INDIANA’S MATERNAL DEATH RATE IS AMONG THE WORST IN THE NATION. A WEST LAFAYETTE NONPROFIT IS DOING SOMETHING ABOUT IT.

There is a certain kind of person who pays attention to whoever is being left out — who moves through the world with peripheral vision trained on the edges, the overlooked, the ones for whom no one has quite shown up.

Lindsay Mputubwele is that kind of person.

Which is why, when she found herself moving through her own pregnancies largely unsupported — not neglected, just alone in the way that American medicine has normalized — she did not absorb it and move on.

She became a doula. And then, when she understood the full scope of who wasn’t being reached, she did something almost no one in her field had done: she built a nonprofit to make sure the women who needed support the most could actually get it.

That decision puts her at the center of one of the most consequential and underexamined failures in American healthcare.

In March of this year, Indiana University Health awarded Transformed Birth Services $720,826 over three years through its Community Impact Investment Fund, a competitive grant program that has distributed more than $41.6 million to Indiana organizations since 2018.

The award will expand maternal health services for low-income families in Tippecanoe and Clinton counties, including women who are currently or formerly incarcerated. The organization started four years ago with $200 in donations; Mputubwele did not pay herself in the first year. It now employs a dozen doulas, serves families in four languages, runs a support program inside the county jail and is converting a shuttle bus into a mobile baby pantry.

There are no other organizations quite like it in Indiana. Look nationally, and you won’t find many there, either.

Mputubwele is the founder and executive director of Transformed Birth Services, a nonprofit doula organization in West Lafayette, Indiana, and she represents something the American healthcare debate tends to overlook: the possibility that the most effective interventions are sometimes the oldest ones.

Doulas — trained, non-medical birth companions who provide continuous support through pregnancy, labor and the postpartum period — are not a new invention. They are, in a meaningful sense, a restoration.

Women have always attended births. The aunt, the neighbor, the midwife’s helper, the woman down the street who had done it six times and knew what to say at three in the morning when the fear set in — these figures were not incidental to birth. They were structural. What the 20th century gave women was epidurals and fetal monitors and cesarean capability. What it took away was everyone else in the room.

The research on what that loss costs is now substantial. Studies have linked continuous doula support to lower rates of cesarean delivery, reduced preterm birth, and improved newborn birth weight. What the data is really measuring, underneath all of it, is what happens to a body when someone is genuinely present for it and what happens when no one is.

In Indiana, the numbers are stark. According to a 2025 brief from the Indiana University Public Policy Institute, the United States recorded 18.6 pregnancy-related deaths per 100,000 live births in 2023, the highest maternal mortality rate among the world’s wealthiest countries, and the state has done its part to drive that number

Black Hoosier women died at a rate of 156 per 100,000 live births in 2021, the highest in the state, and nearly 10 times the national average. The Indiana Maternal Mortality Review Committee has determined that the vast majority of those deaths were preventable. In Tippecanoe County specifically, more than half of fetal and infant deaths reviewed were among Black, Hispanic and other racial and ethnic groups — populations that account for only about 25% of the total population.

Mputubwele came to this understanding not through academia but through experience. She lives in West Lafayette with her husband and their four boys, and her own births — particularly her third — are where the work began.

No one failed her clinically. What was absent had no billing code and no clinical category: someone simply, consistently, entirely there for her. When her fourth son was born, she began training as a childbirth educator through the Childbirth and Postpartum Professional Association and then as a birth doula.

The training introduced her to the full scope of maternal health disparities, to the data on who was suffering and why and to the evidence that doulas could measurably improve outcomes for the families most at risk. What she found, she said, felt less like a career pivot than a calling.

She looked at her accountant. She had been operating a small doula business as an LLC. She asked what it would take to convert it into a nonprofit, to build something that could serve families who couldn’t afford to pay, funded by grants and donations rather than client fees, staffed by a team diverse enough to reflect the community it was meant to serve. Really hard, her accountant said.

“Let’s do it,” she said.

The accountant was right. It was really hard. But Mputubwele had spent years watching pregnant women — low-income women, Black women, women who spoke Arabic or Spanish or Haitian Creole, women moving through one of the most physically and emotionally extreme experiences of their lives — receive care that was technically competent and humanly insufficient.

She had been one of them. She knew what it felt like to leave a delivery room without having been fully seen. The difficulty of building a nonprofit was not, in that context, a reason to stop. It was just the next thing.

The nonprofit model matters because the market has failed here with particular thoroughness. A private doula can cost between $800 and $2,500 for birth support alone, an amount that places the service far beyond the reach of the families most likely to benefit from it.

