Real Support for the Support Person: I Did the Math on the NY Doula Pilot Program

Photo by Jessica Felicio on Unsplash

It’s been stirring in my mind for quite a while now — Every time I see another fundraiser for midwifery school, or hear of another person taking a break to get a job to support themselves or their families for a while, or hear a birth worker tell me about the shocking discrimination they experienced at the hand of a care provider, nurse, midwife or another birth worker, or even think about some of the things I’ve encountered myself as a doula in my community…

“What do you know about the experience of the Black birth worker?”

When this question was asked in a small room of mostly white birth workers in my city, the room fell quiet. And then — I can’t remember if someone literally asked, “Is it different for Black birth workers?” Or not — or maybe in other words — but I know the bit of conversation that followed made it clear that this question just hadn’t really occurred to many people before. 

But yes, it’s different.

And now, I have this awful feeling that I’m a broken record, but if I am… it’s not because I’m broken it’s because the broken things I’m talking about still haven’t healed. And the NY Doula Medicaid ordeal is a prime example of that truth.

Because once I looked into it, it became incredibly clear to me that this initiative is more about lip service to a buzzing topic than actually delivering consistent and quality support to the folks it’s claiming to — and will, beyond that, do a disservice to the folks who support them.

According to the New York State Doula Pilot Program webpage, doulas will be reimbursed $30 per prenatal visit, $300 per birth attended, and $30 per postpartum visit. Why?

“Fees are approximately 43% of NY OB/GYN professional fees and 50% of midwife fees.”*

Alright. So let’s go ahead and think about this.

The average rent for a one-bedroom in New York City is $3,100. The average spent on utilities in the U.S. generally (couldn’t find it for NY specifically) is $211. Average on food is $317. Transportation, $211. Entertainment, $106. Clothing, $106. Insurance and other misc costs, $106 (which is ridiculously low). Let’s pretend this doula has no debt. Let’s say they’re just trying to set aside $100 a month for emergency savings.

Total: $4257 a month for one doula, living alone with no child or partner, (and certainly not also pursuing midwifery school or certification).

The NY Doula Pilot Program page estimates 7 visits and one labor and delivery visit per doula client, a total of $510 per doula client (also note that 2-3 prenatal visits, labor support, and one postpartum visit are standard for most doulas).

So, doing the math, it would take 9 clients a month (9 births, and 63 prenatal visits) for that doula to stay financially afloat (if the reimbursement comes through quickly enough to pay those bills). Let’s just act like this is reasonable for now and move forward…


“But Cheyenne, the NY Doula Pilot Program isn’t only for Black birth workers, so why are you conflating the two?”

It will not only impact Black birth workers but it will largely impact Black birth workers since many do have and will continue to have clients on Medicaid.


“But Cheyenne, the Medicaid Reimbursement doesn’t need to be their only source of income, they can work a part-time job or take clients who can pay better, too.”

Alright let’s say they have a part-time job — 20 hours a week, $12/hr (min wage in NY is $10.40/hr).

Now they’re making $960, so they only need to fill a $3,297 gap. They’d need to attend to 7 clients (7 births and 49 visits) in the remaining 20 hours a week to make that work.**

Not only that, they’d need to specifically have a part-time job with a boss who’s willing to be flexible with them when they get called to a birth during their shift hours — who won’t just fire them — and because inevitably they’re going to have some overlap between working hours and labors — it’s incredibly unlikely they’d even make the full $960 a month.

Now let’s say they take one client a month who can pay $1200 (about the average cost of a doula). They’d need to make $3,057 more.

That’s 6 more clients. Which is a total of 7 clients (7 births and 49 visits). And let’s take a moment to consider that 7 due dates in one month… a few of those babies are coming at the same time. So no way is that doula going to be able to be present for all of those visits and all of those births. So really… they’d need more…

AND, let’s acknowledge the cost of time we’re talking about here. Because you know this doula is going to have to take time to process all the paperwork for all of these clients, and pay for postage or whatever to submit them, and wait for reimbursement to be processed and allotted to them.

“But Cheyenne, maybe they can fundraise the difference.”

Black and POC birth workers are already fundraising to the ends of the earth to support our work. We ask for funds straight up, we offer little rewards, we turn to fun slogan t-shirts — we’ve been doing this.

In fact, we’re already working multiple jobs, too — trying to juggle clients who are able to pay more and those who are not able to pay as much, too — living with roommates to reduce costs, applying for scholarships, dipping into savings, living without certain things, leaning on friends and family, etc.

