March 11, 2025
The Importance of Doula Benefits: Podcast Episode #281
Cynthia and Kristin discussed how doula benefits can help close maternal care gaps, reduce healthcare costs, and promote inclusivity. Cynthia McEwen is the head of DE&I and VP of People at Progyny.
Hello, hello! This is Kristin with Ask the Doulas, and our topic today is the importance of doula benefits. I’m thrilled to have Cynthia McEwen join me. Cynthia is the head of DE&I and the vice president of people at Progyny. Before joining Progyny in 2022, Cynthia spent nearly 20 years at the law firm Cleary Gottlieb Steen & Hamilton and later founded her own consultancy.
In her current role, Cynthia has been instrumental in launching employee resource groups, including those focused on LGBTQ+ support, parenting, and menopause. Welcome, Cynthia!
Thank you for having me, Kristin!
I am so thrilled to chat with you! Our doula agency has clients who utilize your fertility benefits, so it’s wonderful to speak with you directly!
Well, I am happy to have this conversation. Doula benefits are so important, and I’d love to spend a little time talking more about it.
I feel like there is a little bit of confusion related to general health insurance and some of these fertility-related benefits, so would you be able to describe how that’s different, how our listeners can look into their benefits to see if their employer is working with Progyny or another fertility benefit company, or even how to talk to human resources to get that added to their benefit?
Absolutely. So medical insurance carriers – of course, they’re going to carry your prenatal care. They’re going to cover those tests that you’re having done up until the point where you go into labor and delivery. They’re going to provide coverage for the hospital and the doctors and medical professionals who you see as part of that. But very, very often, there isn’t another benefit that is on top of that with your health insurance carrier that would provide for a doula. And so I do think it’s important to know what your benefits are. You can talk to the benefits professionals with your employer. You can call your insurance carrier directly to find out what those coverages are like. And obviously, you can read plan documents and things like that so you can have a better understanding of what is covered and how it’s covered. But again, by and large, doula coverage does not exist in the traditional medical plans, and so this is why you have a company like Progyny that provides that continuum of care from prenatal all the way through to menopause but is adding as part of that continuum this very specialized, very important doula benefit coverage. And so if you don’t have it, that’s obviously one of the reasons why we want people to know that it’s a particularly important coverage that your employer could reach out and find out more about.
Right. And I find that even with my husband’s benefits, I don’t fully understand them, and I don’t think that he has an idea, so if our listeners are expecting, chatting with their partner, also, about their benefit plan and having them investigate to see if there’s a fertility benefit like Progyny as part of that. So not only looking into your own benefits, but checking with your partner.
Absolutely. And the other thing is, think very broadly about your benefits when you are thinking about what coverages you might have. Sometimes there are lifestyle accounts that companies will offer, things like that, that may help with the cost. If right now you’re already pregnant and you’re thinking, oh, I want a doula, but I’m trying to figure out how I can do it – there may be some other benefits that are available, but in terms of some advocacy for expanding the benefit that you may already have in place with your employer, just going to them with information that helps them understand why that expanded benefit is important. It’s something that we are happy to help individuals do so that they can advocate for themselves and for others at their company around why a benefit like this would be important.
Yes, exactly. And so with a fertility benefit, do our listeners need to have gone through a fertility journey themselves, or could they access birth and postpartum doulas through that benefit even if they did not go through IVF or any other fertility methods?
With our current benefit, you do not have to have gone through a fertility and family building journey in order to then have that care during pregnancy and that postpartum care. So even though you could potentially have a continuum of care, it is not built to exclude anyone from being able to access whatever the benefit is that makes sense at the time that they are experiencing the need.
Excellent. I feel like that’s a misconception, so thank you for clearing that up. And why the commitment to not only birth doulas but postpartum doula coverage? I’m curious to hear, of all of the focuses, why Progyny feels that doula care is important.
