Anastasia Newyear held her tiny baby in her arms. She was in a New York City classroom for a final meeting with the woman who had been her bridge and guide to delivering a healthy infant.
Her daughter Aleena wore a sunflower-patterned outfit and squirmed on her mother’s chest. Heather Blount, a doula, was there, too. She was the person who had supported Ms. Newyear through her pregnancy. Now, she was picking Aleena up to give her mother a break, bouncing the 9-week-old baby gently.
The partnership between the two women was vital in helping Ms. Newyear have a healthy pregnancy. More than 3,500 pregnant women in New York City have been connected to doulas through an initiative begun in 2022, which the city’s health department said has helped improve birth outcomes for Black and Hispanic mothers.
But across the United States, mothers are at risk of losing doula services and other maternal care under the major tax and domestic policy law that President Trump signed earlier this year, which could strip Medicaid access from 7.5 million people.
Naima Beckles, the doula coordinator for the Northern Manhattan Perinatal Partnership, a maternal and children’s health group, said that the potential loss of Medicaid coverage had left pregnant patients anxious. The group in Harlem serves Black and brown mothers who are especially vulnerable, including many who live in shelters and are migrants. It’s the agency that provided doula services to Ms. Newyear.
“Clients who do have Medicaid are unsure they’ll be able to hold on to it through the duration of their pregnancy,” Ms. Beckles said.
About two of every five births in the United States are covered through Medicaid. Black women were the most likely (64 percent) to rely on government health insurance when giving birth in 2021, according to the Centers for Disease Control and Prevention.
New York City created the Citywide Doula Initiative to address gaps in maternal care by paying for doula services with city tax dollars. Doulas aren’t physicians but have a distinct role in supporting mothers through pregnancy, labor and life after childbirth. They find methods to keep mothers calm and in the best physical positions for childbirth and also act as liaisons between mothers and doctors.
While the New York City health department does not anticipate that federal cuts will affect free doula care in the city, health officials fear some pregnant mothers could lose Medicaid, which is their entry to maternal and child services.
More than 20 states reimburse doula services through Medicaid, according to the National Health Law Program, which works to improve access to health care for low-income and underserved people. Last year, New York State moved to provide free doula care statewide to mothers enrolled in Medicaid.
When Tenekqua Lisbon, 37, was in labor in a Manhattan hospital in October, her partner, Darryl Bogan, had to leave with their youngest child because children were not allowed in the delivery room. While her partner was gone, Ms. Lisbon gave birth to her daughter, Amari, beside her doula, Stacey Spencer-Willoughby.
“I’m so thankful to have had Stacey because my partner had to leave,” Ms. Lisbon said.
A study published in the American Journal of Public Health in 2024 found that doula care covered by Medicaid can improve maternal health. The report said that mothers who received doula care had a nearly 50 percent lower risk of cesarean sections, which can lead to infections, blood clots and potentially dangerous bleeding. Mothers receiving the care also had a 29 percent lower risk of preterm birth, and were 46 percent more likely to attend a postpartum checkup.
Ms. Newyear, 35, leaned on her mother, who is a nurse, during her pregnancy but needed additional help as she raised a teenager while expecting a newborn. For some women, doulas are all the support they have while pregnant or in labor.
Ms. Newyear’s daughter was born at 37 weeks and weighed only four pounds.
She recalled the moment doctors told her that she would have to undergo an emergency C-section. A flood of questions filled her mind: Would the doctors take care of her? Would she and her baby make it out alive? While she lay in the delivery room, Ms. Newyear said, Ms. Blount was right by her side.
A report published last year found that obstetricians are more likely to conduct C-sections on Black women than white women, putting them at risk of complications and ruptured surgical wounds.
“Just having her there made it a lot better,” Ms. Newyear said. “It would have been harder and scarier going through that process alone.”
Like Ms. Newyear, Ms. Lisbon sought out doula care for more support. She recalled going to a clinic in Harlem in mid-July for a standard OB-GYN visit. She arrived eating pineapple and raspberries so that she could have something in her stomach. Ms. Lisbon said that her physician advised her to monitor her fruit consumption because it could turn into sugar.
After the visit with the doctor, Ms. Lisbon went to the nurse’s office for a glucose test that she hadn’t known she would be taking. She was worried that the fruit she had just eaten could affect the results, but followed instructions to drink a sweet liquid used to conduct the test.
The next day, Ms. Lisbon received results that showed her sugar levels were above normal and was told that she needed another test. She refused.
“I don’t feel I was tested properly,” she said.
Ms. Lisbon was already wary after a doctor had instructed her to take baby aspirin every day, which is recommended for pregnant people who are at risk of complications. Ms. Lisbon said she had no risks.
“This is the second time I’m being put in a position where I feel like my back is against the wall,” Ms. Lisbon said.
Afterward, she searched for prenatal care elsewhere. She found a doula through Mama Glow, a maternal health organization that is the largest provider of free doula care in New York City.
About two months later, 36 weeks into her pregnancy, Ms. Lisbon sat on a gray couch in her Yonkers apartment for a doula session, her small bump visible under her striped dress.
“She makes me feel safe,” Ms. Lisbon said of Ms. Spencer-Willoughby, her new doula.
Health experts are concerned that Medicaid cuts could cause an uptick in maternal deaths among Black and low-income women.
The maternal mortality rate has decreased nationally, falling to 18.6 deaths per 100,000 live births in 2023, from 22.3 deaths per 100,000 births in 2022. But while the death rate has decreased significantly for most racial groups included in the C.D.C.’s study, it has increased for Black women, who are more than three times as likely to die from pregnancy-related causes as white women.
The Medicaid cuts are “going to be detrimental for everyone,” said Angela D. Aina, the executive director of Black Mamas Matter Alliance, an advocacy group. “Black women, Hispanic women, Asian women — everyone.”
Harold Miller, president of the Center for Healthcare Quality and Payment Reform, which works to improve health care payment and delivery systems, said that changes to Medicaid would vary from state to state.
Dr. Ndidiamaka Amutah-Onukagha, director of the Center for Black Maternal Health and Reproductive Justice at the Tufts University medical school, said Medicaid cuts could be especially detrimental for women in states that have banned abortion.
“If you happen to be in a maternal care desert in an abortion-restrictive state and you’re on Medicaid, that’s a triple whammy,” Dr. Amutah-Onukagha said. “That could be deadly.”
For Ms. Newyear, who works at a homeless shelter, receiving care in New York City has meant access to a team of advocates, help finding programs to lower her rent and home visits with a health worker until her baby is 18 months old.
“Medicaid is affordable for mothers like me that cannot pay out of pocket, that are struggling and work regular nine-to-fives,” she said.
After their final doula session, which Ms. Newyear attended alone, Ms. Blount walked her to an Uber. The doula carried a car seat with Aleena nestled under a gray blanket.
Samantha Latson is a Times reporter covering New York City and a member of the 2025-26 Times Fellowship class, a program for journalists early in their careers.
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