Medicaid, which covers roughly 40% of all births in the United States, does not reimburse doula services in Indiana, despite a state bill expressing support for coverage. The result is a system in which access to continuous, human-centered support during birth is effectively rationed by income, which is to say that the women likeliest to face the worst outcomes are also the women least likely to receive the intervention most proven to improve them.

Transformed Birth Services cuts through this with deliberate simplicity: doulas are paid through grant funding, families pay nothing and the red tape that would otherwise mediate between a frightened woman and the person who can help her is removed.

“We really focus on those determinants of health,” Mputubwele said. “Is someone able to get transportation to their prenatal appointments? Does someone have enough food to stay healthy and sustain the nutrients needed for a pregnancy? And then just — having a person to reach out to directly.”

She described a client who was in a minor car accident and didn’t know whether to go to the hospital. She texted Mputubwele. That is the relationship the organization is trying to nurture, available at three in the afternoon or three in the morning, for the questions that don’t fit anywhere else.

For the families who have experienced it, the difference is not subtle. “I received the best support I feel possible,” wrote one client, Desiree. “My doula was there every step of the way when I needed. She helped me stay informed of my choices and explained risks and benefits of everything happening and said. I wish I had come across them sooner in previous pregnancies. Definitely filling a need in our community.”

But the organization’s argument is not only about access. It is about the nature of the support itself, and this is where Mputubwele’s thinking becomes more specific and more challenging. She has built her team to reflect the communities it serves — Black doulas, Muslim doulas, Spanish-speaking doulas — on the premise that culturally competent care is not a nicety but a clinical variable.

The research supports this. Black women report higher rates of feeling unheard and disrespected in obstetric settings, and the quality of the patient-provider relationship has significant effects on outcomes. A doula who shares a client’s language, faith tradition or racial background brings knowledge to the room that cannot be approximated by goodwill alone.

Mputubwele was mentoring an African American doula during a birth, supporting an African American mother in labor. The mother hadn’t had time to do her hair before arriving at the hospital. The doula braided it for her — the mother sitting on a birth ball, in active labor, her hair being tended.

“That humanized her,” Mputubwele said. “Made her feel comfortable and confident and ready for the day ahead. That was a gap I, as a white woman, wouldn’t have been able to fill.”

The work is still widely misunderstood.

She added, with some emphasis, that there is often more for a doula to do once an epidural is placed, not less. Immobility is its own complication in labor; positioning, movement and tension-release techniques remain critical even when a woman cannot feel her legs. The doula does not sit down. She works.

Two of the organization’s doulas have received medical interpreter training from IU Health, allowing them to provide in-person language assistance during labor and delivery rather than relying on remote tablet interpretation, a distinction that becomes significant when a woman is trying to understand her options between contractions.

Mputubwele describes the tablet system with restrained exasperation. The point is not the technology. The point is what it signals: that the experience of a woman who doesn’t speak English is, in practice, considered less worthy of directness, less deserving of the intimacy of an actual person speaking her language in the room where she is giving birth.

It is tempting to read all of this as a critique of medicine, but Mputubwele resists that framing, and her resistance is instructive. Tippecanoe County sits at the center of a regional maternity care desert — no surrounding county has a labor and delivery unit, which means Lafayette’s two hospitals are absorbing not just local demand but the unmet need of a much wider region.

The obstetricians and nurses working in those settings are not indifferent. They are overwhelmed, and they are doing, within the structure available to them, what that structure allows. What the clinical encounter cannot accommodate — what no clinical encounter, however well-intentioned, can fully accommodate — is the whole person in the bed. The doula is not there to fill a gap that medicine created through negligence. She is there to fill a gap that the structure of medicine makes inevitable.

“We need the medical staff,” Mputubwele says. “We need to be working together.”

This is not diplomacy. It is an accurate description of how the work really functions — as a complement to clinical care, not a challenge to it, addressing the dimensions of birth that no amount of medical expertise alone can reach.

Some of what Transformed Birth Services does is not easily categorized. Mputubwele earned a birth-behind-bars certification and approached the Tippecanoe County Sheriff’s Office with a proposal to serve pregnant and postpartum women in the county jail. It’s a population whose maternal health needs are, by any measure, among the most acute and the most ignored.

The organization now provides support visits to incarcerated women, attends births outside the facility and accompanies mothers through the postpartum period, including the separation from their newborns that typically follows delivery. Women who are released are invited to the organization’s support groups, where they can be in community with other mothers navigating the same terrain.

She described, carefully, a hospital birth she attended where law enforcement was involved. The mother had a history of trauma and could, in the shorthand of a medical chart, present as difficult. The doula was there. The doula knew her. What might have become a confrontation — between a traumatized woman and the institutional forces surrounding her — resolved instead into a safe outcome.

“Without the relationship the doula had developed with that mother,” Mputubwele said, “I genuinely feel that outcome could have been very traumatic for the mother and the baby.”