Birthwork, especially in communities of color, can be both emotionally taxing and expensive. As medical providers, midwives must be registered nurses in Illinois to practice legally, leaving many of them in debt. Ultimately, many opt to work at hospitals or private agencies rather than in community midwifery.

Meanwhile, doulas, who provide emotional support to mothers and families during the pregnancy term, are not currently covered by Medicaid, which leaves their services out of reach for many low-income families.

In Illinois, racial disparities in maternal health exacerbate the situation. Here, black women are six times more likely to die of a pregnancy-related condition than white women, regardless of their educational background. 

Access to birthworkers could make a meaningful difference. A recent study of New York women in the Maternal and Child Health Journal found that doula services were associated with a lower instance of low birthweight. Additionally, mothers said they felt doula support gave them a greater voice in important perinatal health decisions. Another study found that states with the highest integration of midwives into the healthcare system also had higher rates of physiological birth, fewer obstetric interventions, and fewer adverse neonatal outcomes.

Black moms and birthworkers say that medical professionals are often dismissive of black women when it comes to maternal care, leading to a focus on intracommunity care. These birthworkers say their job is to empower their clients to center themselves in the birthing process, whether they give birth in a hospital or elsewhere.

“I think people are done being mistreated by our systems, and that has put a fire into the community,” says Qiddist Ashe, 25, a birth and postpartum doula, childbirth educator, and herbalist. “People see the need [for birthworkers]. And now I think it’s about that culture shift and making more opportunities possible.”

This story was produced by City Bureau, a civic journalism lab based in Woodlawn. Learn more and get involved at