More expectant parents in New York will have access to doulas, or nonmedical professionals who provide emotional support during the birthing process, after a new state law was signed this week.
New U.S. Centers for Disease Control and Prevention data shows the national infant mortality rose 3% last year — or the largest increase in 20 years. The U.S. maternal mortality is also higher than European nations.
Gov. Kathy Hochul signed a law Monday to create a statewide directory of licensed doulas enrolled in Medicaid available to help mothers and their newborns transition before, during and after birth. Doula services will also be covered for New Yorkers enrolled in Medicaid starting Jan. 1.
"We're going to make doula care as accessible to as many New Yorkers as possible in communities where they're needed the most," she said Monday before signing the legislation.
Doulas are professional birth coaches that help guide a person before, during and after labor. They don't provide medical care, but give emotional support that can make a difference in helping mothers get the care they need and reduce infant and maternal mortality.
"If somebody spikes a fever after they give birth, we know that that's not normal," said Liz Addeo, a doula and childbirth educator at Afterglow Albany Birth. "Or somebody might say, 'Oh, I'm just tired.' [And] we say, 'No, actually, that might be something more serious that you need to call your provider about.' So again, we don't do anything medical, but we're very well trained in the warning signs of a postpartum emergency."
Addeo says in her five years as a doula, she has spotted early signs of postpartum pre-eclampsia, mood disorder and other conditions with her clients, and helps connect clients to medical providers.
The directory, to be created and maintained by the state Health Department, will make it easier for New Yorkers to find and access a doula to help them through the birthing process.
“The increase in infant mortality among Black infants remains a concern that the department will continue to address," DOH spokeswoman Danielle DeSouza said in a statement Wednesday. "The department remains committed to preventing widening disparities and ensuring that all babies have a fair chance to thrive and grow.”
The department's Perinatal and Infant Community Health Collaborative Initiative was launched in July 2022 with a five-year, $14 million annual fund awarded to 26 programs across the state.
Medical reviews in the National Institute of Health concluded women who use a doula have a 39% decreased need for a C-section, and reduced risk of premature deliveries and likelihood of postpartum depression.
Bill sponsor Sen. Samra Brouk, a Democrat from Rochester, says doula services also help reduce racial disparity in maternal and infant deaths.
Black pregnant women in New York are five times more likely to die during childbirth than white women, and nine times more likely nationwide.
"Nearly 80% of these deaths are preventable," Brouk said, citing last year's DOH report on maternal mortality in the state. "And in half of them, racism and discrimination are cited as contributing to these maternal deaths."
About half the births that occur in New York are covered by Medicaid, the senator said. More than 210,000 live births took place in New York in 2021.
People enrolled in Medicaid are more likely to be medically underserved, or have reduced access to medical providers and needed care, increasing their risk for conditions that lead to infant and maternal mortality and comorbidities.
"When you think about doulas... they are in addition to your OBGYN, or your certified nurse midwife," Brouk said. "They offer this type of informational, physical, emotional support for the birthing person and has been shown to help disrupt some of those contributors to why our maternal mortality crisis is so bad here in New York."
Lawmakers and doulas say they want the Legislature to further expand coverage of doulas and Medicaid reimbursement rates to reduce infant and maternal mortality across New York.
"There's a quote that says if a doula was a drug, it would be a crime not to use it," Addeo said.
There was an average of 918 infant deaths in New York each year from 2018 to 2020, or four infant deaths for per 1,000 live births, or more than two per day, according to the state Health Department.
New York has the fourth-lowest rate of annual infant deaths of all U.S. states, according to the department.