Sure. The first thing – I think we probably know anecdotally, but we probably don’t have enough conversations about this – is that the US has the highest maternal mortality rate of all high income countries. We’re talking about potentially 22 deaths per 100,000 live births, and that’s according to an analysis that was done by a commonwealth fund last June. So the fact is that we have more and more risk, more and more possibilities of things going wrong, where that support that someone might be receiving in those moments could make the difference. And to your point about childbirth versus postpartum, 65% of maternal deaths actually occur postpartum. So it isn’t just in the moment when you’re in labor and you’re delivering, but it’s that care and that attention that happens afterward that also is so very important. And so a doula is there before, during, and after, and if there’s anything that we can do to, one, give people access to the best possible care, but two, to ensure that there’s some advocacy for women who are in a time where it is almost impossible to think about how to advocate for yourself, because you have all these other things going on. There’s a way to layer on that kind of benefit that is, from an employer perspective, likely going to result in a better claims experience. And two, going to result in an employee who is going to be much happier with the experience that they have had because of that support that you’ve been able to provide them through that doula coverage. It’s a win-win. So we’re definitely out here thinking about the health and welfare of the birthing parent during that period, before, during, and after. But we’re also thinking about the realities of what happens when there are complications with births and how that impacts both the individuals and the business that is providing the coverage for that care, before, during, and after, as well.
Absolutely. I agree. The impact on retaining talent and employees – having comprehensive maternal plans would help to retain and recruit new employees.
Absolutely. As businesses, we are often looking for, what are the right benefits for our employees in these moments that they have throughout their lives, because that’s ultimately what employees are looking for when they’re looking for an employer. How intentional has the employer been in this benefits package, and why is that important to me? What is the benefit, either now or later, to having this employer’s benefits package be accessible to me? And so it’s absolutely an attraction tool. And then as noted, a retention tool for those employees who then absolutely find themselves needing and being able to access that care when the time comes. And so it is important to think to the future of your workforce as much as you think about the now of your work.
Exactly. And as far as your personal experience and your belief in advocating for maternal health equity, would you be willing to share a bit about your own journey?
Absolutely. I am blessed to be a mother of five, and so I’ve had very different experiences in giving birth each time. But I will tell you that I had a particularly difficult childbirth experience with my third child. It’s interesting because I actually had a girlfriend of mine who had recently had a baby and she was talking about her doula experience, and I was like, wow, that actually sounds like something that I should do. I would love to – no offense to my husband, but I knew about his usefulness from my previous two pregnancies, and I felt like it would be a good thing for me to actually invest in getting a doula. And as a busy professional, as things happen, I never got around to it. And then it’s much more difficult trying to find someone and to go through that selection process later, and there was no benefit, so I knew that this was going to be an out of pocket experience if we were to do it.
I went into labor a little bit early, and it was a very rough labor experience. I was not able to receive anesthesia. The anesthesiologist simply was not able to find the right space for the epidural, and I was not prepared for a natural birth at all. At some point, the doctor, who I had only seen for 30 minutes, if that, my whole pregnancy, because she wasn’t my regular physician, was there and then gone and then at some point I was told to stop pushing. There was just so much going on. I was so upset. I was in so much pain. And I actually delivered my baby girl, and then I lost consciousness. And all of that – those are all things that can happen. Again, we’ve talked about the risks of childbirth. What was most disappointing for me was that after that experience, knowing how traumatic it had been, I received no support in the hospital. I was sort of whisked away to the room where I would be for the next couple of days. Once I was conscious and aware of my beautiful baby, they would come into the room and do checks on her and do checks on me, and then they would leave. And I was thinking to myself about the pain I was in and thinking about my other experiences. Shouldn’t I be getting up and walking, or don’t they need to take her away to the nursery for a little bit? All of these things were coming up in my mind, and I felt afraid to speak up. At one point, I did mention something to the nurse, and she’s like, well, this is your third baby. By now – I can’t remember the exact words, but it was basically, if you don’t have it down by now, or something like that. And I was like, wow. This has been a very different experience. I’m in a new hospital, different doctor, different everything, and different experience, and it was traumatic, and where’s the – like, is there someone who cares? And I also noticed that the treatment that I received – I got up; I did walk around, because I knew I was supposed to do that, and I pushed the little cart with her in it and went to the nursery. And there were all these babies in the nursery getting all this care from nurses, and I just kept thinking to myself, what am I missing? Why am I being treated differently from these other women who are on this ward with me?
Obviously, I felt very marginalized, but I also, in that moment, thought this is why you need an advocate. This is why someone else could and should be here in these moments because you feel so vulnerable. You feel powerless and don’t know what to do. And it didn’t matter that it was my third pregnancy.
No, every birth and every pregnancy is different, and every birthing experience is different.
Thinking about my health and the health of my baby after that traumatic birth experience, I know that doulas – they stand in the place where access to and understanding of all of the medical things that can happen and then all of the emotional and physical outcomes that can happen as part of that pregnancy and childbirth and postpartum experience – they stand in that place to ensure that you are getting the best care. Even your partner, their support for both of you through that sometimes complicated and risky and dangerous journey to help on the other side of everything. So that’s my own experience. It’s just one that shows that in the place of sometimes disparities in care, there may be a solution to help with better outcomes.
