Initiative rapidly expands doula ranks in Muskegon County, with major implications for birth equity

This entry in the Nonprofit Journal Project is part of a series of articles about how Michigan health care professionals are responding to the state's health care workforce shortage. It is made possible with funding from the Michigan Health Endowment Fund.

In Muskegon County, the infant mortality rate is four times higher for children of color than it is for white children, and 49% of Black births have had inadequate prenatal care. Muskegon-based How YOU Birth Doula Services is working to improve those outcomes for parents and babies by leveraging Michigan's recently added Medicaid coverage for doula services

When How YOU Birth Doula Services started in 2023, two trained doulas were on staff. Today, it has 22 birth and/or postpartum doulas serving families in Muskegon County. Another 15 doulas will be trained this summer.

“We have grown way faster than what any of us ever imagined," says Hillery Ross, How YOU Birth Doula Services' administrative coordinator. "It’s a blessing but it's hard to keep up sometimes.”

Hillery Ross.
Doulas of North America
-certified trainers lead the four-day birth doula and one-day postpartum doula trainings. How YOU Birth Doula Services provides stipends for the trainings, which typically take place over a long weekend so as not to interfere with work. Doulas completing the program receive certification from the state of Michigan.

Because Medicaid reimbursement rates do not pay a living wage, most of the How YOU Birth doulas work other full-time jobs, as well. Ross and her colleagues are advocating for better reimbursement.

We spoke with Ross about How YOU Birth Doula Services’ impact on families in Muskegon County.

Q: How are doulas helping Black mothers and babies have better birth outcomes in Muskegon?

A: They are providing quite a bit of support for our Black moms and our babies. A lot is social support, connecting them with resources that they may need. A lot of our families are low-income or underserved. They have other social factors going on, like homelessness or no insurance, so we connect them to resources that may help them with their utilities, with getting housing, with getting insurance, that type of thing. That’s really affecting the birth outcomes. Just having that support person has proven to be very beneficial for our families that we serve.

How YOU Birth Doula Services team members meet with members of their executive committee.
That support person, that doula, they come in and they check on them. It’s someone that they can talk to. They're not at the hospital alone when they deliver. We had someone who showed up by themselves at the hospital to give birth. The provider called and we actually sent a doula out to be with that person. We've gotten a lot of good feedback about how just having the doula being there as a support has been very beneficial.

We haven't put our data together yet, because we're not quite a year old. We've had about 20 babies to date, and they've all been healthy. About 80% of those were Black. We've had one low-birth-weight baby. Only one was premature, but that baby is thriving now. We've had two C-sections. One was planned and one was an emergency. We've never had a demise.

We also provide postpartum support for our moms as well, so we can ensure that mom and baby are still doing well even after the delivery. These outcomes have made us really happy and excited so we’re trying to expand the services that we offer. A lot of people don't know that they've been qualified for these services. which are paid through Medicaid. So far, all of our mothers have had Medicaid. If we had a private pay, we would take them. We don't turn anybody away.

Q: How are doulas helping Black mothers establish breastfeeding and maintain it longer?

A: Our postpartum doulas are working very hard with our mothers to ensure that they breastfeed as long as possible. We have provided training for our doulas — their initial training has that lactation part to it. We've also provided additional lactation training so we can make breastfeeding one of our focus areas that we are building here in Muskegon.

A How YOU Birth Doula Services doula training class.
About 90% of our moms have at least tried to breastfeed. Breastfeeding is such a healthier way for babies to get the nutrition that they need. Even if they just do it for six weeks, that can affect outcomes exponentially. They have a higher rate of survival. There's a lower chance of [sudden infant death syndrome]. If they breastfeed, it increases the bond between baby and mom — and we know that baby needs to bond with mom as much as possible. Breastfed babies have fewer chronic health issues as children.

We actually had one mom that was struggling, struggling, struggling — and she gave up for about a week. Then she went back to it, and she's still breastfeeding three months later. She was really dependent on that doula to get her through. Our doulas only get paid for so many visits. But they are not limited to those visits. They go above and beyond for sure.

Q: Why is being a doula rewarding work?

A: When you serve the community in any capacity, it's rewarding. Our doulas, they take pride in their community. A lot of them have lived experience, and so they relate to the community. To be able to give back in some type of way, it's just the most fulfilling and rewarding work. They love giving. They love working with our families. And they love making a big difference in the community and being a part of healthier birth outcomes for our babies of color.

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at [email protected] or

Doula class photo courtesy of Access Health's How YOU Birth Doula Services. All other photos by Tommy Allen.
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