And all the while that we do these things, we experience discrimination just like our clients do — day to day in normal life, and in the birth world, too — whether because unconscious or conscious bias based on the color of our skin or because of distaste for / misunderstandings of our roles as support people or all of the above.

And by our peers we are asked to explain (“Can you teach me about…”), solve (“Tell me what I need to do…”) and not to talk about (“Why does race have to be brought into everything?”) the inequities that we face.

As we look into the eyes of the parents that we work with, telling them, “I am here to support you,” many of us are being forced into corners that leave us feeling unsupported ourselves. And then we look around as see that we’re not alone in this. And we talk about it. And we wonder (among other things), “When will something be done to support us?”

And then a headline about a Doula Program pops up. And we open the page. And what do we see…

It is more than a little frustrating. It is literally adding insult to injury to create a system to support a group of people that cannot support the support persons themselves.


“But Cheyenne, if you’re okay with taking on free births in general, why aren’t you grateful for some support from this program for NY doulas?”

Payment from a program like this and payment directly from a client — that’s a horse of a different color.

The families we’re working with on Medicaid aren’t handling budgets of millions of dollars, moving money around on spreadsheets with teams of accountants, looking at income flow from multiple avenues and then telling us, “This is what I have left to set aside for your services.”

Is a response like mine actually ungrateful, or holding a capable authority to a reasonable standard?


But Cheyenne, at least they’re trying something, right? Can you really expect it to be perfect out the gate?”

Birth work is a job. Birth workers are doing a job. A job with expenses we must pay to perform it properly. A job that takes a physical toll on our bodies, and an emotional toll on our beings. A job that sometimes requires that we remain as a continuous support person for 10, 12, 16, 24+ hours.

Yes, it’s a beautiful job that we feel called to and incredibly honored to do… and it’s so impactful that many of us are WILLING to make sacrifices to do it — but that does not mean we shouldn’t expect to be able to sustain our own lives through it.

And I’m not saying that I don’t think folks should participate in this pilot program, or that it shouldn’t exist at all. I hope that many people do participate and find ways to make it work for them, and advocate for improvements that would make it better.

But I have a very real concern that there’s no intent to improve it — that in fact, people somewhere are patting themselves on the back for what they’ve created — a system that perpetuates the “Strong Black Woman” trope by making “Strong Black Birth Workers” who must make due with the little allotted to us on top of the regular set of stressors we continue to have.

Nothing would make me happier than to be proven wrong on that.

Because to be honest, I’m not interested in the “Strong Black Birth Worker” blue ribbon for myself or anyone else. I want safety, support, joy and empowerment. As we stand in the gap for those who are bringing new life into the world, I want birth workers to be able to have full lives of our own.


*This doesn’t justify the payment of the doula, it just means that OB/GYNs and midwives are also being underpaid and done a disservice when they’re reimbursed by Medicaid, too.

**None of this began to address taxes.

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"These Are the Days I've Been Waiting For." A Short Story

Photo by Jessica Felicio on Unsplash

A short story.

“These are the days I’ve been waiting for,” she said to herself, looking at half of her face in the bathroom mirror as the other half leaned against the door frame.

Nevermind that she has no idea what that really means. It was a statement of sentiment more than of fact, because facts have no place in a moment like that. A moment when time doesn’t cease but just ceases to matter. Arbitrary. Like whatever her neighbor is doing upstairs or whoever is passing on the sidewalk outside of her view — it simply isn’t relevant to where she is right then.

It’s the kind of moment she doesn’t even want to let build up inside her chest because what goes up… can’t stay there… so she leaves the room to gather dishes from the dining table and put them in the sink, and to shut off the kitchen lights, and the dining room/living room light and the hall light. And she changes into warm, soft clothes just right for sleep, leaving laundry on the floor half-kicked beneath the bed and plugs her iPhone in and reaches for the last small light on the bedside table — pausing —

She still wants that warm feeling, though… even though she knows from time and time again of past experience, it always trails away and into other days with a much different face looking back at her in the bathroom mirror.

But that’s the thing. When the thick, cold, low day comes — or the angry, bright, heavy day falls — or the bitter, dark, tangled day looms — she’ll need this one — this moment — the memory of the full, warm glow that comes from somewhere she doesn’t even know the name of. That sweeps over from the inside. That winds out widely in every direction. It won’t destroy her hardships altogether… but it’ll take the edge off, remind her there is another side — that she knows, too.

So she smiles, lets it grow inside her, lets it well and stir and simmer and settle within her…

She rubs her eyes, tired. The moment passed.

