Dogs Lily and Daisy ran in excited circles, chasing their tails and barking as the doorbell rang.
Jen Shea opened the door to her house in Rocky Hill to welcome her doula, Desirae Whittle.
They exchanged hellos and hugs, as well as a personalized candle; the banter was light and easy, for theirs is a relationship that goes back more than five years.
Shea had postpartum depression. Whittle was her safety net.
“Desirae has been a safe space for me,” Shea said. “She’s witnessed the highs and lows of my IVF, pregnancy, birth and postpartum journeys. Having Desirae [be] a part of my story made a major difference in my experiences. Now, I am so lucky to have Desirae in my life as a wonderful friend.”
One in eight women experience postpartum depression. Data shows nearly half of all women in the U.S. experiencing postpartum depression are not diagnosed by a health care professional. Some fall through the gaps and are caught by doulas.
Doulas are not doctors. Doulas are not midwives, so they don’t manage labor and deliver babies. But they get training and certification to become part coach, part caregiver, offering physical and emotional support before, during and after childbirth. They help with everything from checklists and chores to mental health check-ins.
There’s a growing desire for more doulas, so efforts are underway in Connecticut to expand the doula population, involving the state as well as hospital systems.
Whittle said being a perinatal doula is her calling.
“Especially this community I love serving, expecting after the unexpected,” she said.
‘Can’t do it on my own’
Whittle’s own personal experience of loss and anxiety informs her work as a doula.
“I also experienced infertility,” Whittle said. “I also had postpartum anxiety, and then was medicated for a second pregnancy. I have no problem sharing my story with my clients because I want them to know, ‘Hold on, I was in the same place.’”
Whittle met Shea at a fertility clinic. Both had experienced pregnancy losses and were struggling to become mothers. Shea earlier had an ectopic pregnancy, which was not viable because the fertilized egg was implanted outside the uterus.
So when Shea became pregnant with her daughter Adeline, 4, there was no question in her mind that Whittle was the one she wanted by her side.
After delivering her little girl, though, Shea said she felt anything but happy.
“I felt like I often had thoughts of just not wanting to be here,” she said.
Even though Shea was a social worker – she had clients with mental health needs on psychiatric medication – she refused to be medicated for her own anxiety and depression.
Part of it was skepticism with the system.
“I have had postpartum clients who have said ‘I filled it out honestly [a form checked ‘yes’ to depression] and nobody responded to me, nobody followed up on that,’” Shea said.
Another issue was driven by social expectations placed on new mothers.
“I think it feels like a failure that I can’t do it on my own,” she said.
There was an additional reason behind Shea’s refusal of psychiatric treatment – something that Whittle understood.
“They haven’t gotten pregnant yet, right?” Whittle said. “And so you don’t want to hurt their feelings when they’re on the other end thinking ‘I would be happy to have postpartum depression, I would just be happy to have a baby in my hand.’”
Shea’s depression went unnoticed at OB-GYN and pediatrician checkups.
“I am someone who masks extremely well,” Shea said. “I can be in the worst point in my life and people would think I am happy-go-lucky.”
But Whittle noticed.
“One of the advantages of being the doula, as opposed to the medical provider, is that we get to be with our clients for a very long time,” Whittle said. “So I have a good baseline of how Jen is when she is not super anxious.”
Whittle kept a close watch on Shea’s mood, making sure that Shea was not experiencing suicidal ideation, and checking in frequently with Shea’s husband regarding mood changes.
Shea said she had always turned to Whittle to share her “worries, concerns, fears and struggles.” Having a safe space kept her from further spiraling, Shea said.
Their bond is also why, two years later, Whittle got a call out of the blue.
Shea was in distress – she had a second ectopic pregnancy and it had ruptured. Shea was going into an emergency surgery to prevent complications that could be deadly.
“We weren't trying. … I just happened to get pregnant naturally,” Shea said. “And that took me into a really, really, really, really dark place.”
This time, Whittle pushed Shea hard to see a psychiatrist for medication.
