As states across the South and Midwest ban abortion, maternal mortality and morbidity rates are climbing nationwide, yet Massachusetts has one of the lowest maternal mortality rates in the country. Even so, our severe maternal morbidity rate — defined as unexpected, life-threatening complications during labor, delivery, or the postpartum period that result in significant health consequences for the mother — more than doubled between 2011 and 2022, surging from 52 to 113 per 10,000 deliveries.
Over the last decade, closures of maternity care units, including the Holyoke Birth Center in 2020, have reduced access to timely care, increasing the risk of birth complications, especially for women of color. In 2020, the rate of maternal morbidity for Black women in Massachusetts was 2.3 times higher than for white women, while Latinas were 1.4 times more likely to experience complications.
In response, Massachusetts enacted comprehensive legislation in 2024 to improve maternal health outcomes, including expanded access to midwifery, birth centers, and doula services. A critical component of this expanded care is insurance coverage for doula care, with MassHealth now required to cover services for up to 12 months postpartum. Doulas are non-medical perinatal professionals who advocate for the person giving birth, helping them manage pain, and ease their transition to parenthood. They provide physical, informational, and trauma-informed emotional support before, during, and after childbirth.
Research consistently shows that doula care improves birth outcomes — fewer cesarean deliveries, fewer vacuum or forceps births, fewer preterm births and low birthweight infants, shorter labors, and a reduced need for pain medications. Furthermore, doula care reduces rates of maternal mental health disorders, improves mother-baby bonding and infant care, and leads to more positive feelings about the birth experience overall.
Doula care can help address key failures and inequities in the U.S. maternal healthcare system:
● High Cesarean Rates: The cesarean delivery rate is approximately 33%, twice as high as the World Health Organization deems ideal. Cesareans carry a higher risk of severe maternal morbidity and require longer recovery times.
● Preterm Births: The rate of premature birth — the leading cause of infant mortality — has risen, with Black mothers 1.5 times more likely to deliver prematurely.
● Mental Health: Maternal mental health disorders, such as postpartum depression, affect roughly 20% of pregnant women and are the leading cause of pregnancy-related death.
For women of color and low-income women in particular, doulas help mitigate birth complications often driven by systemic stress and medical bias. Doulas bridge the communication gap, acting as trusted advocates who ensure patient preferences are respected. In one study, Medicaid recipients with doula care had a 47% lower risk of cesarean delivery, a 29% lower risk of preterm birth, and were 46% more likely to attend a postpartum checkup.
Local Impact: The Pioneer Valley Doula Collaborative
In western Massachusetts, the Pioneer Valley Doula Collaborative (PVDC) connects families to trained, compassionate doulas offering prenatal, labor, and postpartum support. Covered by MassHealth, PVDC doulas take a holistic, patient-centered approach to childbirth.
“I am called to birthwork because I believe deeply that all people have the right to live autonomously in their bodies and deserve to have the pregnancy and birth that they desire,” said Jess, a PVDC doula.
Fellow doula Kayla emphasized the transformative nature of childbirth: “I believe our birth experiences shape the rest of our lives. How we start our journey into parenthood can mold us into new versions of ourselves.”
PVDC focuses on serving those most vulnerable to the shortcomings of standard maternal healthcare, including BIPOC, LGBTQ+, and low-income families and individuals.
“Families navigating poverty, housing instability, mental health challenges, and systemic barriers need more than a birth plan. They need consistent, compassionate, connected support,” PVDC leadership notes.
Courtney, a PVDC client, shared her experience: “As a Black woman, I have experienced discrimination in healthcare and heard such awful birthing stories from friends. With these fears in mind, I decided to seek out some extra help from a doula. We found our doula on the PVDC team! It felt so much smoother to do this with a doula in the room.”
In addition to fostering safer and more satisfying birth experiences, doula care is economically beneficial. Because Medicaid is the largest single payer of maternity care in the United States, reducing cesarean deliveries and NICU stays through doula care could save Medicaid around $1,000 per birth, totaling hundreds of millions of dollars annually.
Two pending bills offer Massachusetts the opportunity to further strengthen this vital care. State Rep. Lindsay Sabadosa, D-Northampton, has co-sponsored H.4344, which would increase doula hours covered by insurance from eight to 20, allowing doulas to fully support their clients, while H.5021 aims to expand the doula workforce by funding individual training and the organizations that oversee and support doulas.
Please ask your representatives to support these bills, and spread the word about the profound benefits of doula care — it saves lives, improves outcomes, and in Massachusetts, it’s now covered by health insurance.
Carrie N. Baker is a professor in the Program for the Study of Women, Gender and Sexuality at Smith College and a regular contributor to Ms. Magazine. Minna Most is a senior majoring in the Program for the Study of Women, Gender, and Sexuality Major at Smith College and an intern for the Pioneer Valley Doula Collaborative.