By Jennifer Chambers
jchambers@detroitnews.com
Soon after learning she was pregnant, Nyah Phillips envisioned her baby’s delivery in a hospital with her partner and mother at her side for support.
A doula being in the delivery room during such a pivotal and private moment was not part of her vision.
“I was like, why do I want somebody who I don’t know there?” said Phillips of Inkster, who is due later this month. “I figured it would be helpful for some people who don’t have family or support.”
Then Phillips met Camaria Wafer, a Detroit-based doula who offers practical support to expectant and new moms, at a Black Breastfeeding event last summer. She learned how doulas help with everything from picking out baby clothes to choosing prenatal vitamins to simply holding the baby once it’s born so moms can eat a hot meal.
“I said, ‘Oh. I thought doulas just went to doctor’s appointments,’” Phillips said. “That, for me, was mind-blowing. That is what made my eyes big. That is very different.”
Phillips hired Wafer, and the pair created a birth plan together. They met in December to discuss which supplements Phillips should take in her third trimester, and at another appointment, Phillips and her partner met with Wafer to review the birth plan.
Wafer will attend the birth. Her services will be paid for under Michigan’s Medicaid program, which covers Phillips, as part of a three-year-old initiative by the state to improve health outcomes for moms and babies by getting more low-income women to sign up for doula assistance. Michigan’s infant mortality rate is above the national average, while Detroit’s rate is last among the country’s 100 major cities, according to a 2025 March of Dimes report.
Doulas, who have been around for centuries, are trained birth professionals who help women have safe, healthy and positive birth experiences. More than 1,000 trained doulas are on a statewide registry as part of a Michigan initiative to reduce infant and maternal mortality that includes Medicaid health coverage for doula services.
Doulas do not provide medical care, but focus on the needs of the mother by offering mental, physical, and emotional support, usually as part of a larger care team that includes doctors and nurses.
A person can connect with a doula at any point during a pregnancy or after delivery. During labor, a doula can provide hands-on comfort measures, breathing and coping strategies, and information to help moms feel calm and prepared. Some doulas come in after the birth of a child by specializing in helping families transition to life with a new baby.
“I always tell people in shorthand: Midwives catch babies, doulas hold mamas,” Wafer told The Detroit News. “So we are there primarily for the mom. We’re also there for the family, the dads and the baby. However we can support that family is what a doula does.”
Doula initiative launched
Michigan health officials see doulas as key to improving the state’s poor record for maternal and infant health, particularly for women of color.
The Michigan Department of Health and Human Services launched a Doula Initiative in 2023 and, for the first time, began covering doula services as a Medicaid benefit for mostly low-income residents in January 2023. The coverage was expanded in October 2024 to include 12 months of doula care with 12 visits during pregnancy and postpartum, as well as hospital delivery.
Since the start of doula coverage on Jan. 1, 2023, through the summer of 2025, Michigan Medicaid has reimbursed more than 16,000 doula services, including individual visits and individual labor and delivery support, to more than 3,000 Medicaid beneficiaries. The program has paid nearly $3.5 million to Michigan Medicaid-enrolled doulas who provide direct support to birthing individuals, state officials said.
The state’s Doula Initiative provides funding for doula training, creates a doula registry and offers reimbursement for doula services during pregnancy, labor, and postpartum.
“We wanted to take the next step to ensure that everyone had access to doula services,” said Dawn Shanafelt, director of the division of maternal and infant health at the Michigan Department of Health and Human Services.
Prior to 2023, there were two ways to have a doula as part of a care team, Shanafelt said — if an individual could pay for one or find a doula covered by a grant. Doulas set their own price per visit or for a series of visits, starting at $2,000 for a package. Postpartum visits range from $25-$45 an hour, depending on the client and her needs.
State health officials launched the Doula Initiative to increase the doula workforce and created rules around which trainings qualify a person to become a doula in Michigan and receive federal Medicaid reimbursement. The state also established a 25-member Doula Advisory Council.
“We were one of the first states in the nation (for Medicaid reimbursement), and what makes us unique is that we have community-based doulas that are part of our initiative,” Shanafelt said. “Other states didn’t necessarily have that. But we knew in order for doulas to have a successful impact, we needed to have doulas that are from the community that are serving the community. Essentially, we wanted to fund what works.”
More than 1,000 doulas are on the MDHHS Doula Registry, surpassing the state’s 2028 goal of 500. About 720 doulas are verified as having completed one of the state department’s training programs and have become Medicaid-enrolled providers.
State rules for a doula require training in communication, coping, labor support and newborn care. Candidates must be at least 18 years old, have a high school diploma and have completed approved training (or demonstrating experience) for the state registry.
Culture of caring for women
Wafer of Detroit is a Medicaid-approved doula who also contracts with Michigan Family Doulas, a Metro Detroit-based agency that pairs families with doulas for hire. She has been a doula for more than two dozen clients and sees her role as working with the maternity care team, including nurses, midwives and doctors.
Wafer said the doulas have a cultural importance in families and help mothers explore options and desires during pregnancy, birth and the post-delivery period.
The idea of women helping other women during childbirth is not new. According to the Motherhood Center, a New York-based clinical treatment center, the origins of doulas can be traced to ancient Greece, where women supported each other during childbirth. The word “doula” comes from the Greek word “doulē,” which means “female servant.”
“Every culture has a woman around, or somebody around, caring for mom,” said Wafer, 26. “I ask them (what they want), and I listen.”
Wafer recently worked for a mom whose baby had been in a neonatal intensive care unit for months. The mom needed Wafer to help at the hospital so she could go home and care for her older children there.