The light goes out.

And within the hour, she falls asleep.

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Why I Might Not Be Self-Employed If I Had My Way

Photo by Daniel Spase on Unsplash

About a month ago, I had the immense pleasure of being interviewed for The Dream Differed Podcast. Now, let me set the scene for you. This was a breakfast interview — a whole breakfast. Waffles made in front of me, bacon, mimosas — just, mm. Hosts Christian and Cayman must’ve known something about me when they planned this. Total strangers only moments before, they had me warmed up and gabbing for well over an hour with ease. 

But seriously, Christian and Cayman’s questions stirred up some incredibly significant reflections for me — including the topic of todays’ blog post. As December begins, I’m looking back on two years of self-employment. Two years of not always knowing month to month where my income is going to come from or how much it is going to be. Why?

When Christian asked a question that touched on this, I said:  

(13:30) “I think I just came to understand that that was the only way I was going to have the power to make the decisions that felt dignified to me, and appropriate — even within the nonprofit world… I really expected [the nonprofit and doula worlds] to be spaces where people were very thoughtful, very open to conversation, very reflective, and — you know — we’re doing it for the community right? That’s the slogan, that’s on the brochure, that’s on the website, and everything so why wouldn’t people carry that into their actions and the way that they talk to their coworkers and the way that we make decisions, but then the reality of being in the space and being like —  

”Oh, as soon as I say something I’m a ‘non-productive member’ of this community — as soon as I point something out, it’s like, ‘well, 'I don’t understand that experience, what’s your basis?’ What’s my basis? I’m my basis! I’m the basis!... I carry the legitimacy of what I’m saying with me; I’ve carried it my whole life.”

I needed my work AND my life to be valued. And I needed the lessons and sensitivities of my life’s experience to have a tangible impact and role in my work.

I needed this partly for me — to feed my own soul, which surely gets weary in the workplace when I feel undervalued and silenced — but also because I was seeing that it had DIRECT impact on the outcomes of my work, which had to do with the quality and direction of peoples’ individual and communal lives!

I haven’t innately changed. The way I work hasn’t really changed either. When I was working for someone else, I was still just as genuine and hardworking as I am now. I still cared for the people I worked with and near the same way I care for folks now. I still pulled long hours and did things from a place of passion.

But I didn’t have the power or the influence to be sure that my own good intentions weren’t being… overshadowed or undermined or maybe even upended entirely… by systematic flaws.

Now, to this point it sounds like I’m saying the opposite of this blog post’s title, and — yes that’s sort of true. Unless I come to a point where I understand that practically, I need to put my self-employment to the side in order to sustain my life — I’m likely going to stay self-employed. 

But… in an ideal world, if I had my way, I wouldn’t have those concerns I expressed to Christian and Cayman.

In an ideal world, if I had my way, I could be a part of a company or a nonprofit that provided benefits, and vacation time, and vocational development, and genuinely communicated with the folks they served, intentionally and self-critically pursued the goals they claimed to be committed to, really valued and listened and heard staff who voiced concerns about the communal culture, and did hard work to be sure that the communal culture aligned with the mission… and more...

In an ideal world I never would have felt like I had to go my own way to provide the kind of support I would want to be provided if the tables turned.

If in this world, I ever find a place that proposed to hire me full-time and met those qualifications, I’d absolutely entertain the option. 

So, when Christian asked me if the freedom of self-employment equates to happiness to me, here’s what I said,  

(17:53 in the audio) “I don’t know. I think right now, in a way yes because it just feels like the route… when I think about my ideal, I don’t know if self-employment is ideal. I mean, I’d love to have security, you know, and feel like I’m a part of something that’s not just me. I think it’s exhausting, honestly, being self-employed, and you have to have all these hats on that it’s just not possible for someone’s strengths to be in all the areas that you have to manage when you’re running your own business, so you’re going to have weak spots… and doing things in community is always better, but… if the community’s not ready, sometimes you just do it on your own and that is happier.”

After speaking with Cheyenne, it became very clear to us that the Breakfast of Champions includes many mimosas, the right amount of waffles, and heaping helpings of hope.

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This Month in Music: November Vibes

Photo by Brenna Huff on Unsplash

I listen to music constantly. Work, eat, workout, play — these are some songs that have been traveling with me through November. What songs have been getting you through your month?

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Don’t Tell Me How Culturally Competent You Are and Why

Photo by Houcine Ncib on Unsplash

I’ve been having a really hard time lately. All my life I’ve been in spaces like these ones. Spaces where I’m one of a few Black people or people of color, and I have white people around me (often many of whom I like/admire/appreciate) who are asking me for answers to problems that are quite honestly… not the kinds of problems that have bullet-point answers. So what can I say?

