In hospital settings that are dominated by white health care providers, the complaints and concerns of black people and other women of color are often dismissed as dramatics. People of color can also find similar issues with white doulas.
The dismissal of potentially deadly problems reported by black women to doctors and nurses are thought to contribute to a pregnancy related mortality rate that is double to triple that of white women, as found by a CDC report.
“These disparities are devastating for families and communities and we must work to eliminate them,” Emily Petersen, M.D., medical officer at CDC’s Division of Reproductive Health and lead author of the CDC report, said in a press release. “There is an urgent need to identify and evaluate the complex factors contributing to these disparities and to design interventions that will reduce preventable pregnancy-related deaths.”
There were 1,059 pregnancy related deaths reported in California between 2002 and 2007, according to The California Pregnancy-Associated Mortality Review Report from 2002 to 2007, paid for in part by the California Department of Public Health. Pregnancy related deaths refer to deaths that occur during pregnancy or within one year of giving birth, regardless of cause.
Although black people account for only 5% of California’s population, they made up 21% of the pregnancy related deaths reported in the state.
With the risk of dying due to pregnancy or birth being significantly higher for Black, Native American and Alaskan Native women in the US, some are turning to birth doulas of the same cultural background to act as both a guide and advocate for them during their birthing plan. Locally, the Long Beach based Birth Workers of Color Collective is connecting clients to doulas whose practices and backgrounds resonate with them culturally.
A doula is someone trained to provide both physical and emotional support during pregnancy, birth and afterwards. Their role can include guiding mothers in labor through breathing exercises, recommending body positions to shorten labor, teaching lactation techniques and much more.
“This collective was formed in response to the birth and health disparities that people of color face during pregnancy,” Birth Worker of Color co-founder Stevie Merino told the Signal Tribune, “the lack of representation of doulas/birthworkers of color in the mainstream doula community, and the appropriation of traditions around pregnancy/birth/postpartum. The mission of this collective of birth workers is to reclaim our medicine, share our knowledge with our community, and heal. Together, we are bringing unique skills, resources and experiences to our work as birth workers, healers and people of color.”
To make doula care available to individuals of different economic standing, the Birth Workers of Color Collective charges clients on a sliding scale.
The Maternal CARE Act was introduced to the senate by California Senator Kamala D. Harris in 2018 to provide grant money to train healthcare workers, especially those involved in pregnancy and birth, against implicit bias.
“Pervasive racial bias against black women and unequal treatment of black women exist in the health care system,” the Maternal CARE Act states, “often resulting in inadequate treatment for pain and dismissal of cultural norms with respect to health. A 2016 study by University of Virginia researchers found that white medical students and residents often believed biological myths about racial differences in patients, including that black patients have less-sensitive nerve endings and thicker skin than their white counterparts. Providers, however, are not consistently required to undergo implicit bias, cultural competency, or empathy training.”
The Maternal CARE Act was read twice to the senate and then recommended to the Committee on Finance. This was the last recorded action on the bill, and was recorded on August 22, 2018.
Long Beach’s black babies have also been reported as dying within the first year of life at higher rates than babies of other races in the city. According to a Community Health Assessment by the City of Long Beach’s Health and Human Services Department in July 2013, black babies in Long Beach died at a higher rate than Asian and Hispanic babies every year from 1998 to 2008. The mortality rate for black babies under one year old was also higher than both the state of California’s and the city of Long Beach’s average during this time period.
Long Beach’s infant mortality rate for the general population was 4.7 deaths per 1000 live births between 2003 and 2004. This was even lower than the state of California’s average of 5.3 infant deaths per 1000 live births.
In contrast, the highest rate of infant mortality in Long Beach’s black community during the 10 year period occurred during this same time period. By the end of 2004, an average of 11.2 black infants per 1000 live births died before their first birthday in the city that year.
Black mothers were also recorded as having a higher rate of premature babies every year between 1998 and 2008.
With the additional hazards black mothers and their babies face during pregnancy, a doula that relates and empathizes with them can be an important resource.
Birthworkers of Color have been providing doula training to and for people of color since 2017. The Long Beach doula collective has trained over 100 doulas since then. All its members attend training provided by the collective, to ensure all members have the same foundational knowledge. This training is augmented by each individual doula’s approach, unique experiences, skills and traditions.
Roles similar to that of doula have been part of multiple cultures’ birthing traditions for thousands of years.
However, due to hospital restrictions caused by the coronavirus pandemic, expectant mothers now have to choose between having either their partner or doula present with them during labor. Hospitals across LA County are only allowing mothers in delivery rooms to have one guest, and doulas are not considered part of the medical staff.
“Some of our doulas have switched predominately to virtual support,” Merino said, “and others have decided to stop offering services altogether as many potential clients would prefer in person support and hospital policies are forcing them to not have that option. A few of our doulas who are still supporting in person have actually had clients intentionally choose to have them at the birth, rather than a family member or partner, because of the educational & advocacy component and navigating the hospitals during this time.”
Some hospitals are also requiring that even doulas who attend a birth as a guest produce certification of some sort, despite there currently being no standard certification program or regulating body for doulas.
“Our doulas are just as equipped, just as skilled, and just as trained as certified doulas,” Merino told the Signal Tribune, “the only thing that is different is a piece of paper. Unlike many trainings that offer certification— our doulas have access to continued mentorship, education, and monthly meetings/skill building, and they have an entire community of birthworkers to turn to— one can argue that they may be even more equipped in many instances. So the question is who are these requirements for? Who do they benefit? Who are they harming? People of color and marginalized communities experience the most disparities and many especially in recent years have become more disgruntled at the medical industrial complex leading them to seek alternatives to care and doula support. We know from research that having care providers/support that look like us can drastically improve our health outcomes—if doulas of color are the ones experiencing the most barriers from these new, possibly long term policies past the pandemic, birthing people of color will again be the most impacted.”
Doulas belonging to the Birthworkers of Color Collective can provide support and services for all pregnancy outcomes including birth, loss, abortion, miscarriage and more. The collective also provides childbirth education, postpartum and lactation services, as well as different healing and traditional modalities.
Prospective clients are encouraged to reach out if they are looking for a specific service or cultural practice.
“We provide inclusive support to our communities of color,” Merino said.