Exactly. And certainly doulas don’t speak for our clients or try to have any control over how the birth goes, but we are there to remind them of their wishes. We create a birth plan with them, give them resources, and if things are not emergent, we can slow things down and help them ask questions to feel like birth isn’t happening to them, the way it happened to you, and that they’re making informed decisions every step of the way. And if a partner’s involved, that they’re also having a full understanding of any potential interventions or any complications, as you mentioned with your pain management not being an option and not having prepared for an unmedicated birth during pregnancy by taking classes and focusing on breathing or having a doula there to physically support. And that can be traumatic! There are so many benefits to doulas, not only with that information and physical support, but that emotional and coaching role.
Absolutely. And I’ve been able to see that for myself again with others who have had the journey, that supported journey with a doula. So I guess I can’t say enough about why from both a personal and a professional perspective, why doula coverage can be such a critical addition to a benefit package.
Agreed. We are so thankful for the work that Progyny is doing and being on the forefront of advocating for additional not just medical support but expanding that birth and baby team to include doulas and other professionals.
Absolutely.
So are there any other tips or statistics that you’d like to share with our audience, Cynthia?
I would like to point out – because again, some of the rationale for doula coverage or the need for doula coverage does hit from a sort of cultural perspective, as well. As an African American woman, I am acutely aware of the disparities. We obviously already talked about the maternal mortality rate, but Black women are almost twice as likely to die during childbirth. That statistic is particularly alarming. I know there is a lot of research being done around the why for that, but the point here is that there may be a number of reasons that are starting in that preconception phase all the way through postpartum that need some attention and need some research. But either way, that additional support becomes even more important when the risks are higher.
The presence of doulas in the African American community is particularly important. Again, it’s that access to the best care. It’s that disparity sometimes that can take place within the medical world and the world in which we live. It’s also the understanding of those individual birthing journeys. Having someone as a doula with cultural competence, someone who can speak your language and speak the language of the medical professionals and other individuals who are involved in your care throughout that continuum. So I wanted to just bring up the fact that we know that there are certain communities of individuals for whom the additional support in that childbirth process is even more critical and can have even more impact.
Again, things like the cost of claims and what happens with the mother and the baby after deliveries, those kinds of things. Even though we obviously talk about inclusivity when it comes to our benefits packages, it is often that adding a benefit like doula coverage will have a bigger impact on a particular population within your work force. And that’s the other thing that I just wanted to be sure to add here.
Thank you. Yeah, it’s a very important point. And my final point is that doulas are for everyone. So at Gold Coast, we pride ourselves on judgment-free support. There’s a misconception that doulas are only for home births and are only for unmedicated births. But we support planned surgical births, clients who want an epidural right when they get to the hospital, or unmedicated. And then postpartum doulas can support every type of feeding and parenting goals. Households can look very different and so can that postnatal recovery phase, and the why for having a doula, whether rest or help with the newborn or feeding support or sibling care even – there are just so many different things. Every day can even look different for a postpartum doula. But I do like to bring that up. If people are navigating the benefits and thinking a doula may not be for them because they heard the doulas are only for the unmedicated births – that is not true.
That is an excellent point. And again, to the point about having an inclusive benefit, that it is for everyone and that it would be accessible for everyone who needs it and desires it. And I think just getting that information out there is so important so that there isn’t a misconception about who can benefit from having that wonderful support system through one of the most important journeys of your life.
Exactly. Well, thank you, Cynthia! I’d love to have you fill our listeners in on the best ways to connect with you, whether it’s social media platforms or your website.
Sure. I would absolutely welcome individuals to reach out to me on LinkedIn. I’m pretty easy to find there, so please do feel free to connect with me there. You can also go to our company website, which is Progyny.com. There are lots of resources on our site that will help you understand more about doula coverage, about the kinds of coverages that we offer to employers so that they can then offer them to their employees. Also, how to advocate for yourself and for others in this journey to better health. So I encourage people to reach out in those ways to get more information, get more informed, and take action.
Thank you so much! I appreciate all of the information you shared and the work you’re doing in this space!
And I appreciate yours, as well. It was wonderful having this conversation with you.
IMPORTANT LINKS
Birth and postpartum support from Gold Coast Doulas