The path leading to the track at a Durham middle school on Saturday was marked with signs bearing the names of Black women who died from pregnancy-related causes.
Walkers and runners participating in a fundraiser for MAAME, or a Durham nonprofit that offers doula care, walked past the signs, reminders of the tragedies that the organization is working to prevent.
MAAME stands for Mobilizing African American Mothers through Empowerment. It’s also the Twi word for woman or mother.
Laura Gonzalez Dutor arrived at the fundraiser with her partner Uriah Shaw and their one-month-old daughter Ember to pick up baby supplies.
Gonzalez Dutor had doula care during her pregnancy, and said it helped reduce her anxiety.
“She gave me a sense of peace, in a way, because she was very knowledgeable about everything,” Gonzalez Dutor said. “I knew that there was always going to be someone, in addition to my partner, that would be able to advocate for me and just help me make informed decisions.”
Uriah Shaw and Laura Gonzalez Dutor of Durham attend the MAAME fundraiser with their one-month-old daughter Ember on April 26, 2026. Gonzalez Dutor said her doula helped ease her anxiety. (Photo: Lynn Bonner/NC Newsline)Women in the United States die from pregnancy-related deaths at higher rates than any other wealthy country. Black women in the United States died from pregnancy-related causes at three times the rate of white women, according to CDC data from 2024.
In North Carolina, maternal deaths among Black women were nearly twice as high as for white women from 2018-2020, according to the North Carolina Maternal Mortality Review Committee. Nearly 80% of those deaths were considered preventable.
Doulas offer non-medical support before and during births. Some work with the families of newborns.
Research studies have found that doula care reduces the likelihood of Cesarean sections. Low-income mothers who had doulas were four times less likely to have low-weight babies and two times less likely to experience birth complications, according to one study.
Studies also show racism and implicit bias play a role in the higher rate of Black maternal deaths.
Efforts to improve those statistics are facing new challenges. Last year, the Trump administration canceled grants studying maternal health as it sought to end diversity, equity, and inclusion efforts, Stateline reported.
Maya Jackson, executive director of MAAME, said her organization has felt the ripple effects. Soon after national grants were axed last year, $10,000 in sponsorships that would have helped MAAME meet a $15,000 fundraising goal were canceled, she said.
Some of the money MAAME raises goes to subsidize doula care for people who can’t afford the full price. With less money, MAAME had to reduce local services, Jackson said.
MAAME also works in counties beyond the Triangle as part of a UNC study looking at ways to narrow the gap between Black and white maternal death rates.
MAAME received American Rescue Plan funds from Durham County a few years ago.
Advocates, experts tout proposals to reduce Black maternal deaths in North Carolina
That money has helped the organization survive the lean times, Jackson said. “We’re good for another year,” she said. “But if there are more decreases in funding, it will get tough.”
Private insurance does not typically cover doula care. Two of the state’s four Medicaid managed care organizations offer doula care as an extra service, though one company limits the benefit to certain counties.
The state has been talking for years about offering doula care as a regular part of Medicaid maternity care coverage.
The Child Fatality Task Force has repeatedly recommended that Medicaid cover doula services. Gov. Roy Cooper proposed Medicaid reimbursement for doulas at the end of his second term, but the legislature did not fund it.
A division of the state Department of Health and Human Services hosted a doula summit in 2022 with North Carolina doulas and practitioners from states where they are eligible for Medicaid reimbursement. A report from the summit said “doulas overwhelmingly agreed that Medicaid reimbursement of doula services is essential because all pregnant patients deserve access to doula services, and doulas should be paid a living wage in order to make services accessible.” But they identified low Medicaid reimbursement rates, administrative burdens, and a need for referrals as potential downsides.
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SUPPORTKey legislators said last month they were interested and have asked for information on how other states have approached Medicaid reimbursements. Twenty-nine states provide doula services under Medicaid or are preparing to do so.
Two doulas at the fundraiser were in deep discussion about the pros and cons of Medicaid reimbursement.
Tatiana Smith is a community doula who travels between New Jersey, where Medicaid pays for doula care, and North Carolina.
New Jersey’s reimbursement rates are low, Smith said, and include a flat fee for attending a birth, even though there’s no telling how many hours someone’s labor will last.
Doulas were frozen out of important decisions about Medicaid reimbursements there, she said.
“You want to work with Medicaid because you want more people to have access,” Smith said. “But then, on the other hand, we need to be sitting at the table and helping make those decisions.”
Medicaid officials don’t understand the work, said Melanie Patrick, owner of Emerald Doulas, which operates in the Triangle.
“Medicaid deciding how we work, who’s going to certify us, whether or not we’re certified, and then deciding how much we’re going to earn doesn’t make sense, because they don’t understand what we do,” she said.
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