This article was the start of our collaborative partnership with Humana to provide transportation to Humana Medicaid participants.
Her Story
About Alexa
Alexa Scisney is a Louisville, Kentucky–based direct doula, maternal and child health advocate, and Executive Director of Granny's Birth Initiative (GBI), a community-driven organization dedicated to improving outcomes for mothers, babies, and families. After beginning her career supporting families as a nanny and home health worker, she completed her direct doula training in 2018 and has since devoted her work to expanding access to culturally responsive, community-centered maternal care. Through Granny's Birth Initiative, Alexa leads innovative programs focused on birth support, postpartum care, transportation, education, and resource coordination, all designed to strengthen the communities they serve.
Driven by the belief that the best solutions to maternal health challenges already exist within communities, Alexa has built a model of care that blends traditional birth wisdom with modern innovation. Under her leadership, Granny's Birth Initiative has launched initiatives such as the Maternity Pantry, Granny's HUB, Doula Dash transportation services, and workforce development programs that connect families with essential support before, during, and after birth. Her work emphasizes listening to families first, restoring community traditions, and creating sustainable systems that improve maternal and infant health across Kentucky and beyond.
Alexa's leadership is grounded in integrity, independence, and faith. She chose to step away from nursing school in order to preserve the freedom to build community-based systems without institutional limitations, trusting her vision and the calling she believes was placed on her life. She credits her success to perseverance, embracing failure as part of growth, and honoring the strength of her maternal lineage following her own birth experience. As a recognized speaker and advocate for birth equity, Alexa encourages the next generation of maternal health leaders to trust their journey, embrace both ancestral knowledge and modern practices, and remain committed to creating the solutions their communities truly need.
Her Interview
Ten minutes with Alexa
01What do you attribute your success to?
I think I'm extremely comfortable with my failures. They're not failures to me. I just don't understand why people are even scared to fail. God's given me a vision, and I understand what it means to put purpose on life. I just now am really starting to connect with Him personally after having my direct birth experience myself. God brought me back to my ancestral ways and taken my maternal lineage seriously. My women are fire. I gotta give tribute to my daddy because he didn't treat us different because we weren't no boys.
02What’s the best career advice you’ve ever received?
The best career advice I have ever received came from two mentors who shaped my leadership in different ways. My mother taught me that empowering others through education, confidence, and compassion creates lasting impact, a philosophy that continues to guide my work as a doula and maternal health advocate. Jackie McGranahan of the ACLU of Kentucky reinforced that passion alone is not enough to create sustainable change. She showed me the importance of building strong organizational foundations, thinking strategically about long-term growth, and investing in meaningful partnerships. Her mentorship helped me establish Granny's Birth Initiative as a formal organization and secure its first major grant. Together, their guidance taught me that lasting community impact comes from combining purpose with preparation, and that great leaders create opportunities by empowering others to succeed.
03What advice would you give to young women entering your industry?
I really feel like the journey brings clarity. You have to trust it. It's not about ignoring what our parents are trying to tell you. You have to take the old and marry it with the new and what you're dealing with and the vision you're trying to bring into life. Just keep trusting it. When I was in nursing school they was trying to get me to sign and I would have to owe them because I had to pay out of pocket. I did not give away or sign any of those contracts. I kept my freedom to be able to create a system of women's health by the community for the community. I'm so grateful for being a dropout now because I would have thought I knew what the community needed and them books ain't telling nothing.
04What are the biggest challenges or opportunities in your field right now?
One of the biggest challenges in maternal health is addressing persistent disparities in access, education, and outcomes, particularly for underserved communities. At the same time, I see tremendous opportunity to expand community-based care, strengthen partnerships between healthcare providers and birth workers, and advocate for policies that improve support for mothers and families. I believe lasting change requires both compassionate, individualized care and strategic efforts to build systems that empower families before, during, and after birth.
05What values are most important to you in your work and personal life?
Integrity is the value that guides every decision I make, both personally and professionally. I believe trust is earned through honesty, consistency, and accountability, and I strive to lead with those principles in every interaction. My faith, commitment to service, and dedication to doing what is right—especially when no one is watching—shape the way I care for families, build relationships, and lead my organization.
Her Content Hub
Articles by Alexa
It takes a village: Perinatal care managers and community doulas work together to build maternal support
How MCO & CBO collaborations can Birth KY Better.
Maternal Mortality and Morbidity
One does not have to search far to find that the United States is experiencing a maternal health crisis; a crisis that has continued to rise both during and in the aftermath of the global COVID 19 pandemic. Additionally, the maternal health crisis is a crisis of health equity and systemic racism, as Black women are at least three times more likely to die in pregnancy, birth, and the year after birth, than their white counterparts across all socioeconomic lines (Centers for Disease Control and Prevention, 2023).