What do I say to someone who says to me, “I’ve heard that I need to reach out to you because I need to hear from Black folks, but I’ve also heard that I shouldn’t burden you with the work of asking you these questions?” 

“Yes.” I feel for the tension here. Both of those perspectives are valid. I want people to listen to Black voices. I also want people to respect that calling on Black voices means those Black people speaking have to enter the uncomfortable and challenging space of figuring out how to communicate their experience to people who may be hearing about these things for the first time and have push-back to the truth.

It is labor. It is mental and emotional labor, not to mention actual time that you are taking away from hours they could worked, or moments they could have had with friends or family, or self-care that they probably already don’t get enough of. And considering the history of Black bodies and labor… probably a good idea to be very mindful of that.

So then someone says, “I will pay you to talk to me/my group. I know it’s labor, and I will pay you for it.”

Okay. Thanks… I appreciate the consideration. But, now I’m wondering… to what end?  

One does not simply become trained in cultural competency (Lord of the Rings reference intentional, hence the meme).

If you’re going to pay me or any other Black person to talk to you so that you can now say to someone else, “I’m trained! I’m qualified! I can work great with Black folks now!” then you’ll be wasting your money and I’ll be wasting my time AND worse, putting my stamp on your misunderstanding of what we’re dealing with.

So then someone says, “So you want me to listen to you. But you don’t want me to always call on you. And you don’t want me to pay you?”

Look, if you and I live in the same city, interact in the same online spaces, have any organic ways of connecting at all — here’s what I want.

I want you to know me. I want to know that there’s no agenda to our communications. That you’re not going to make some big announcement post on Instagram or add to your list of services or raise your rates because we had this conversation.

There are groups that do trainings and that’s great. I’m not knocking trainings. I’m just saying unless I have told you specifically that I am a trainer and I offer this training and you've paid me for said training and it is the day of the training and we are in training…

I am not your training field. I am a human being.

And that’s why I want to know you too. I don’t want to feel tense around you. I don’t want to

have a really hard time knowing what to do with my face when I hear you say that you love all the babies in Africa in a conversation about Black women in America, or talk about the little bit of Blackness in your family member, or the civil rights social justice history of your uncle.

If someone brings you up I want to be like, “Oh! You know Janie too? She’s great, I saw her over at Brewer’s the other day. I think she just had a birth at St. Mary’s but I don’t remember, she was on her way to yoga so we just chatted for a minute — I know I’m trying to get like her with that self-care rhythm.”

See how normal that is? I want to be normal with you.

I don’t want you to think I’m being mean when my face contorts when you say things that I know you have good intentions saying. But I want you to know that I have a hard time hearing those things because they feel incredibly distant from what is going on between you and me in the moments that you say them. Don’t try to tell me how cultural competent you are by building some sort of verbal resume for it.

Cultural competency is the life that you live. It is listening, it is acting, it is evaluating the impact of your actions, listening more, acting more, evaluating more, and on and on and on. And yeah it’s going to be hard and not everyone’s going to love your decisions or approve of them.

But what are you doing this for? Are you doing it for praise? Or are you doing it for impact?

And what is impact? Do you have to be at the center of it? Or could you be satisfied pouring in and stepping back?

I have work to do too. Because our world has raised us to see each other in strict and narrow ways I associate whiteness with connections and resources (often accurately, let’s be real). But because of this sometimes I have to remind myself, look this is a person with an experience, just like I am a person with my experience. I don’t want to take you for granted, either.

I get that White folks are not a monolith any more than Black folks are. I can’t and don’t expect every white person to have the same access and availability. But I absolutely do expect any White person who tells me they want to do better to start showing me.

Like I said, this work is both of ours. But realize this…

While it’s likely that you (White Folks) have been grappling with these issues fairly recently in your life — and as distant potential participants in injustice (like you often say, “I didn’t own slaves / I don’t personally do XYZ / I’m not one of these politicians”) — many POC have been aware and grappling with these issues since around age 10 or younger — as the personal and generational recipients of discrimination.

I specifically remember the day I realized… not just that I was Black but that being Black meant something bad could happen to me or someone I loved. I was 8 years old. So I’ve been at this for almost 20 years.

Sometimes I get angry. Tired. Sad. But I’m still in it… and (though there are some folks I do have to establish boundaries with) I’m in it with you, not against you. So let’s do this thing.

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