During her time in prison, Topeka K. Sam suffered through untreated uterine fibroids and a surgery that did not relieve them and caused excessive bleeding. Meanwhile, the commissary limited the amount of menstrual pads Sam could purchase and forced her to show male guards her used pads in order to purchase more.

Alongside her own reproductive health traumas, she witnessed the poor conditions of pregnant incarcerated women. After her release, she founded the Ladies of Hope Ministries and began organizing and advocating for legislative change, including demanding dignity for incarcerated women by ending abusive policies like the shackling of pregnant people and making menstrual products free.

During this legislative organizing work, Sam met and became familiar with a number of the existing prison doula programs and noticed that there was a lack of representation within them; there were no formerly incarcerated doulas.

That’s how the Ladies of Hope Ministries’ new doula initiative came to be. The New York City-based LOHM, in partnership with Mama Glow and Optum, launched the training program in 2021 to create job opportunities and trauma-informed pregnancy support for incarcerated women and gender nonconforming folks. The program aims to solve large-scale problems—prison birth and poverty—by providing services and resources directly to those impacted, and empowering them to be part of the solution.

“As a person who has actually been in a prison, going back in a prison to support women who are there, my approach to it is going to be different than someone who’s never been. It just is,” Sam, the Ladies of Hope Ministries’ founder and executive director, said. “Those closest to the problem are closest to the solutions.”

Every year, an estimated 58,000 pregnant people are admitted to jails or prisons in the United States, and thousands of pregnancies will end, through birth or other outcomes, in incarceration—in facilities that lack proper support, policies, and resources for birthing people. Once released, formerly incarcerated people experience disproportionate rates of unemployment (over 27 percent compared to the national unemployment rate of 4 percent) and poverty. It’s because of these bleak realities that the LOHM started its initiative aimed at preparing women and nonbinary people impacted by the criminal legal system to provide trauma-informed doula services to their communities.

Doulas are often the first line of defense for birthing people, especially those from communities that are neglected or harmed by medical systems. Typically, doulas provide clients with physical and emotional support, guidance, advocacy, and education before, during, and after the birthing process.

“Prison doula programs are far and few in the U.S. [and] can be short-lived due to lack of funding and ability to sustain themselves. The few programs that currently remain are majority volunteer-based programs,” geunsaeng ahn, a community-based full-spectrum doula, reported in an article for the Margins in late 2020. “The remaining prison doula programs that are fully active are predominantly run by cis white women who have been able to fund and sustain such programs with their own resources.”

The LOHM’s initiative, which trained 50 doulas in its inaugural year, hopes to shift the current environment of reproductive justice in incarceration, while equipping its participants with resources, information, and skills to be successful birth workers and advocates. Last year’s cohort is in the process of finishing up their doula certifications—by attending live births and reading required materials—and the organization is gearing up to begin its second year.

The program also takes a holistic approach, offering trainees help with healing from trauma, entrepreneurial education, and opportunities to engage in advocacy work and paid speaking engagements through the organization.

“It’s important to know that there’s lots of pop up [prison doula] initiatives doing this work, and while they’re all very important, the LOHM is set different because we are people who have experienced it ourselves, and we are making sure we are training other people who have been directly impacted,” said Tonja Honsey, the organization’s health equity program director. “And then we’re helping them to build a business, to become entrepreneurs, to end poverty and incarceration at the same time.” Honsey, another incarceration survivor, experienced firsthand what it was like to be pregnant and a parent while incarcerated.

Honsey said the Ladies of Hope Ministries is working on pushing for policy changes around Medicaid reimbursement for doulas in the community, because “historically having a doula is a privilege that people [who] do not have the wealth or the resources are not afforded, so if they can be reimbursed by their health-care company then that opens the doors for the people who really need the support to have it.” Medicaid coverage for doula services varies widely by state.

Section 1905(a) of the Social Security Act also makes providing doula services in prison inaccessible to many. Section 1905(a), known as the inmate exclusion policy, excludes people incarcerated in prison and jails from federal Medicaid coverage. The LOHM wants to see the policy repealed so that its cohort of doulas can provide services to the incarcerated community without having to volunteer or offer free services. Honsey said the organization wants to “make sure that people are making a living wage and it’s not something they’re having to volunteer for or going out and fundraising for.”

“When I was going back and forth to county jail, on one occasion I was pregnant and the treatment at medical was like assembly line at a warehouse—in, out, no personal interaction,” said Tabatha Trammell, a formerly incarcerated woman from Georgia who participated in the doula training last year. “It made being pregnant a burden or sin, just to get basic triage assistance.”

Trammell told Rewire New Group that she wants to use her training to go into the county jail in her area to advocate for and educate women and girls. She also wants to educate local churches and clergy on how to be a pillar of support for pregnant teens, as opposed to the shame and disownment she experienced as a youth.

“The program itself was a healing process for me and past trauma that came from sexual abuse, religious stigma, abandonment issues. … I addressed resentment for the church which abandoned me and disassociated me for a teen unwed pregnancy, so pregnancy for me was sinful, shameful, and secretive. I learned how to listen to and love my body,” Trammell said.

“This training isn’t only a healing tool but an empowerment tool for our system-impacted sisters to start our own businesses as doulas. The program has taught us how to market, network, and communicate effectively.”

For the doula initiative’s second year, the Ladies of Hope Ministries will be partnering with Commonsense Childbirth for training, and participants will receive certifications to provide childbirth education, doula, and lactation specialist services upon completion. The program is on track to certify up to 120 doulas over the course of the year. The organization will also be partnering with Las Colinas Detention Facility, a women’s jail in California, to begin educating and training currently incarcerated women.