As Hurricane Ian approached southern Florida in late September, Tifanny Burks got a call from a recent client.
A single mother of three, including an infant Burks had helped deliver, was facing eviction and scrambling to find a place to weather the storm.
Burks, who uses they/her pronouns, connected their client with lawyers who could help her fight the eviction. She and her family could shelter at home.
Tifanny Burks is a doula. Part of the job is helping a client through pregnancy and birth, Burks said; the rest is “having those connections and being able to reference people out.” Aside from lawyers, Burks said they have referred clients to therapists and OB-GYNs.
In the days surrounding the hurricane, parents throughout Miami-Dade county were turning toward doulas for guidance on getting through the storm, according to Esther McCant, another Miami-based doula.
A changing climate gives them little choice: doulas are always on call. “We do our work and the weather is what it is,” McCant said.
It’s a phenomenon taking place across the country. Doulas, trusted community figures, are increasingly helping their clients weather the climate crisis.
“Traditional providers like OB-GYNs tend to spend far too little time with patients to get into their environmental health risks,” said Skye Wheeler, a researcher at Human Rights Watch. “Doulas spend much more time with their clients. They’re also great planners and are perfectly placed to help clients think through affordable ways to get ready for heat, or hurricanes.”
In Miami, doulas like McCant have organized workshops advising clients on how to stay safe during a heatwave; in New Mexico, they mobilized during wildfires that burned through much of the state earlier this year.
Doulas often come from the same communities as their clients, Wheeler said; that helps build trust and can make them more effective advocates. “They see things from their clients’ point of view, so they understand the importance of a healthy environment for a healthy pregnancy and the ways stress and marginalization [can] undermine that,” she said.
The climate crisis is exacerbating an existing maternal health crisis. Extreme heat and air pollution are linked with preterm labor, low birth weight, stillbirth and other negative pregnancy outcomes. Stress related to wildfires, flooding and hurricanes –– which are becoming more common and severe with climate change — also adversely affects pregnancy outcomes.
Black and Brown communities — already facing higher rates of maternal mortality, stillbirth and premature birth — are more likely to live in hotter neighborhoods with worse air quality, a legacy of racist redlining policies, making pregnancy increasingly dangerous.
“If it’s hotter [in those neighborhoods] the people that are going to be struggling the most are those who are living in underserved communities and might not have access to robust AC or are unable to buy different fans to keep cool,” said Burks, who like many of their clients is Black.
“You now see more doulas having conversations about the implications and impact [of climate change],” they added. “A lot of times people just don’t know, and think that [certain stresses] are happening to them and it’s random but don’t connect it to a larger issue.”
Doulas, who spend 6 to 11 times more time with their clients than hospital and clinical staff do and are associated with lower rates of Cesarean sections, can be a powerful tool in reducing health disparities.
Doulas are unique in that they make home visits, said Jessalyn Ballerano, a doula in Eugene, Oregon. “I’m seeing if air is clean and safe, if there are any dangers, if there is food in the fridge, if they are eating regularly, if they have enough water, if they have easy water access,” she said. “It takes some experience and skills to successfully investigate that in a collaborative way with the family.”
Ballerano, who previously lived in Oakland, California, said navigating wildfire smoke, air pollution and risk of evacuation — and understanding how it would affect pregnant people and families — became a part of her life there.
When she gets a new client, Ballerano typically offers them a resource list that includes information on nutrition, support groups and healthcare providers. “More and more, that resource list is going to include aspects for evacuation, fire safety, food access in case of disaster and emergency preparedness resources,” she said. Ballerano works at the perinatal health nonprofit Nuturely, where she recently helped to organize a series of workshops in which doulas, climate advocates and healthcare workers discussed ways to best assist pregnant people and new parents during wildfires.
Doulas play a number of roles, said Shonte Terhune-Smith, a doula in Flint, Michigan.
“[Doulas] are a labor companion. An educator. A resource. A friend. Emotional and physical support in the prenatal, birthing and postpartum process,” she said. And that work doesn’t end with the birth of a child.
In Flint, where tens of thousands of residents were exposed to dangerous levels of lead, Terhune-Smith educated new mothers on the importance of breastfeeding or using bottled water with formula, to keep their children safe.
Doulas aren’t paid to be frontline climate workers. Though they spend countless hours advising clients before, during and after birth, they’re typically paid a flat fee that ranges from a few hundred dollars to $1,500 per birth.
“Doulas are already getting burned out fighting against the racism and injustice that drives inequitable maternal health and birth outcomes and they aren’t properly compensated,” said Wheeler. One reason they’re paid so little is that they’re not always covered by insurance and therefore are often paid out of pocket.
In April of this year, Democratic lawmakers, including Sen. Elizabeth Warren and Rep. Lauren Underwood, introduced a bill called the “Mamas First Act,” which would, among other things, expand Medicaid to include doula and midwife care. The bill is part of a larger package of legislation aimed at reducing maternal health disparities known as the Momnibus, which also includes provisions on funding research into the effects of climate change on pregnancy.
Tonni Oberly, a doula and researcher at the National Birth Equity Collaborative (NBEC), described the legislation as “important steps in the right direction for giving birthing people the support they need and deserve.”
As she sees it, supporting doulas is one way to invest in frontline communities.
“Doulas are part of the community. So what communities face, doulas often face those same challenges,” Oberly said. “If doulas are serving clients in a heat wave or a food desert, then doulas are very well facing a heat wave or experiencing a food apartheid.”
Back in Miami, Burks is already preparing for the next heatwave and hurricane. They try to stay on top of the latest research examining the connections between extreme weather and maternal health.
“The more I’m knowledgeable and informed, the more I can inform my clients,” they said.