In Her ZIP Code: A Doula’s Mission To Uplift Brooklyn’s Underserved Mothers

The midday sun is sweltering, but that does not stop the citizens of Bedford-Stuyvesant. 

A jerk chicken joint sells baskets of meat, rice, beans, and plantains in the Brooklyn neighborhood. Two smiling friends ride their scooters and chat in Spanish. The Daily Press, a coffee shop beloved by the community, has its door propped open. R&B star Mary J. Blige’s soulful song Enough Cryin plays under a chorus of chatter. 

Makeda Dawson-Davis parallel parks her red Nissan next to the shop to grab a morning coffee. Her first client lives in Bedford-Stuyvesant—the doula herself does, too. Dawson-Davis’ work takes her all over Brooklyn. Tomorrow, she could be in Brownsville or Crown Heights. It just depends on the day.

Dawson-Davis is a doula, who guides women through pregnancy, labor, and the postpartum period. During her at-home checkups, Dawson-Davis asks a lot of questions: “Do you have a birth plan? How are your providers treating you? What milestones has the baby hit? How was the transition back to work?” 

However, her first question is always, “Should I take off my shoes?”

It’s for the same reason she keeps essential oils and a bright purple pocket fan in her work bag: For a doula, making the mother feel comfortable is first priority. That could mean banishing the sterile smell of a hospital room, soothing labor-induced hot flashes, or respecting house rules.

Not that Dawson-Davis could ever appear imposing. It is clear the doula adores color—from her multi-colored dreadlocks to the lush pastels of her floral dress and bright orange heels, to the rainbow bag strap on her shoulder. Her warm brown eyes and reassuring smile make you feel instantly at ease. You can’t help but trust her.

Mothers in crisis

The service Dawson-Davis provides is in great need, across the city and nation.

In terms of maternal mortality, or pregnancy-related death during or up to a year after the gestational period, the United States is one of the worst places in the developed world for women to give birth. According to The World Factbook, the U.S. maternal mortality rate is higher than in Lebanon, Egypt, Ukraine, and the Gaza Strip, and the statistics become more dire for minorities: Black women in New York City are nine times more likely to die from pregnancy-related complications than white women.

Dr. Linda Genen is the chief medical officer at Progeny Health, which offers maternal support to Medicaid recipients. Genen says unequal access to maternal care is one reason for the racial and socioeconomic gap in maternal mortality, since Medicaid pays for almost 50 percent of births in New York.  

“These are women who just can't afford private insurance, so having access to doulas and having Medicaid cover doula care really helps,” Genen says. “There are not enough [obstetricians] for all of the births we have.”

Even if a patient does have a doctor, monthly checkups are only feasible for mothers who can take off from work without losing their jobs. Doulas, on the other hand, perform checkups at home. They can help patients identify the warning signs of preeclampsia and gestational diabetes—two of the most common causes of maternal mortality—and provide preventive care like nutrition counseling. 

Doulas like Dawson-Davis can also accompany their clients to appointments, ensuring they understand medical terminology and looking out for symptoms of a potentially life-threatening condition. Genen says that a postpartum woman with severe headaches, for example, should not just be told, “Take two aspirin.” Her blood pressure should be checked for abnormalities. Just having another person in the room to advocate for a higher level of care can save lives. 

Both sides of the table

Dawson-Davis’ client arrives at the hospital at 6:00am for her scheduled cesarean section. Nurses change shifts at 7:00am, doctors do not arrive until 8, and every time a patient in active labor arrives, the client's delivery time is pushed back. She is starving because mothers cannot eat on the day of surgery, and her family is relegated to the waiting area. 

She is frustrated, but she is not alone.

Dawson-Davis’ doula status means she is allowed to wait with her client in the triage, or assessment unit. She assures her that this is normal for scheduled c-sections and is able to travel between doctors and family members to keep everyone updated on the time frame for delivery. Her lavender oil diffuser and relaxing piano jazz music ensure that, when her client finally goes into labor at 3:00pm, the space feels fit to welcome new life. 

Dawson-Davis knows what her clients need because she first entered the world of non-medical maternal care as a client herself, experiencing firsthand the disadvantages faced by Black mothers. 

“I like to say I’ve been on both sides of the table,” she says. 

Dawson-Davis had to have open heart surgery when her oldest son, now 16, was 4 months old. She was barely able to lift her baby during recovery, and when she got pregnant with her second son in 2013, Dawson-Davis knew she needed help.

That’s when she got a call from Healthy Start Brooklyn, a sponsor of maternal programs in the borough, offering her a doula. When Dawson-Davis struggled to breastfeed after coming home from the hospital, her doula was instrumental in helping her stimulate the natural feeding process.

What Dawson-Davis learned allowed her to begin counseling friends and family, and she was good at it. Now, in addition to being a trained doula, Dawson-Davis is a certified lactation counselor and teaches classes in newborn care. After that first postpartum doula training, she never looked back.

