Cook County launches free doula program

Cook County’s public health system is launching free doula services for pregnant patients to help reduce health disparities.

Nearly 1,000 mostly Black or Latina patients at Cook County Health are pregnant, and they will be offered a choice to have a doula support and advocate for them before, during and after labor.

“This program is a direct response to the stark and unacceptable disparities in maternal health that have plagued Black women for far too long,” said Cook County Commissioner Donna Miller, who led the initiative.

Doulas can educate patients and their families on what to expect before birth. During labor, they can provide emotional and physical support to help cope with the stress and pain — offering reassurance and squeezing near a woman’s hips during a contraction, for example. After the baby arrives, doulas can help parents navigate everything from breastfeeding their babies to feeding themselves during what can be a stressful time those first few weeks and months at home.

Shalonda Carter, a reproductive life planning coach at Cook County Health who also is a trained doula, describes the role of a doula as being an anti-stressor, a companion, a mother, sister, a therapist. She said she has cried with her patients, even danced with them during labor.

“Our role is to help women find their voices and use their voices,” Carter said. “We do not speak for them. Instead we support them in their self-advocacy.”

The county’s move comes as deaths among pregnant women — while rare — have increased across Illinois. The majority of those deaths were possibly preventable, according to a 2023 state report on maternal morbidity and mortality. Black women were disproportionately affected, and more pregnant women who died lost their lives months after giving birth as they fell through the cracks of a complicated health system.

Cook County was among seven counties in Illinois that from 2016-20 had a severe maternal morbidity rate of at least 100 per 10,000 births, the state report showed. That means a group of potentially “life-threatening, unexpected maternal conditions or complications” happened during labor and delivery, such as hemorrhaging or kidney failure.

Research shows having a doula is linked to better health outcomes for mothers and babies, including fewer premature births and lower C-section rates. These major abdominal surgeries can be lifesaving but have potential consequences that disproportionately affect Black women, such as infections and hysterectomies.

Miller said she wished she knew about doulas and how they advocate for and empower patients when she had her son 21 years ago. Miller said an anesthesiologist was preparing her for an epidural to undergo a C-section when he asked her repeatedly if she had ever used drugs, even though she kept saying ‘no.’

“My husband was like, ‘Wait a second. Didn’t you already ask her that, and now you’re asking her three times?’ Miller recalled.

The anesthesiologist replied that he wanted to make sure Miller understood the question, she said. Now she questions if he asked her about drugs because she’s a Black woman.

“What if I didn’t have my husband here?” Miller said. “‘I immediately got stressed out by him insulting me.”

Miller said that’s when she learned about having an advocate and wants to make sure patients at Cook County Health, one of the largest public health systems in the nation, have the option.

The county plans to spend about $1 million a year through 2027 on a contract with Prism Health, which will provide 10 doulas. There will either be doulas who speak Spanish and Mandarin, the languages their patients speak, or there will be interpreters.

The county plans to track how well the doula program helps patients and their newborns. The goal is to start the program in January.

Kristen Schorsch covers public health and Cook County for WBEZ.