Photo: Shantay Davies Balch, winner of a $350,000 grant from the James Irvine Foundation to tackle the Black maternal health crisis by training Black doulas throughout Fresno County, explains doula care fundamentals during a training session. (Courtesy: James Irvine Foundation)
With the Black maternal health crisis worsening, Shantay Davies-Balch is growing a rapid-response doula network across Fresno County.
Shantay Davies-Balch, winner of a $350,000 grant from the James Irvine Foundation to tackle the Black maternal health crisis by training Black doulas throughout Fresno County, explains doula care fundamentals during a training session. (Courtesy: James Irvine Foundation)
With the Black maternal health crisis worsening, Shantay Davies-Balch is growing a rapid-response doula network across Fresno County.
The U.S. has the highest maternal death rate of any high-income country, despite a pandemic decline, with 22.3 maternal deaths per 100,000 live births in 2022 — more than double and sometimes triple many other high-income countries.
Black maternal deaths remain highest, at 49.5 deaths per 100,000 live births.
Over 80% of maternal deaths are preventable.
“After losing my mother to preventable breast cancer and enduring pre-term births despite taking every precaution, I felt the need to do something about this and advocate for Black maternal health in my community,” said Davies-Balch, who grew up in Fresno and studied health care administration at Fresno Pacific University.
In 2005, while working corporate roles in business, she trained as a birth assistant at local clinics and eventually became a doula — a trained professional providing physical, emotional and educational support to patients before, during and after childbirth.
Since launching a 125-hour training program through the BWPC project Black Doula Network (BDN) in 2021, she has trained 10 doulas in Fresno, more than tripling the number of Black doulas working countywide — “and our goal is 30 by the end of next year,” she said.
For these efforts, she received a $350,000 grant last month as part of the philanthropic James Irvine Foundation Annual Leadership Awards.
Shantay R. Davies-Balch, 2025 Leadership Award Recipient
Although BDN has already secured hospital privileges at half the hospitals in Fresno County and gained approval to work through three major insurance systems, expanding doula services for thousands of mothers, Davies-Balch said that gaining the trust of medical]providers was a steep uphill battle.
“When we first started this work with only a few doulas to train, we did evaluations and engagements with over 80 local physicians and nurses, and we found that almost none of them had ever worked with a doula before,” she explained.
“They had misinformation about what the doulas did, the scope of practice, as though we were going to tell their patients to do something against medical advice,” she continued. “We don’t lead the birth experience or tell you there’s one way to achieve a positive one … we help you advocate for what you need from your doctors.”
According to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, “one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”
“We had our work cut out for us, and to do it, we built out a comprehensive training for doulas to work with licensed providers, and for providers to connect their patients with a doula,” Davies-Balch said.
“Since then, we’ve been working very closely with the hospitals, which was never, ever before done here. We not only have contracts with the hospitals to let our doulas work, but our doulas are invited to hospitals to speak about their work,” she added. “The Irvine award will really help us invite not only more doulas but outreach to more audiences about the change that this work at the community level can do.”
This local speaking series has led to a recent collaboration with the University of California, San Francisco, where BDN doulas will work with hospital research residents to co-train with doulas across fields, from obstetrics and gynecology to pediatrics, serving mothers even after childbirth.
A big win for BDN came in early 2023, when Medi-Cal — California’s version of Medicaid — rolled out a doula service program for enrollees statewide.
Though most doulas across Fresno County and California are still independent with out-of-pocket fees, doula care saves $58.4 million from the $26.2 billion spent on preterm delivery in the U.S. — or $51,600 per baby — and prevents 3,288 preterm births annually.
Davies-Balch estimated that private pay for local doulas “ranges from $1,500 to $3,500 depending on what you’re hiring them to do.”
Part of the challenge in integrating doulas with public insurance is that “everyone has a different set of credentials. It’s not a monolith,” she explained.
“For instance, I have an MBA for the administration side of things, I’m also a certified lactation educator and a certified newborn care specialist. Crucial to building trust is being open about what you are and aren’t qualified to do, because everyone has a different background,” she continued.
“It’s also key to protecting the people you serve,” Davies-Balch added. “If a provider you’re working with doesn’t even know what a doula does and asks you to do something outside your scope like taking vitals or treating conditions, what a doula does is know what licensed support to call on instead.”
No universal doula training system exists, and California does not require doulas to earn a certificate; in place of one, Medi-Cal lets doulas enroll through five years of experience and three letters of recommendation from licensed providers, community-based organizations, or enrolled doulas.
“Before we open up training this year for our third cohort of doulas, on our way to our goal of 30 by 2026, we want to make sure that the billing infrastructure part is there with the state. That’s the biggest bottleneck for doulas,” she explained.
Medi-Cal repayment delays is a concern for doulas statewide, so much so that on March 3, doulas and doula groups sent an open letter to the California Department of Health Care Services, which administers Medi-Cal, describing denied and delayed reimbursement and asking for a clearer billing process.
“Though the benefit is there to help the mothers who need it most, even with doing tons of paperwork, it still takes months and months before the doulas get the repayment they need to support themselves,” said Davies-Balch. “These Irvine funds will absolutely help us add on more people to work through the billing.”
“This time-heavy, labor-intensive, admin side of things — it’s like a different world compared to the heart of our work, which is helping mothers, fighting this maternity health crisis,” she added. “But we need to make sure our doulas eat, that they’re not burnt out. When we bridge that gap, we find out it’s a circle.”