Expanding citywide

In 2022, New York City Mayor Eric Adams signed the Citywide Doula Initiative (CDI) into law in an effort to lower the Black maternal mortality rate. Historically, doulas have been volunteers, and the salaried few rely on competitive government grants to make a living. The ordinance created an infrastructure for funding doula organizations that extends beyond individual grants and launched a six-month apprenticeship program with one-on-one mentorship as a path to certification.

The CDI also matches new and existing doulas in the city with organizations like By My Side Birth Support Program, where Dawson-Davis has worked for over eight years, and makes doula services free for women on Medicaid. Care has expanded from just Brooklyn to 33 neighborhoods across the city identified as having high health and socioeconomic disparities. The New Family Home Visits Initiative, under which the CDI falls, has served over 12,000 families in the two years since its inception. 

Doulas with the CDI must complete a comprehensive training program, provided by local organizations like Ancient Song Doula Services and Mama Glow or a countrywide enterprise like DONA International, to qualify for caregiving. The curriculum includes the physiology of childbirth, stages of labor, and lactation support so doulas can help clients during delivery and understand medical terminology when talking to doctors. Additional courses in bodily autonomy and informed consent allow them to help clients make decisions about their bodies.

Doulas who choose to become Medicaid providers must do even more. New caregivers must attend at least three births and undergo at least 24 hours of competency training. A second path for experienced doulas requires attending at least 30 births and logging at least 1,000 hours of birth and postpartum care from the last 10 years. 

This represents a major step forward for women’s reproductive rights, which have taken a hit in recent years. However, there are still not enough doulas.

On the Assembly floor

In 2019, a new bill proposed by Assemblywoman Amy Paulin was on the New York state Senate floor. It would require doulas to be of “good moral character,” a vague term lacking clear criteria, among other requirements like certification fees and state testing.

According to Chanel Porchia-Albert, founder and president of Ancient Song Doula Services and a commissioner on the New York City Commission for Gender Equity, the bill was inequitable and marginalized large groups of people. 

“Say someone previously was incarcerated and they hadn't had an offense that was anything sexually related,” she says. “These individuals are now no longer allowed to be in this particular workforce.” 

When Porchia-Albert heard the news, she hopped on a train to Albany almost immediately. Paulin agreed to meet her at the back of the Assembly chamber to hear the objections of an industry leader, and although the bill passed on the floor, a campaign spearheaded by Ancient Song galvanized doula organizations around the state against the bill. It was soon vetoed by then-Governor Andrew Cuomo. 

Porchia-Albert was on her first political campaign in middle school. At age 13, she got a job at the City of Paterson, New Jersey, mayor’s office under Mayor Bill Pascrell, and she worked on several other campaigns throughout college. Six kids and several years later, talking about maternal and reproductive rights still ignites a spark in her eyes.

“I think we oftentimes as individuals diminish how much power we actually have,” she says during a Zoom conversation while on a work trip in Washington, D.C. “It is grassroots movements that inform legislative policies, not the other way around.”

In New York, the battle for equity in maternal health care is fought as much on the Assembly floor as it is in obstetric offices and delivery rooms. Hard-won victories like a new standing order for doula Medicaid reimbursement ensure that doulas across the state will receive $1,500 per pregnant person served, as well as establish a directory for expectant parents to locate a doula in their community. 

However, the number of birthing centers in New York City has shrunk from five to one in recent years, and after the overturning of Roe v. Wade in 2022, doulas are fighting for simple reproductive rights for their clients.

The CDI is currently structured to support contract work. This means that, instead of having a salary, doulas are hired for one birth at a time. Many doulas have children of their own and are often supporting their families paycheck-to-paycheck. They receive no benefits like health or dental care. 

“We can't have a sustainable society without being able to have that infrastructure in place,” Porchia-Albert says.

Without that sustainability, it is difficult to develop a workforce. Porchia-Albert describes Ancient Song as a revolving door, with doulas only remaining as long as the meager pay and benefits allow. 

Building community

Dawson-Davis’ favorite part of being a doula are those precious moments after a baby is born. 

“What could be better than watching somebody take their first breath?” she says. “We've gone through all the hard work, and this is the reward, and it's breathtaking.”

According to Dawson-Davis, all of the jobs she’s had in her life involve working with the community, ever since she was a high school history teacher before becoming a doula. She lives in the ZIP code she serves—her clients are women who look like her, receive medical care from the same institutions, and need the same resources. She’s even served her former history students. 

Porchia-Albert agrees. She knows firsthand what it feels like to be on Medicaid. 

“People want to feel valued,” she says. “No one wants to feel less than.”

Ancient Song started in her living room as a safe space for community members to learn about their reproductive health choices. She would receive clients in her living room and cook for them afterward. In Porchia-Albert’s community, people look after one another. It’s just what they do. 

Doula work isn’t only a profession. It is a way of life.