Recovery Doulas Help Moms Beat Addiction, Keep Their Babies

When a woman undergoing surgery after a miscarriage begged hospital staff not to give her narcotics, they administered fentanyl anyway. Her doula, Emmalee Hortin, watched her client's hard-won recovery suddenly feel threatened.

Hortin is part of a growing workforce of recovery doulas who specialize in supporting moms with substance use disorder through pregnancy and beyond. Many, like Hortin who's nine years into her own recovery, draw on personal experience to help families navigate their most vulnerable moments.

The need is urgent. Mental health conditions and substance use are leading causes of maternal death in America, according to the CDC. Without support, pregnancy can be an especially dangerous time for people trying to get sober.

Recovery doulas fill a critical gap in care. They advocate for patients in hospitals, support them through cravings and stressors, and create personalized care plans with medical teams. Because many are in recovery themselves, they build trust faster than traditional providers.

"It's a lot easier for us to build rapport with people because there's not a power differential or that systemic mistrust," said Britt Westmoreland, who coordinates the University of Colorado's recovery coach doula program. She knows the stigma and difficulties firsthand.

That stigma often prevents moms from reaching out for help. The shame is compounded for Black and Indigenous women, who research shows are disproportionately drug tested during labor and investigated by child welfare agencies.

Julianne Denny, an Indigenous birth worker who is Cree, Ojibway and Mikmaq, trained at Montana's One Health center. "It's my job to remind [moms] of their humanity and that they can gain control over their addictions and they can keep their babies," she said.

The work goes deep. Hortin supports recovering moms for up to three years postpartum, helping them feel empowered through successful pregnancies.

The Ripple Effect

The support is becoming more accessible. Utah just approved Medicaid reimbursement for certified doulas starting April 1. Colorado passed similar legislation, joining a growing list of states recognizing this specialized care as essential.

At the University of Utah's SUPeRAD Clinic, medical director Dr. Marcela Smid now sees over 50 patients in just three days, with families traveling from rural Wyoming, Idaho and Nevada. "Now that we will be able to be paid through Medicaid, a lot of doulas will be able to feel this work is sustainable for them," said Utah doula Aleece Weaver.

Community health centers like One Health are training doulas from across Montana in peer recovery work. The model is spreading as more clinics incorporate recovery doulas into their teams.

"No matter what these parents are struggling or facing, that's not all they are," Hortin said. "When we keep people held to our stigma and our bias, why would they want to change when no one's willing to trust that they can?"

Families are keeping their babies, moms are staying in recovery, and a new generation is growing up with parents who fought hard to be there for them.