On a sunny Tuesday morning at the Hispanic Health Council in Hartford, seven Spanish-speaking doulas-in-training were gathered around a table taking notes. They were responding to what they said was a calling to help Hispanic mothers with childbirth, and to support new moms through every part of becoming a parent.
"Latina women, we don't ask for support," said Myra Vasquez, one of the trainees. "We don't ask for help."
To make it easier for Latinas to get help, the Hispanic Health Council, in collaboration with Hartford Hospital, launched its Spanish-speaking doula program last year. The effort to bridge access gaps comes after Connecticut Medicaid began reimbursing doulas for their work.
And it's part of a growing effort in Connecticut and across the country to better serve Latinas, who often face a variety of struggles as they access healthcare, from language barriers to cultural differences.
Doulas are caregivers who help clients navigate the healthcare system before, during and after childbirth. That kind of assistance can make a significant difference for Hispanic and Latina mothers in Connecticut and beyond, as data shows many face greater barriers accessing care. Compared to white women, Hispanic mothers are more likely to have births for which they received late or no prenatal care.
For Vasquez, this work is personal. She was inspired by the strength of her mom and grandmother, she said, and she aspired to honor that strength in other women.
"To give back to these women, especially people like my mom, my grandmother, and see that in all of my clients," said Vasquez.
Barriers to treatment
Doulas continue caring for new moms in the crucial weeks after a baby is born, a time when many experience both physical and emotional challenges. One study found nearly half of Hispanic mothers had early symptoms of postpartum depression, compared with about a third of white mothers.
Symptoms include sharp mood swings, hopelessness, crying, an inability to bond with one’s baby, and thoughts of suicide.
Postpartum depression and other mood disorders are partly driven by hormones. But research also suggests socioeconomics plays a role.
Economic insecurity is an added burden for some new moms, said Bianca Noroñas, director of the health council's Maternal and Child Health Center.
Doulas trained by the council learn to ask parents important questions like whether they have enough food, secure housing and transportation to the hospital, and if they experience domestic violence, she said.
"We know that all these kind of problems are going to affect directly the mental health of the mother and the future of the baby," Noroñas said.
Other barriers are cultural.
The phrase "la ropa sucia se lava en casa" — similar to "don't air your dirty laundry in public" — is entrenched in the culture.
"Some people do not seek treatment for mental illness out of fear of being labeled as 'locos' (crazy) or bringing shame and unwanted attention to their families," according to the National Alliance on Mental Illness.
Values like familismo, a concept in which one's identity is tied to the family unit, and marianismo, the belief that women must be self-sacrificing, can lead to depression and anxiety arising from the pressure to meet these cultural standards, according to the American Psychological Association.
Another hoop to jump? About one in 10 Hispanic adults in the U.S. who received healthcare in the past three years reported being treated unfairly or with disrespect by a healthcare provider because of their racial or ethnic background, KFF research showed.
Language can also be an obstacle. Some research shows Spanish-speaking moms report getting less timely or adequate prenatal care. One study of a large health system in the Midwest found a smaller share of Spanish speakers were screened for prenatal depression.
Mental health challenges during pregnancy may also impact the child. Studies have shown the link between depression during pregnancy and a baby’s low birth weight, which puts a newborn at risk for health complications.
Since the council launched the program, the demand for Spanish-speaking doulas has continued to increase, Noroñas said. Nearly 90 people have been served by the program.
"We have families that come here and they ask us to receive this service because sometimes they have to go completely by themselves to a hospital," she said. "They don’t speak the language, they don’t have a social connection with the clinical providers."
Doulas who have those connections pick up on important nuances, said Diana Luna, another trainee.
"Sometimes when other people act as our translators, they translate what they believe we are saying," she said, speaking in Spanish. "But it’s not really what we feel."
When doulas are from the patients' community
The U.S. averaged a C grade for maternal mental health in the latest report card issued by the Policy Center for Maternal Mental Health, a national nonprofit. Connecticut earned a C, and no state received an A grade.
The criteria was fourfold: screening and detection, providers and treatment, policy and payment, and parental support.
Nationally, maternal mental health disorders such as depression affect roughly 20% of people who are pregnant during the perinatal period, meaning the time before and after giving birth. But less than 20% are screened or treated for postpartum depression, according to the center.
Up to 40% of Latina and Hispanic women giving birth across the country will experience a maternal mental health disorder, according to the center. Political factors — such as immigration policies, immigration status and fear associated with legal systems — increase distress and risk for mental health conditions, and discourage individuals from seeking healthcare, according to the center.
About a quarter of all babies born in Connecticut are Hispanic, according to March of Dimes. And health systems are taking note.
Doulas being trained through the Hispanic Health Council receive additional hands-on lessons at Hartford Hospital.
"We recognize that there was a low number of Spanish-speaking doulas," said Daileann Hemmings, director of maternal health equity for Hartford Healthcare. "So it's to help in reaching that program and providing a place for them to get their learning opportunity."
When Wuinifer Matos of Hartford gave birth to her son at Hartford Hospital in May, her doula, Annette Cruz, was by her side. Cruz was trained at the Hispanic Health Council.
"She turned a long and intense 24-hour labor into an empowering and beautiful experience," Matos said, speaking in an interview with help from a translation app.
Matos experienced severe postpartum anxiety.
"Annette was amazing because she created a safe space for me to talk about it without judgment," Matos said. "She listened to me, validated my emotions, and reminded me that I was not alone. She encouraged me to talk with my healthcare provider."
Helping form stronger bonds between mother and baby
Around the country, some groups are promoting the model of community-based doulas. The idea is new mothers have better health outcomes when they’re cared for by doulas who look like them and are from their communities.
HealthConnect One, a nonprofit that trains community-based doulas in 35 states, has seen promising results, according to Twylla Dillion, the group’s executive director.
In New Jersey, for example, doulas serving Hispanic, immigrant and at-risk families in two counties helped reduce preterm births, low birthweight babies and low-risk C-sections, Dillion said.
"It has definitely increased the uptake of breast feeding," she said. "Especially if you talk about postpartum depression, that early attachment between mom and baby is very important."
'It's OK to just reach out'
In Connecticut, the Department of Public Health has issued 89 doula licenses since March 2024. Twelve licenses went to women trained by the council, and there’s currently a waitlist for the doula-training program. The Connecticut Health Foundation has renewed funding for an additional year.
In the Hispanic Health Council’s training room, a warm Earth-tone mural of five pregnant women fills up one wall. They tenderly hold their bellies. On a side table beneath the mural, artwork hangs from a piece of driftwood. Each cohort adds to it when they graduate. The tiny yellow stockings, flowers and hearts symbolize new birth and maternal love.
Vasquez, the doula-in-training at the council, aspires to erase the stigma around seeking mental health care.
Doulas can refer clients to the council's mental health treatment center, which is staffed by bilingual clinicians.
Vasquez said she wants to encourage other women to ask for help if they need it.
"It's OK to just reach out," she said, "and talk about your problems with a trained professional."
If you are pregnant or are a new parent and are feeling overwhelmed, sad, or anxious and need someone to talk to, the National Maternal Mental Health Hotline can help – 24/7 – call or text 1-833-852-6262. if you or someone you know is in crisis, you can call or text the 988 Suicide and Crisis Lifeline. In Connecticut, you can call 211, the state’s 24/7 crisis hotline. When in an immediate crisis, call 911.
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.
Connecticut Health Foundation is a funder of Connecticut Public. English translations by Rachel Iacovone, Daniela Doncel and Diana Montaño.
