in the thick of budget negotiations. It's also an election year and there's so many different legislative priorities this year. So in a perfect world, what would doula access expansion and focusing on maternal health, what would that look like this session? What would a successful legislative session look like?

SB: Well, my success is going to be when every single New Yorker who wants a doula gets one. That's my north star. That's my success. That's my goal. But I think for right now we're really focused on specifically in the budget, right, we want to make sure that we're making investments in maternal health and maternal mental health. Success will look like Department of Health continuing to keep doulas at the table as they continue to roll out this Medicaid benefit and not just at the table of decision making, but also at the center of the decision making so we've tried as best we can to help facilitate that relationship but that's going to be crucial, right, to make sure that we can actually bring this all to fruition, and I think it's continuing to listen to the people who are most impacted and that was one of the things that I said when I entered this seat a few years ago. I was very aware that there are huge spots of New Yorkers who have, by in large, been ignored for many, many years by state government. I vowed to stop that at least on my own part. So when I entered this seat, it was really important that I talked to some of our most vulnerable New Yorkers and what I learned is some of our most vulnerable are our Black and Brown mothers and to make sure they're feeling seen and heard, and the decisions we make will benefit them. We know when it benefits them, it's going to benefit everyone.

SD: Well, there's a lot there and there's a lot to look forward to this session. But we'll have to leave it there for now. Thank you so much, Senator, for your time.

SB: Thank you so much.