Harambee Doulas Care & Holistic Services Provides Crucial Support and Guidance During Pregnancy and Beyond: Support When Mothers Need It Most
FAR LEFT: Front row: Aida Leflore, board vice-chair and treasurer, Tehmina Islam, director of Clinical Services and Midwife Consultant. Back row: Daphne Daniels, board chair, Uchenna Jones, director of Doula Education and nurse consultant, Emelle Holmes Drammeh, board-at-large and birth doula, Chandra Lewis, director of Doula Programming. Not pictured: Chiebonam Smith, board secretary; (LEFT) Harambee client AJ and the newest HDCHS family member, Baby Z;
ABOVE: Uchenna Jones (l-r), Tehmina Islam, Chandra Lewis
by Jonathan Gramling
Back in the 1990s, the Harambee Center was basically a one-stop shop for mothers and children. Head Start was there. Family Enhancement was there. The Madison Public Library was there along with other child-centered organizations including the Harambee Doulas. But all of that changed.
“Up until 2010 or so, Harambee had the Harambee Center on the south side of Madison,” said Chandra Lewis. “Because of local politics and funding, that original center was closed. And so in about 2014, we came back in another form. We were Harambee Village Doulas. You may have heard of Harambee Birth and Family Center. We are the same organization with the same mission. Nothing has changed but the name. Late last year in 2024, Harambee Village Doulas and Harambee Birth & Family Center ended as a business organization. And so we started a brand-new 501(c)(3) non-profit. And that is the Harambee Doula Care & Holistic Services that you are sitting in today. we are kind of Harambee 3.0. We are Harambee Doula Care & Holistic Services. So we have a three-person co-founding team. It’s myself, director of Doula Programming, Tehmina Islam, our community midwife and Uchenna Jones, our nurse consultant. We kept all of the doulas. We kept all of the admin staff except for our executive director who stepped away due to her health. That’s why new started a new business organization and all of the rebranding that you see today.”
What is a doula, one might ask.
“Doula is a term that was popularized in the 1970s and 1980s,” Lewis said. “It really just means ‘Someone who helps.’ It’s someone who helps the person give birth. But there have been doulas since eons and millennia. People have always come together communally to help those in need. And so being a doula is an ancestral communal process. It has evolved into a status symbol or a class symbol, whoever can afford to pay for a doula can have one. But cost should never be a barrier to access for care. And so we seek to bring doulas back to the community. That is why about 90-95 percent of the people whom Harambee serves are even on Medicaid or are Medicaid eligible. They would not be able to pay for our services otherwise. As an agency, our mission is to make sure that there is that equitable access to care so that every birthing person has the dignity of choice of representation and is able to have the birth that they want to have.”
And that equitable access is important. The disparity of healthy birth outcomes that Black women and their children face are the result, in part, on their position in society and the resources at their disposal.
“There are so many other stressors besides pregnancy, especially if you are head-of-household,” Lewis said. “What if you have other children? The number one factors for low birth weight in Black infants is pre-term birth. And it is because of those stressors, because they are going into labor earlier, because their babies don’t have a chance to go to gestation, sometimes just having that communal support, having that constant face that has been with you prenatally has been
known to lower labor by an average of 41 minutes. So having that trusted person there whom you can talk to about everything in your life, whether it is your job or navigating systems, you have that trusted support person. And sometimes, you are able to go to term. There is an anecdote of a person whom Harambee has served. That person is a mother of seven. And that mother had never gone to term with any of her children. But because of her care, I was her doula and Tehmina was her midwife, with her seventh child, she was able to go to term.”
Doulas are a one-person support team.
“In two words, a doula is a support system,” Lewis said. “We provide physical support. That might be in the form of a massage or counter-pressure or other comfort measures you may think of. We provide informational support. So we are someone to debrief with. It’s a little bit safer than Google. If you go to your doctor’s appointment and they said something that you didn’t understand or you don’t understand why they gave me this test and they want to do this test, you can call a doula and debrief. And they are a trusted source of information for you, better than ChatGPT or TiK ToK. A doula would be a trusted source of information. They also provide emotional support. Life is challenging. And sometimes, you just need someone to reach out to you. And then depending on that relationship or circumstances, a doula can also offer spiritual support if that is a relationship that they have with their client. So in one word, I woulds say we are support. We are that trusted friend or that trusted partner or that other third party who is nonjudgmental.”
