Like her grandmothers before her, Cindy Noemi Olivares Lopez has been supporting women through labor and delivery since she was a teenager. She comes from a line of Maya Guatemalan “Comadronas,” or midwives, and is now a doula (a non-clinical birth worker) herself.
“Caring for women in the community is a way of life for me,” Lopez says. “In birth and in postpartum, showing up for people has always been the way we do it.”
Currently, Lopez is sharing birth work with others. She’s leading Venice Family Clinic’s first cohort of community doula trainees, made possible through a grant from the R&S Kayne Foundation, at the new Inglewood Crenshaw Children and Family Center. Community doula training emphasizes taking the cultural heritage, customs and sensitivities of patients into account while addressing their physical, mental and emotional perinatal needs. Often, community doulas are based in the same communities as their patients.
The program is an expansion of Venice Family Clinic’s doula-assisted birth services, which the Clinic began offering in 2022. With Medi-Cal beginning to cover doula services in 2023, Lopez is excited to train more doulas to bring these skills to their own communities, and make a living doing so.
A maternal health crisis
Despite the long-standing legacy of birth work in communities like Lopez’s, midwife and doula care in the United States is not common. This isn’t for lack of interest – a survey of 2,500 California mothers showed that over half were interested in doula support. But most cited issues with cost or lack of available services and education about non-clinical birth support as reasons they did not have one. California is one of the few states that covers doula care for Medicaid enrollees, and private insurance coverage can vary.
Connecting more pregnant people with doula and midwife care is one of the ways experts are trying to address the United States’ maternal health crisis. The U.S. has the highest maternal mortality rate of any developed country. Maternal health outcomes are particularly and tragically high for people of color, especially Black women. Childbirth related-death is three times more common for Black people than it is for white people – and most of these birth-related deaths that rob newborns of their mothers are entirely preventable.
Among other issues, experts attribute racial inequality in health care access and treatment as a major cause of this disparity. Language barriers, implicit biases and lack of trust between medical workers and patients can all contribute to missed treatment needs. Unstable housing, lack of reliable transportation and variable access to nutritious food can also put people of color at higher risk.
A community-based remedy
For all of these concerns, community birth workers like Lopez can make a difference. In fact, experts – including members of Congress – are advocating for expanding doula and midwife care to combat the maternal health crisis.
“Community-based birth workers more than likely share similar lived experiences as their patients,” Lopez says. “Sharing cultures and languages can help bridge that gap in health care.”
Studies show that working with doulas and midwives can lead to better birth outcomes, such as improved APGAR scores and lower rates of emergency caesarian sections. But helping deliver a baby is just a part of the story. Doulas address the whole birthing lifecycle, whether that means coaching through labor or reducing stress at home—especially since stress can negatively impact birth and contribute to conditions like pre-eclampsia.
One day, Lopez arrived at the home of a new patient who was in active labor. She noticed that the patient’s house was completely unfurnished, with nothing but a mattress on the floor. So Lopez put out a call to her community on social media, and within 48 hours had sourced a microwave, crib, clothes, diapers and more. While Lopez says doula work can vary from person to person, she sees efforts like this as part of a doula’s job because it’s about reducing postpartum stress. In the case of this new mom, furnishing her home for a child would be one less thing for her to worry about when she came home from the hospital.
“By better supporting women during pregnancy, through birth and in postpartum, birth work creates safer spaces for mothers and babies,” Lopez says. “It’s about how we are supporting the birth giver as a whole person. How we are sustaining life.”