In the United States, Black women are more than three times as likely to die from pregnancy-related causes than White women. Doulas (and other birth workers) are key support persons who can help combat the structural barriers that cause this disparity.
Mortality Crisis
Black women die at a rate of 40 per every 100,000 live births compared to 12.4 White women, according to the CDC Pregnancy Mortality Surveillance System. Race discrimination—in myriad overlapping manifestations—contributes to this stark gap. Some reasons are socioeconomic: Because of historical oppression, Black women face higher levels of poverty and decreased access to healthcare, which can worsen birthing complications. However, inequities in mortality levels cut across class lines, with many contributing factors affecting all Black women.
Dr. Tonya Davis, a clinical training director for Counseling@Northwestern, the online Master of Arts in Counseling program from The Family Institute at Northwestern University, points out that “when health care professionals stereotype, make assumptions, and/or believe that Black women are over-exaggerating about their symptoms, these actions can leave room for dangerous health consequences if left unchecked or unchallenged.”
Doulas
Pregnant Black women—or genderqueer or transgender men—can turn to doulas for support against structural discrimination that can jeopardize their safety. Doulas are birth workers who traditionally assist mothers before, during, and after labor and birth. They are not medical professionals but work in tandem with doctors or midwives to address clients’ physical, emotional, and mental needs. Doulas are typically associated with the white and rich: services are not usually covered by insurance, and can cost upward of $1,000. However, many doulas, especially women of color, are stepping in to serve as a resource to improve care and safety of pregnant Black women. They can help navigate the complexities of the health care system and connect low-income women to optimal resources for prenatal nutrition. During appointments and the labor process, doulas serve as advocates and protect clients against doctors who may push unwanted procedures or dismiss pain, a common problem during Black women’s pregnancy.
Community-level organizations such as Ancient Song Doula Services in Brooklyn work to make doula care accessible to low-income women of color, often through volunteer or sliding-scale services. Public officials have taken note of birth workers’ positive influence on mortality rates for Black women and babies, which has led to experimental programs covering doula costs through Medicaid in New York, Minnesota, and Oregon.
Birth Work Options
For those who may be considering incorporating birth work into their pregnancy plans, there are a variety of options to consider:
Birth Doula
Birth doulas work with clients before, during, and after labor. Doulas who specialize in working with low-income women of color often provide assistance with the health care system, nutrition, and other natal-related essentials.
Postpartum Doula
Postpartum doulas assist mothers with transition just after birth, focusing on recovery from the birth experience, nursing, and infant bonding. Birth doulas often transition into postpartum doulas.
Family Life Doula
Bringing a newborn home shifts existing family dynamics. Family life doulas help siblings and non-birthing parents with the transition at home.
Bereavement Doula
A bereavement doula provides support to families in the tragic event of pregnancy loss.
Midwife
Many Black women have experienced trauma in traditional medical settings that exist within a sometimes racist system that undervalues their pain and experiences. A doula can help navigate and advocate in the face of structural barriers in these settings, but some women may also choose to opt out of the traditional hospital birthing experience altogether. Certified nurse midwives are advanced practice registered nurses who can deliver babies in the safety and privacy of one’s own home, or at a birthing center or hospital. (Note: Midwifery laws vary from state to state.)
Monitrice
While doulas are essentially labor support persons and midwives are primary care providers, monitrices offer a blend of the two. They offer similar services to doulas but have training that allows them to perform some clinical assessments such as vaginal examinations and blood pressure checks. Monitrices are especially helpful in allowing women to labor at home as long as possible.
Lactation Consultant
A lactation consultant is a board-certified health professional who provides breastfeeding education and support, addresses breastfeeding challenges, and works with a mother to develop a plan to reach personalized breastfeeding goals. There are a range of other lactation support professionals, including Certified Lactation Counselors and peer counselors.
Counseling
Birth care workers can be viable alternatives for Black women who are understandably distrustful of the mainstream medical establishment, which has a long history of abuse and mistreatment of Black patients. That mistrust often extends to counseling services. Dr. Davis works to disseminate information on culturally sensitive counseling that can be helpful for pregnant Black women. In a piece for Counseling@Northwestern on how to support Black moms’ physical and mental health, she proffers counseling as a way to contextualize new emotions and body changes, normalize unfamiliar experiences, prepare for the shifts to family life, and work through the differences between expectations and realities of motherhood. The article also offers a list of helpful organizations focused on the reproductive health of Black women, including Black Girls' Breastfeeding Club.
The alarmingly high rate of mortality for Black women and their babies is a public health crisis that should spark large scale change. But without signs of major upheaval on the way, Black women can turn to birth care workers and counseling to navigate structural barriers to safe pregnancies and childbirths.