“And mom’s like, ‘Hey, I think I’m starting to experience some postpartum depression. I have other kids at home that I need to take care of. Can you go sit at the NICU with the baby? Because I cannot physically or mentally take sitting there for one more minute,’” Wafer said of the client.
For clients with Michigan Family Doulas, Wafer will do overnight shifts at the home of a new baby. She cares for the baby when it wakes up, needs changing and feeding, and then takes care of household chores, including washing bottles and folding laundry, so the parents can sleep. These clients are direct pay and separate from Medicaid.
Wafer said her job includes advocating for the mother in a medical office or hospital setting. For one of her clients, Wafer spoke with the mom about labor positions and comfort measures, then brought the dad in to get them more involved.
“I’m trained in trauma-informed care as well, so understanding that a lot of my clients in Detroit that I deal with have a lot of sexual trauma and domestic violence, medical trauma. So I have a trauma session with one of my clients,” Wafer said.
Wafer, who has a political science degree from Wayne State University, says her position as a doula allows her, in some cases, to talk to clients about their roles and relationships and serve as a bridge for a struggling family.
“A lot of times I’m dealing with first-generation parents. … They don’t even know what a father looks like,” she said. “The idea of becoming a father freaks them out, and that’s why some guys are just like, ‘I give up.’”
Training doulas of color
Wafer, who is designing her own doula app, obtained her own training, secured liability insurance and applied for the Medicaid registry so she could work with women on Medicaid. Her training came from Birthworkers of Color Collective, a California-based nonprofit, where she learned virtually during the pandemic.
The Birthworkers of Color Collective is one of the few Medicaid-approved doula training organizations in Michigan. The national organization has trained doulas in 22 states and has been working in Michigan since 2024.
In April 2024, the Michigan collective hosted its first doula-of-color training program, training 27 doulas with state Department of Health and Human Services funding and scholarships to work in Michigan’s Medicaid communities. In 2025, the group hosted three trainings in the state: two in Detroit and one in Flint, said Stevie Merino, president and founder of the Brithworkers of Color Collective.
Merino said her group helped doulas through the Medicaid process, which can be challenging with its paperwork, timelines and rules. A doula’s approach is unique to the needs of the clients, Merino said, and training for doulas can vary.
“For our approach, there is that cultural relevancy and cultural sensitivity,” Merino said. “A lot of research shows that sometimes people prefer to have their care support reflect them, and that can increase their positive health experiences. Especially when a lot of Black and Brown women are going into hospitals and dying at disproportional rates, or their babies are.”
Maternal and infant health results in the United States and Michigan are worse than in the rest of the developed world. Michigan has a high preterm birth rate (10.3%), according to analysis by the March of Dimes, while the rate for Detroit — with a population that is more than three-quarters Black — stands at 15.6%.
Michigan has been among the worst-performing states in its infant mortality rates, though the numbers are improving. State health officials announced earlier this year that Michigan recorded the lowest infant mortality rate in its history in 2023. That year, 607 infants under the age of one died, and the state’s infant mortality rate declined to 6.1 infant deaths per 1,000 live births — a decrease from 2022’s 650 deaths and 6.3 deaths per 1,000 live births.
Deaths among Black infants fell to 11.9 deaths per 1,000 live births in 2023, also a record low. While the numbers are a reduction from 2022’s 14.1 deaths per 1,000 births, the rate is still nearly three times that of White infant deaths.
A 2024 Citizens Research Council of Michigan report said research shows that doulas are associated with better delivery outcomes, including reduced cesarean sections, premature deliveries and the length of labor.
Karley Abramson, a health policy research associate at the CRC, told The News in December that Michigan increased the Medicaid reimbursement rate substantially to put it in line with most other states in 2024.
“This means that the potential doula earnings per Medicaid pregnancy more than doubled. And unsurprisingly, this seems to have brought a lot more doulas into the program/workforce,” Abramson said.
The state enacted a Doula scholarship fund in April to help train people, but state officials said no funding was appropriated for the program in the state budget, and the program has not yet been established. The Doula Initiative has sponsored 40 doula training sessions since 2023.
Abramson said research shows positive outcomes from doula involvement, and the cost of promoting the use of doulas is relatively low compared with some other health care policy levers.
“There was a pretty clear issue (reimbursement rates) that the state addressed, and it seems to have increased the workforce,” Abramson said.
Doing pregnancy differently
Tierney Morant of Detroit was in her fourth pregnancy when she decided to consider a doula. She hired Wafer to be in the delivery room with her, and on Nov. 12, she welcomed her son, Nekhi White, into the world. Medicaid is paying for Wafer’s doula services.
As the 26-year-old went into labor in November, Morant said she was surprised by how much pain she was in despite having an epidural, as she had with the three other pregnancies. Wafer was there to massage her back when contractions became severe and reminded her to loosen her face and breathe as labor progressed, Morant said.
“That was wonderful. She was massaging. That felt excellent. It was so great,” Morant recalled.
Just before Christmas, Wafer paid a visit to Morant and her baby and learned breastfeeding was going well, but Morant needed help wrapping Christmas gifts while her three daughters were out of the home. She has also been struggling with post-partum depression.
While Morant nursed, Wafer brought wrapping paper into the family room, and the women talked about life with a new baby. A lit Christmas tree and the family’s stockings hung nearby.
“I didn’t have a lot of support during my pregnancy,” Morant said, smiling, as Wafer stood holding and burping baby Nekhi. “As far as the emotional support, you did your thing.”
“When I first started having babies, I was young. So a lot of stuff, I didn’t really think about,” Morant said. “So this time, I’m older, I’m gonna do a whole lot of things differently.”