Figure One: Graph depicting the growing disparity in maternal mortality rates in the last four years
Strategies to reduce maternal morbidity and mortality need to be comprehensive and use a multipronged approach to tackle the different contributing factors and barriers which have led to these worsening outcomes. Many factors contribute to maternal health disparities, including variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias (CDC, 2023). Two strategies utilized to successfully address these disparities include: increasing access to doula care and promoting perinatal care management among high-risk populations (Knocke, et.al, 2022) (Chou, et.al, 2021).
Often each of these strategies are utilized independent of one another. However, one Medicaid Managed Care Organization in Kentucky has sought to promote collaboration and innovation to improve maternal health outcomes, by partnering its Medicaid perinatal care management program with community-based doulas to increase access to perinatal care and support for their membership.
A Unique Partnership to Improve Access to Maternal Care
Humana Healthy Horizons in Kentucky services over 160,000 Medicaid members across the state. In addition to offering physical and behavioral health care management, Humana Healthy Horizons offers a perinatal care management program called HumanaBeginnings. In 2021, a value added, or extra benefit, was launched for members to have access to doula care through reimbursement to doula providers. By definition, “Doulas are nonclinical trained professionals who can provide emotional, physical, and informational support during pregnancy, delivery, and after childbirth. Access to doula services has been historically limited in the U.S., with greater utilization among higher-income individuals, since doula services are often not reimbursed by health coverage programs including most state Medicaid programs” (Knocke, et.al, 2022). This was the first managed care organization in Kentucky to test the impact of providing reimbursement to doula providers for their Medicaid members.
To best ensure participants had knowledge of and access to this new benefit, the HumanaBeginnings team began directly networking with community doulas, educating members on doula care, and then referring their program members to community doula partners. In 2023, the organization was able to utilize these networked relationships to develop a pilot project aimed at increasing access to prenatal and postpartum visits. This pilot project provides eligible members with free transportation to all maternity care visits needed to support a healthy pregnancy, birth, and newborn, through a partnership with community doula organization, Granny’s Birth Initiative.
Founded in 2018, Granny’s Birth Initiative is an innovative, Black-led, doula organization which according to their mission “seeks to support disenfranchised birthing families often overlooked due to societal shame or lack of acceptance including birthing people that are BIPOC, incarcerated or homeless girls/women, those in foster care or transitioning out”. Their goal is to “create access to Doula and lactation support, birth education, legal support, and other resources that are the key tools in our fight to decrease maternal and infant mortality in Black and other marginalized communities”. Granny’s Birth Initiative (GBI) founders recognize the critical need to address social determinant of health factors contributing to the current maternal health crisis. Through their work in the community, they identified transportation and childcare access as significant barriers to perinatal care and decided to form a unique ride share and childcare service called Doula Dash. Doulas and trained perinatal health workers provide these services so that any birthing person in need can attend all necessary medical appointments at low cost.
The pilot project developed with GBI, through a grant from Humana, allows the HumanaBeginnings team to screen eligible members for transportation needs and barriers, provide them a unique code for Doula Dash so that all rides are free, and assist members with scheduling the service online. Granny’s Birth Initiative then confirms the members ride and completes the ride and/or childcare service for them. Each member can use the code as many times as needed to ensure they receive care. Members may also attend WIC visits, breastfeeding classes, infant care visits, and more, using Doula Dash, to ensure they can access any maternal supports needed throughout their journey. The unique part of this project is the impact of the provision of childcare services on transportation access and the expansion of rides available to the member specific to maternity services which may not be covered under their state Medicaid transportation benefit. This project is currently ongoing but the goal at close is to understand the impact of this transportation service on prenatal, postpartum, and well child visit access and HEDIS rates for the participating members and the possibilities and need for scaling up or continuing the program in the future.
Actions for Perinatal Care Managers
Care Managers and care management programs have an incredible opportunity to address the maternal health crisis. Through the lived experience of this unique pilot project, we recommend that perinatal care managers consider the following as they work to impact maternal health.
First, care managers can ensure they are well informed about maternal health data, including drivers and barriers, of the current maternal health crisis. It is imperative that we understand the health disparities our members and patients are facing and that we are up to date on the best practices and interventions. Doula care has been proven as an important evidence-based intervention to improve maternal outcomes, although it is by no means the sole answer to the crisis. Care managers can educate themselves and their members on the benefits of having a doula and encourage members to access doula care whenever available. When well educated about doula care, care managers can also advocate for the coverage of these services in the areas where they work, either through base benefit coverage or grants and other funding.