“I also experienced infertility and loss,” Whittle said. “I also had postpartum anxiety, and then was medicated for a second pregnancy. I have no problem sharing my story with my clients because I want them to know, ‘Hold on, I was in the same place.’”
Shea was prescribed the antidepressant Zoloft – she stayed on it when pregnant with her son Camden, now a year old – and she continues to take the medication.
“I could see night and day, my postpartum experience has been completely different, in a good way the second time,” Shea said.
Expanding the doula population
Experts say the U.S. is far behind other countries that offer more intentional postpartum care. Some countries in Europe cover home visits for midwives and nurses to check on new moms in the days after giving birth.
Compared to women in other high-income countries, women in the U.S. are the least likely to have supports such as home visits and guaranteed paid leave during this critical time.
Meanwhile, the U.S. has the highest maternal mortality rate of any high-income nation, with maternal death rates highest for Black women, according to the Commonwealth Fund.
Nearly two of three maternal deaths in the U.S. occur during the postpartum period, up to 42 days following birth, data from the Commonwealth Fund showed.
Offering more access to doulas could help reduce those rates, advocates say.
Efforts are underway in Connecticut to train more doulas.
Connecticut began reimbursing doulas last year through its state Medicaid program HUSKY, and more people are getting certified and applying to the Connecticut Department of Public Health – a process required to become eligible for state reimbursements.
Connecticut is one of 26 states that cover doula services with Medicaid, according to the National Academy for State Health Policy.
With Medicaid, doulas in Connecticut are reimbursed $800 for labor and delivery support, and $100 per visit for up to four home visits. Self-paying clients pay between $50 and 75 per hour; for labor and delivery support, they pay around $1,000 and upwards.
Before the state launched Medicaid reimbursements, Connecticut had around 150 doulas. In just the past several months, doulas have become more popular locally – with more people enrolling in certification programs, according to area nonprofits. The state is in the process of gathering data on Medicaid reimbursements for the first year.
Across the country, more than 45 states and Washington, D.C., have created legislation for public and private insurers to cover the services of peripartum doulas to help tackle the crisis, according to Georgetown University’s McCourt School of Public Policy.
In Connecticut, hospitals are getting on board to expand doula collaborations, though doulas are paid directly by patients out-of-pocket or via Medicaid. State law does not mandate insurers to cover peripartum doula services. Some private insurers have started to offer doula coverage, though reimbursing doula care is far from the norm.
Hartford HealthCare is working to expand the hospital system’s collaboration with maternal care doulas as part of its wider outreach to the community.
“We do see it as important that patients have adequate care that is accessible,”said Daileann Hemmings, director of maternal health equity who leads the program. “Doulas help to really address some of the needs that hospital clinicians aren’t able to, because they’re able to have relationships that are outside of the hospital setting.”
Whittle is part of an effort to train more Spanish-speaking doulas at Hartford Hospital, in collaboration with the Hispanic Health Council, a nonprofit.
“[The Spanish-speaking doulas in training] get foundational information from the Hispanic Health Council, but they come and observe births and have that experience under their belt before going independent at Hartford Hospital,” Hemmings said.
Part of that training is to teach future doulas to identify postpartum mood disorders, especially in a population that is less likely to seek mental health treatment.
Up to 40% of Latina and Hispanic women giving birth will experience a maternal mental health disorder such as maternal depression, according to data from the Policy Center for Maternal Mental Health.
An enduring bond
At her home, Shea’s kids are running around and making a ruckus as Shea and Whittle catch up.
Shea looked at her daughter, who was wobbling around with what seemed to be the biggest toy lion ever made.
The sight got Shea nostalgic as she recalled when Addie was born, with Whittle at her side.
Whittle had been with Shea in the operating room as she had a C-section. And she was with Shea as Addie was taken to the neo-natal ICU.
“Desirae stayed with me and pet my hair and held my puke bag,” she said.
Shea said it would have been terrifying to have been there by herself.
“I’m so grateful,” she said.
About this story
This story is part of the Mental Health Parity Collaborative. Connecticut Public is among selected newsrooms across the U.S. working with The Carter Center to cover stories on mental health care access and inequities.