Doulas stand ready to provide support at any time during a woman’s pregnancy.
“We get calls as early as six-weeks,” Lewis said. “‘I just found out today.’ Sometimes we get calls as late as 38-weeks. We like to get them closely around the beginning of the second trimester because we want people to enjoy their pregnancy and enjoy the feeling and getting used to the change in their body. Between the first 13 weeks, sometimes challenges happen and pregnancies might not be viable. So we advise people to wait until that 13-14th week when they are heading into their second trimester to connect with their doulas. So as close to that as possible. Some people know right away. ‘I don’t care. I need my doula for all of my prenatal journey.’ But as soon as someone needs that support, they are able to reach out.”
Doulas are there from prenatal to postpartum. Along the way, doulas form that special bond with the expectant mother.
“Going through that whole prenatal journey allows us to build trust,” Lewis said. “And it’s trust when it is different from someone who looks like you versus a provider who is coming into the room for 15 minutes. Your doula spends that amount of time with you with more touch points that any provider would. And they get to know how that person looks. They get to know how that person sounds. And so you might come in and say, ‘Hey, how are you doing?’ ‘Oh, I’m fine.’ And you doula is like, ‘You’re not fine. Tell them what is going on.’ It’s really observation and getting to build the trusted relationship.”
The doula is there for the expectant mother and so there are few time boundaries that are placed on the relationship.
“The amount of time that they spend together varies,” Lewis said. “We ask our doulas to do a minimum of three prenatal visits that continue with labor and birth support and a minimum of three postpartum visits up to 6-8 weeks postpartum through that acute period. But you can have more touch points with your doula if that is your relationship and that is what you require, especially if you are a highly anxious person. Some people meet weekly. Some people meet biweekly. Some people may meet monthly. It just depends on what that client needs because each person’s care is individualized to what they need and they are the driver of that relationship. There are phone calls, text messages, zoom. ‘Let’s meet at the park.’ We’ve had people walk around the mall and do prenatal visits. We’ve had people meet at Panera on a 20-minute lunch break. So we fit into your life. And we shouldn’t be a stressor for your life. We meet you where you are, wherever that may be.”
Doulas are members of the care team, even having badges from Meriter and SSM Health that identify them as a part of the team. During the birthing process, the doula is that voice of reason for the mother while she goes through an intense time of pain and wonder.
“The doula would have worked with that client to talk about their arrival plan,” Lewis said. “Most times, doulas arrive between four centimeters and when that client is in active labor, which happens at six centimeters. Sometimes they can arrive earlier if needed. But they will have discussed that hospital arrival plan. Our role is to remind you of what you want. So prenatally, we have already talked about what your options are. We’ve already talked about what your preferences are. It’s our job to remind you, ‘Hey you said you didn’t want an epidural. Do you want to try movement instead? Of course, it’s okay to change your mind because we made this plan before you were in pain.’ We give people permission to take ownership and agency of their own experience. And it is our job to provide the information so that they can make the best choices for them. So we remind them to use their brain. We remind them to ask what the benefits are of any procedure or anything that comes up, what the risks are, ask if there are any alternatives, ask them what their body or their intuition is saying. And then what if we do nothing. Do we have to do that right now? It’s our job to slow down the process so that our clients can get the information that they need. Do they want to break their water? What happens when they break their water? Don’t just say yes because they are in a white coat. What do you really want to do. And just remind them that it is their process. And sometimes it is okay to say no.”
Doulas play a delicate role. They play no decision-making role. They are, in essence, hired by the expectant mother and are not a part of the hospital staff. And yet, they need to be able to work effectively on behalf of the expectant mother.
“We are there to be a doctor support as well,” Lewis said. “Hopefully, it’s not adversarial. We don’t want an adversarial relationship. We want to work with the doctor. We don’t overrule our clients. We don’t offer medical advice. We don’t do any clinical procedures. We’re there to offer physical support in the form of comfort measures, whether that be a warm towel, whipping the forehead or running to the nutrition room and grabbing a drink. We are there to provide that information. ‘Did you understand? Did you ask all of your questions? Did you get all of your answers? Remember you said this. Is that truly what you want?’ That way the client or the birthing person themselves can make an informed choice. And then we are there for emotional support. What if your plan changes? The only thing we know is babies do what they want and plans change. ‘What do we do when the plan changes? Are you okay if the plan changes?’ And then in the event of an emergency, trust your provider. And sometimes we have to remind our clients, ‘Call your provider, not us, because we don’t do clinical or medical advice.’”