Second, care managers can network and develop relationships with community doulas and perinatal health workers in the communities they serve. This is a crucial component to breaking down silos in care. Networking helps to improve referral success and provide collaborative care. Doula providers and care managers can work together on member and patient concerns, including social determinants of health. Developed relationships can ensure the care management programs are most up to date on services available to community so they can quickly and efficiently ensure families can access birth support. Care managers should focus on developing diverse relationships, centering Black led organizations, and connecting families to culturally congruent doula providers.
Lastly, care managers can look for ways to innovate and close the gaps in care they see in their own community. Increasingly, grassroots, community-based organizations are providing unique social determinants of health services such as is seen with Doula Dash in Louisville, Kentucky. Care managers can promote and advocate for projects within their office, hospital, insurance company or organization which promote collaboration and connection to these needed services to address the unique needs of birthing persons and their families in accessing maternity care.
Conclusion
Both the World Health Organization (WHO)(2021) and Healthy People 2030 (Office of Disease Prevention and Health Promotion, 2023) have increasing prenatal care access as sustainable goals to reducing maternal death and illness. Research indicates there is a positive correlation with increased number of prenatal visits on improved maternal health outcomes (WHO, 2021). Both community doulas and perinatal care management programs play a critical role in assisting birthing persons in obtaining full access to perinatal care and in reducing the deleterious impact of maternal morbidity and mortality. Partnerships between care management programs and community doulas can not only build “a village” of support around patients and members but can also provide an opportunity to address social determinants of health needs in unique ways to break down the complex societal and systemic barriers to full access to perinatal care, in hopes of improving maternal health outcomes for all.
References
Centers for Disease Control and Prevention (2023). Working Together to Address Black Maternal Mortality. Retrieved from Working Together to Reduce Black Maternal Mortality | Health Equity Features | CDC
Chou, C. C., Liaw, J. J., Chen, C. C., Liou, Y. M., & Wang, C. J. (2021). Effects of a Case Management Program for Women With Pregnancy-Induced Hypertension. The journal of nursing research : JNR, 29(5), e169. https://doi.org/10.1097/jnr.0000000000000450
Granny’s Birth Initiative (2023). Our Mission. Retrieved from Home | Granny’s Birth Initiative | Birth Kentucky Better (gbiky.org)
Knocke,K.,Chappel,A., Sugar, S., De Lew, N., Sommers, B. (2022). Doula Care and Maternal Health: An Evidence Review. PDF. Retrieved from ASPE-Doula-Issue-Brief-12-13-22.pdf (hhs.gov)
Office of Disease Prevention and Health Promotion (2023). Healthy People 2030: Pregnancy and Childbirth. Retrieved from Pregnancy and Childbirth - Healthy People 2030 | health.gov
World Health Organization (2021). New Global Targets to Prevent Maternal Deaths. Retrieved from New global targets to prevent maternal deaths (who.int
Author Bios
Alexa Scisney (She/They) is the Founder and Executive Director of Granny’s Birth Initiative. They are a Certified Labor Doula and Certified Midwife Assistant. Alexa is an experienced Postpartum Doula and also provides Lactation Education and Birth Plan consulting in her home community of Louisville, Kentucky. Granny’s Birth Initiative services include: transportation services through Doula Dash, basic needs and maternity supplies through their Maternity Pantry program, and a postpartum meal service to address ongoing food insecurity of birthing families. Alexa is a passionate and skilled birth worker currently pursuing her ASN in hopes of becoming a Labor and Delivery Nurse in the near future. Read more about Granny’s Birth Initiative here: Home | Granny’s Birth Initiative | Birth Kentucky Better (gbiky.org)
502-242-8595
Lauren Buchwald BSN, RN, MSc (she/her) is Nurse Manager for the HumanaBeginnings care management program for Humana Healthy Horizons in Kentucky. Lauren has over 15 years of experience in maternal child health nursing including Labor and Delivery, Neonatal ICU, Postpartum, Pediatric ICU, Public Health and Perinatal Care Management. Lauren holds a Master of Science in Global Health and Infectious Diseases and is currently pursuing a Doctorate of Nursing Practice as a Public Health Nurse Leader. Lauren is passionate about reducing maternal and infant health disparities in her community of Louisville, Kentucky. Read more about HumanaBeginnings program here: Kentucky Medicaid: From Pregnancy to Parenthood - Humana
502-553-7819
Join Influential Women and start making an impact. Register now.