When Tristin Dockery was in labor with her first son in 2021, she only had one request: To get up and walk around her hospital room.
The nurse on duty said no.
So Dockery, then 20, stayed in her uncomfortable hospital bed as one contraction followed another. It was at the height of COVID. She and her husband were alone. And Dockery didn’t think she had much choice but to do as she was told.
“We were young and we’d never had a baby,” she said. “We didn’t know what we were doing.”
Dockery, an esthetician who works and lives 50 miles east of Kansas City in Lexington, was determined that things would be different last year when she learned she was pregnant again. She turned to the Maternal and Infant Health Center (MaIH) in Lexington.
The organization provided a doula who helped Dockery through her pregnancy and the first months after she gave birth.
“I had someone who was going to be there,” Dockery said, “who was going to help me focus on what I needed and what I wanted.”
On June 26, Altruism Inc., the nonprofit that runs the MaIH Center in Lexington, will open a second center. This one is in Kansas City’s urban Westside neighborhood.
The Kansas City MaIH Center is being opened in partnership with Samuel U. Rodgers Health Center and will share space with the health center’s maternity care clinic at 2121 Summit St.
Putting doula care and other nonclinical support services in the same space with maternal health is an effort to remove a potential barrier that could keep expectant parents from getting all the services they need, said Janelle Harvey Jordan, chief operating officer at the Samuel Rodgers center.
“We’re trying to help mothers by having everything in one area,” Jordan said. Offering doula services provides “an avenue for new moms to have better outcomes.”
What is a doula?
Doulas don’t provide medical care, but they establish relationships with patients and answer questions, give advice and offer support. They also advocate for patients, helping them communicate with their medical provider.
Studies show that the extra attention and education significantly boosts maternal outcomes, lowering the risk of cesarean deliveries by 47% and cutting the chance of preterm deliveries by 29%. Doulas also improve by 46% the rate at which new parents show up for postpartum medical checkups.
Once considered a perk only for those who could afford it, doulas are increasingly seen as an important tool in the effort to improve maternal health outcomes and reduce pregnancy-related deaths in poor and underserved communities.
In fact, last year Medicaid programs in both Missouri and Kansas began covering doula services. In its emergency rule granting the coverage last fall, Missouri’s Department of Social Services cited “an immediate danger to public health, safety or welfare of pregnant women in Missouri” as the reason doula services should be covered.
It is one of the changes Missouri’s Medicaid program has made in recent years to try to improve the state’s concerning maternal mortality rate.
According to data collected by KFF, a health policy research organization, Missouri’s maternal mortality rate between 2018 and 2022 was 24 deaths per 100,000 live births, and Kansas’ was 23 deaths per 100,000 live births. For the United States overall, the rate was 23.
But in Missouri the pregnancy-related mortality rate was three times worse for Black people than for white people. And in Kansas, more than half of pregnancy-related deaths were people who identified as racial and ethnic minorities.
In both states, pregnancy mortality reviews found that most deaths related to pregnancy were preventable.
According to the March of Dimes, more than 20% of Missouri infants were born to people who did not get adequate prenatal care. And in Kansas, the organization found that almost 17% of infants were born to people who didn’t get adequate prenatal care.
Balancing the scales
Tonia Wright, Altruism’s CEO, is confident that making doula care available to more expectant parents will mean that more people get the care they need, and that will help balance the scales.
“In Missouri, a woman who is covered by Medicaid is seven times more likely to have a pregnancy-associated death,” Wright said. “By allowing doulas to bill for their services, it’s leveling the playing field between Medicaid-covered pregnant people and privately insured pregnant people.”
Wright, whose marketing firm, Grace Advertising & Consulting Inc., has long advised health care organizations, decided after the pandemic to form a nonprofit to help smaller health-related organizations. At first she thought she would help them with marketing and advocacy. But then she saw an even greater need and decided to tackle health disparities directly.
“The statistics in Missouri about maternal and infant health were just landing hard,” she said. “COVID had ripped the veil and really laid bare what was happening, especially for poor white women, Black women and Hispanic women. I could not escape the research studies, the news stories. So I pivoted.”
That’s when she founded the MaIH Center in Lexington.
It offers doulas for free to clients without insurance. The Kansas City center will do the same.
People who have doula care tend to have better outcomes, Wright said, because their needs are more likely met. Someone with access to government food assistance and regular health checkups — services a doula might help set up for a client — is less likely to have gestational diabetes, pregnancy-related high blood pressure and even postpartum depression. Those are all leading causes of maternal deaths.
Dockery said her doula, Shariah Edwards, helped her deal with severe morning sickness, which lasted her entire second pregnancy. She helped Dockery write a birth plan, so when she went into labor her wishes about medication and other things would already be in her medical chart.
And Edwards was with Dockery at the hospital for her labor and delivery, making sure her plan was followed. After Dockery’s second son was born, Edwards stayed by her side, Dockery said, helping her deal with postpartum depression.
“She came to my house,” she said. “She watched the baby so I could take a nap. She offered to help me clean up. And she really just sat with me a lot and talked through it all.”
Doulas aren’t new to Sam Rodgers
Doulas are not new to the maternity care the Samuel Rodgers center provides. The community health clinic, a federally qualified health clinic, participated in a program funded by UnitedHealthcare to encourage new approaches to prenatal and postpartum care.
The center experimented with multicultural outreach campaigns, emphasized screenings to identify patients facing social barriers to care and offered patients help signing up for Medicaid, government food aid and other community programs.
The result, according to a UnitedHealthcare blog post, was a 30% increase in behavioral health and dental care for obstetric patients, a 3.6% improvement in full-term births and a 90% improvement in people showing up for postnatal care appointments.
And in 2023, the Samuel Rodgers center received a $2 million grant from the Health Resources and Services Administration to continue this work, which included offering doula care.
The health center’s new partnership with Altruism is helping extend that work again. It’s not hard to find benefits to giving patients the extra support a doula provides, said Bob Theis, Sam Rodgers’ chief executive officer.
Helping a pregnant person maintain a healthy pregnancy not only makes that birthing person healthier, it makes their new baby healthier.
“Having a good prenatal care program results in healthy birth weight babies and healthy birth weight babies bring stronger children into the world,” Theis said.
And caring for a baby at a healthy weight can cost a fraction of what it takes to care for a baby who comes into the world early or underweight. Theis said a low birth-weight baby’s care might cost 10 times more than a baby born at a healthy weight.
At least by the measure of birth weight, Sam Rodgers’ efforts to promote and improve prenatal care are paying off. Theis said the center’s percentage of low birth-weight babies fell to 5.5% in 2024 from 8% four years earlier.
Extending doula care by partnering with Altruism, he said, will add to that success.
“We’re building healthy kids in our community,” Theis said, “because one day I’m going to retire, and I want to make sure that we’re building a strong community of strong children to take care of me when I’m ready.”
This story was originally published by The Beacon, a fellow member of the KC Media Collective.