During the delivery process, the doula is there to offer physical and emotional support.
“We tell people birth is like Las Vegas,” Lewis said. “What happens there, stays there. I have been hand squeezed. I have been bitten. But we do whatever we need to do. I might be there to remind your wife that it is okay to scream. That actually helps you get oxygen down to the baby. Vocalize or do it at a high pitch or do it at a low pitch. We just remind them why they need to do the things that they do. It’s okay. And the number one thing that we hear is, ‘I don’t want to poop.’ Poop happens. But that’s how we know we are using the right muscles. It’s okay. It just normalizes birth because people don’t normalize birth. It’s always seems to be a thing to manage instead of a life thing that happens.”
Once the baby is born, the doula remains at the mother’s side to help with the transition.
“Our doulas will normally stay through that recovery period, so at least 2-3 hours after birth, when they are moved from the birth room to the postpartum floor,” Lewis said. “And then we’ll make our transition. We’ll go home and get a nap. And then we’ll come back in 24 hours to check on our new family when they are still in the hospital.”
As the mother and her child transition back home, there are a new set of challenges that the mother faces and new sources of tension while giving the baby everything that they need.
“We’ll check on them when they make that transition home,” Lewis said. “And hopefully within that first week, three weeks and six weeks. Sometimes you need a friend. It might be a mental health check-in. ‘How are you doing?’ Sometimes that new parent might just need another adult to talk to. Sometimes you might need me to just hold the baby for 20 minutes so that you can take a shower and feel human. That’s what a doula can do. Sometimes a doula will walk in and see, ‘Oh these dishes need to be washed before you can cook. Let’s not talk about what you are eating. Let me just go ahead and wash these dishes while we’re having a conversation.’ Sometimes it might just be an observation of what that person may need because they are transitioning. It’s a new role in their life. They may not know what they need. Hopefully prenatally, they have talked about practical division of labor during postpartum. Talked about freedom meals during postpartum. Talked about who your support system is. Who can you call at 3 a.m. when you are having a breakdown? Maybe we’ve talked about crisis planning. What are some things that we need to observe as your family before you get into crisis so that we know when someone needs to step in. Those are touch points that we would have prenatally to help us practically plan for postpartum. And if you have a good doula, they will help you plan for your postpartum before it gets here.”
While the doula plays an important role in the prenatal, birthing and postpartum periods, their services are rarely — if ever — covered by health insurance plans. And doulas price is anywhere from $500 to $1,500 at minimum.
“There is one insurance payer in Dane County that does cover doula services for their Medicaid population,” Lewis said. “And that is Dean Health Plan. The health plans will cover doula services for anyone who is on DHP as a part of their Badger Care. If they are Black, they can get a doula at no cost through Harambee. If they are Latinx, they can get it at no cost through Groups for Change. They have a made a commitment to community health. They are the only ones. If you are on BadgerCare, Harambee has become PNCC, Prenatal Care Coordination, certified. So we are able to offer a few more touch points prenatally and postpartum and a few more education points. And then bill Medicaid. But Medicaid does not cover services for labor and birth. How many touch points are added prenatally, how many touch points are added postpartum so that doula’s rate of $1,500, on average, are covered. We don’t ask our doulas to take on more work. But as an agency, Tehmina will go do more PNCC. I will reach out and do a PNCC visit or Uchenna will so that our doulas don’t feel that burden. But the only way for us to bill Medicaid for someone who does not have DHP is to enroll them in that PNCC program.”
Right now, some research is going on to determine the value added of doula care.. But that may not lead to doulas being covered by health insurance plans, at least not in the near future.
“Standard of care here in the U.S.. you get an OB first,” Lewis said. “In other places, you would see a midwife. And then you would get an OB if you had an issue or you needed specialized care. I would love to see a return to midwifery care and have doulas built into that as a way that we offer care in the beginning. That’s why we work with a midwife here at Harambee. But a doula should always be offered, honestly, if they can be paid for by insurance company as a standard when someone is entering that reproductive period of their life because a birth doula can help navigate so much of the system pressures that are placed on that birthing person, a doula should just be standard of care.”
Next issue: The World of Doulas