Beyond the Hospital Walls: Doulas as Lifelines for Black Mothers

A Steady Hand in Crisis: The Doula’s Role in the Delivery Room

DALLAS — When Janelle Naomi Rouse, a 35-year-old Black woman and educator for the Center for Racial Justice in Education, became pregnant, she imagined a natural childbirth. Suddenly, 14 months ago, she lay beneath the bright surgical lamp in the operating room, awaiting the birth of her first child via c-section, the sterile sheet meant to shield her eyes. Instead, a light reflected off the sheet and she saw the incision across her lower abdomen.. “I accidentally looked up,” she said, her voice slowing. “And I could see everything in the reflection—I started hyperventilating. I was having a panic attack.” 

Fortunately, she had a doula, who caught her in that spiral of panic and pulled her back. “She looked me right in the eyes and said, ‘Stop looking over there. Look at my face. Everything is fine,” Rouse, an artist and educator, recalled. “She calmed me down.” In that moment, amid fluorescent lights, beeping monitors, and masked surgeons, it wasn’t the doctors or nurses who grounded Rouse. Instead, it was the steady, focused presence of a woman trained to stand beside her, breathe with her, and speak the words that reminded her she was safe. “It was like having a friend, a sister… but also someone who had been through it, who was an expert, who could advocate for me.” 

Dallas’ Maternal Health Divide: Black Mothers at Higher Risk

In Dallas County, significant disparities in maternal and infant health persist, highlighting a critical public health challenge. From 2018 to 2020, the county’s infant mortality rate was 6.2 deaths per 1,000 live births, but this number masks a stark racial divide. According to Dallas County Health and Human Services (DCHHS), Black infants are three times more likely to die before their first birthday than white infants. 

These inequities are attributed to a combination of factors, including implicit bias within the healthcare system, chronic disease, and a lack of access to quality care. In response, Dallas County’s Maternal & Child Health Program and the recent resolution declaring April 2025 as Black Maternal Health Month aim to address these issues by improving access to care and promoting community-wide awareness. 

However, for decades, pregnant Black women in the United States have experienced significantly higher rates of severe health complications compared to White women. Both Black patients and their infants are two to three times more likely to die within a year of childbirth than their White counterparts, even when accounting for factors like education and socioeconomic status. Our current perinatal care system is failing. “Especially Black women have been just absolutely poorly treated throughout history,” said Tara Haelle, a science and health journalist. 

The Legacy of Black Midwives and Community Care

One way to address the racial inequalities in maternal healthcare is to use doulas. Doulas, non-medically trained birth workers, play a growing role in addressing maternal health disparities by providing culturally informed, trauma-sensitive support. They help clients navigate medical racism and access care that is often lacking in traditional healthcare. 

“I think it is really important here to keep in mind the cultural context and history. For over 100 years, Black women were the only women who were there for other black women who were birthing,” said Haelle. “For a lot of history in general, women were the ones who helped women first.” In the 18th

and early 19th centuries, grand midwives from the community used to assist Black women giving birth. These caretakers imparted their background and lived experiences. 

“It was only when the field became more medicalized, it happened gradually and suddenly, there was a shift,” said Haelle. The healthcare system started putting a higher priority on lowering morbidity and mortality as delivery got more clinical and transferred from homes to hospitals, frequently losing respect for the women’s preferences and support systems. 

Healing Through Trust: Doulas as Advocates Against Medical Racism

Now, there has been another shift: healthcare teams that work with doulas. On one hand, they assist in reestablishing this equilibrium by putting patients’ needs, preferences, and significant support networks back at the forefront, all the while keeping safety and autonomy in mind. “Concordance of care in terms of either race, ethnicity, values, or religion has an impact on outcomes because there’s greater trust between the patient and the provider,” said Haelle. 

The impact of doulas for all women is clear: vaginal birth after cesarean delivery, improved attendance of postpartum office visits, improved breastfeeding rates, and fewer preterm deliveries. One study from the American Journal of Public Health found that women with doula support had a 47% lower risk of cesarean delivery compared to those without a doula. “The effect of doula care is consistent across race and insurance status,” said Dr. Lara S. Lemon, who wrote “Quantifying the association between doula care and maternal and neonatal outcomes.” 

Barriers to Access: Cost, Policy, and Systemic Hurdles

While doulas are often seen as helpful adjuncts to the healthcare system, the term “reproductive justice” grew from women of color who honed in on calling out racial inequality in maternal healthcare. Only 6% of birthing mothers receive doula care, a resource not many women are taking advantage of, which is caused by several factors.

From a lack of recognition of doula services by Medicaid agencies to the pricey out-of-pocket costs for private doula care, which can reach up to $2,000 in places like Dallas. This has ultimately fed into the barrier of maternal healthcare experiences for women across America. 

In addition to the steep financial cost, the Trump administration has initiated substantial cuts and restructuring within the Department of Health and Human Services (HHS), affecting programs vital to maternal and child health. Additionally, freezing the Title X funding for organizations like Planned Parenthood threatens access to essential reproductive health services. These actions, coupled with efforts to rescind diversity, equity, and inclusion (DEI) practices, jeopardize the progress made in supporting marginalized communities. Making it substantially harder to get these services in Dallas. 

Reproductive Justice and the Spiritual Calling of Birth Work

Quamisha Mcelrath, 34-year-old Dallas Native, used a doula/midwife service for her first child and always knew that was the best decision for her while hoping for a home birth. “I consider myself to be pretty holistic, so I never even thought giving birth in a hospital was a pathway that I would choose just from what I know statistics-wise around black women feeling like their voices are not heard in that type of setting,” she said. 

“I had a full Black women staff–the midwife, midwife assistant, and doula,” she said. “My doula checked on us throughout the process, leading up to labor. She gave us some strategies that you can use while you’re at home.” In this context, doula care becomes more than emotional support during labor; it is a form of reproductive justice. Doulas help amplify the voices of Black women in healthcare settings where they are too often ignored, misheard, or dismissed. 

Unquestionably, this ripple effect reflects the very impact Rouse described when her doula stepped in during a critical moment in her c-section. She called it a “spiritual energy,” a kind of ancestral calling. “I think the doula is not like an occupation. I feel it’s a calling similar to teaching or preaching,” she said. “It’s dealing with some spiritual energy; they are the people who have been called to bring humans to the earth.” Her words reflect a grounded hope that presence, care, and community can still make all the difference, even within a system slow to change.