Doulas Work on the Front Lines of the Climate Crisis

As trusted community figures, doulas are increasingly helping their clients stay safe during heat waves, hurricanes, and wildfires, all of which put pregnant people at higher risk.

As Hurricane Ian approached southern Florida in late September, Tifanny Burks got a call from a recent client.

A single mother of three, including an infant Burks had helped deliver, was facing eviction and scrambling to find a place to weather the storm.

Burks, who uses they/her pronouns, connected their client with lawyers who could help the mother fight the eviction so she and her family could shelter at home.

Tifanny Burks is a doula. Part of the job is helping a client through pregnancy and birth, Burks said; the rest is 鈥渉aving those connections and being able to reference people out.鈥� Aside from lawyers, Burks said they have referred clients to therapists and OB-GYNs.

In the days surrounding the hurricane, parents throughout Miami-Dade County were turning toward doulas for guidance on getting through the storm, according to , another Miami-based doula.

A changing climate gives them little choice: Doulas are always on call. 鈥淲e do our work, and the weather is what it is,鈥� McCant said.

It鈥檚 a phenomenon taking place across the country. Doulas, trusted community figures, are increasingly helping their clients weather the climate crisis.

鈥淭raditional providers like OB-GYNs tend to spend far too little time with patients to get into their environmental health risks,鈥� said Skye Wheeler, a researcher at Human Rights Watch. 鈥淒oulas spend much more time with their clients. They鈥檙e also great planners and are perfectly placed to help clients think through affordable ways to get ready for heat or hurricanes.鈥�

In Miami, doulas like McCant have organized workshops advising clients on how to stay safe during a heat wave; in New Mexico, they mobilized during wildfires that burned through much of the state earlier this year.

Doulas often come from the same communities as their clients, Wheeler said; that helps build trust and can make them more effective advocates. 鈥淭hey see things from their clients鈥� point of view, so they understand the importance of a healthy environment for a healthy pregnancy and the ways stress and marginalization [can] undermine that,鈥� she said.

The climate crisis is exacerbating an existing . Extreme heat and air pollution are preterm labor, low birth weight, stillbirth, and other negative pregnancy outcomes. Stress related to wildfires, flooding, and hurricanes鈥攚hich are becoming 鈥攁lso adversely affects pregnancy outcomes.

Black and Brown communities鈥攁lready facing higher rates of maternal mortality, stillbirth, and premature birth鈥攁re more likely to live in with , a legacy of , making pregnancy increasingly dangerous.

鈥淚f it鈥檚 hotter [in those neighborhoods], the people that are going to be struggling the most are those who are living in underserved communities and might not have access to robust AC or are unable to buy different fans to keep cool,鈥� said Burks, who, like many of their clients, is Black.

鈥淵ou now see more doulas having conversations about the implications and impact [of climate change],鈥� they added. 鈥淎 lot of times, people just don鈥檛 know, and think that [certain stresses] are happening to them and it鈥檚 random but don鈥檛 connect it to a larger issue.鈥�

Doulas, who spend more time with their clients than hospital and clinical staff do, and who are associated with lower rates of cesarean sections, can be a powerful tool in reducing health disparities.

Doulas are unique in that they make home visits, said Jessalyn Ballerano, a doula in Eugene, Oregon. 鈥淚鈥檓 seeing if air is clean and safe, if there are any dangers, if there is food in the fridge, if they are eating regularly, if they have enough water, if they have easy water access,鈥� she said. 鈥淚t takes some experience and skills to successfully investigate that in a collaborative way with the family.鈥�

Ballerano, who previously lived in Oakland, California, said navigating wildfire smoke, air pollution, and risk of evacuation鈥攁nd understanding how it would affect pregnant people and families鈥攂ecame a part of her life there.

When she gets a new client, Ballerano typically offers them a resource list that includes information on nutrition, support groups, and health care providers. 鈥淢ore and more, that resource list is going to include aspects for evacuation, fire safety, food access in case of disaster, and emergency preparedness resources,鈥� she said. Ballerano works at the perinatal health nonprofit Nurturely, where she recently helped organize a in which doulas, climate advocates, and health care workers discussed ways to best assist pregnant people and new parents during wildfires.

Doulas play a number of roles, said Shonte鈥� Terhune-Smith, a doula in Flint, Michigan.

鈥淸Doulas] are a labor companion. An educator. A resource. A friend. Emotional and physical support in the prenatal, birthing, and postpartum process,鈥� she said. And that work doesn鈥檛 end with the birth of a child.

In Flint, where tens of thousands of residents were exposed to dangerous levels of lead, Terhune-Smith educated new mothers on the importance of breastfeeding or using bottled water with formula to keep their children safe.

Doulas aren鈥檛 paid to be frontline climate workers. Though they spend countless hours advising clients before, during, and after birth, they鈥檙e typically paid a flat fee that from a few hundred dollars to $1,500 per birth.

鈥淒oulas are already getting burned out fighting against the racism and injustice that drives inequitable maternal health and birth outcomes, and they aren鈥檛 properly compensated,鈥� said Wheeler. One reason they鈥檙e paid so little is that they鈥檙e not always covered by insurance and therefore are often .

In April of this year, Democratic lawmakers, including Sen. Elizabeth Warren and Rep. Lauren Underwood, called the , which would, among other things, expand Medicaid to include doula and midwife care. The bill is part of a larger package of legislation aimed at reducing maternal health disparities known as the , which also includes provisions on funding research into the effects of climate change on pregnancy.

Tonni Oberly, a doula and researcher at the , described the legislation as 鈥渋mportant steps in the right direction for giving birthing people the support they need and deserve.鈥�

As she sees it, supporting doulas is one way to invest in frontline communities.

鈥淒oulas are part of the community. So what communities face, doulas often face those same challenges,鈥� Oberly said. 鈥淚f doulas are serving clients in a heat wave or a food desert, then doulas are very well facing a heat wave or experiencing a food apartheid.鈥�

Back in Miami, Burks is already preparing for the next heat wave and hurricane. They try to stay on top of the latest research examining the connections between extreme weather and maternal health.

鈥淭he more I鈥檓 knowledgeable and informed, the more I can inform my clients,鈥� they said.

This article originally appeared in , an editorially independent, nonprofit news service covering climate change. Follow .