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Life or Death: The Role of Doulas In Improving Black Maternal Health

By: Jacquelyn Clemmons    |    May 07, 2021
Life or Death: The Role of Doulas In Improving Black Maternal Health

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Black women are more at risk of complications during pregnancy and childbirth. A support person can help.I often feel overwhelmed by the facts surrounding black maternal health. Factors like racism, sexism, income inequality, and lack of access to resources unquestionably influence a mother's birthing experience. This fact alone sends my blood pressure through the roof.

I'm consumed with figuring out ways to improve birth outcomes in my community. Speaking with maternal and perinatal health advocates about the best approach to solve these problems usually leads down an endless rabbit hole of where to begin.

The scope of the statistics is staggering. But nothing — and I do mean nothing — makes me want to advocate for change more than my own personal experiences.

The reality facing black moms

As a mother of three children, I've experienced three hospital births. Each pregnancy and subsequent delivery was as different as night and day, but one common theme was my lack of safety.

About 7 weeks into my first pregnancy, I went for a checkup at my local health center, concerned about an infection. Without an exam or any physical touch, the doctor wrote a prescription and sent me home.

A couple days later I was on the phone with my mother, a physician, who asked how my visit had gone. When I shared the name of the medication I was prescribed she quickly put me on hold to look it up. As she suspected, it never should have been prescribed.

If I had taken the medication, it would have caused a spontaneous abortion in my first trimester. There are no words to describe how thankful I was that I waited to get that order filled. Nor are there words to describe the terror that flooded my heart when thinking about what could have happened.

Before, I had a healthy respect for "the experts" and not much reason to feel otherwise. I don't remember having an underlying distrust for hospitals or doctors prior to that experience. Sadly, the lack of care and disregard that I encountered showed up in my later pregnancies as well.

During my second pregnancy, when I showed up at the hospital concerned about abdominal pain, I was repeatedly sent home. The staff seemed to believe I was overreacting, so my OB called the hospital on my behalf to insist they admit me.

After being admitted, they found I was dehydrated and experiencing preterm labor. Without intervention, I would have given birth prematurely. That visit resulted in 3 months of bed rest.

Last, but certainly not least, my third birth experience was also handled badly. While I enjoyed a super healthy, high-energy pregnancy, labor and delivery was another story. I was shocked at my care.

Between the forceful cervix check and the anesthesiologist who told me he could give me an epidural with the lights out (and actually tried to), I feared for my safety again. In spite of the horrified looks on the faces of all in the room, I was ignored. I was reminded of how I was disregarded in the past.

According to the Centers for Disease Control and Prevention (CDC), black women are dying at roughly 3 times the rate of white women in birth-related deaths. That statistic gets more dire with age. Black women over age 30, are 4 to 5 times more likely to die in childbirth than white women.

We are also more likely to experience more complications throughout the course of our pregnancies and less likely to have access to proper care during our postpartum period. Preeclampsia, fibroids, imbalanced nutrition, and low quality maternity care plague our communities.

Admittedly, many of the factors impacting those statistics are preventable. Unfortunately, over the last couple of decades, despite medical advancements and data showing the large disparities, not much has changed.

According to research conducted by Center for American Progress, predominantly black neighborhoods are still hard-pressed for quality grocery stores, well-funded health centers and hospitals, and consistent health coverage.

Many might assume the disparity we face is primarily an economic issue. That's not true. According to the CDC, black mothers with a college degree are 5.2 times more likely to die in childbirth than their white counterparts.

The lack of safety in birth affects every black mother, from Olympic champion Serena Williams to the high-school educated young woman giving birth right now.

Black women of all socioeconomic backgrounds are facing life or death challenges. Blackness appears to be the only commonality that decreases a birthing person's chance at a healthy pregnancy and delivery. If she's black and birthing, she may be in the fight of her life.

Doula care offers a solution

Each time I gave birth, I made sure my mother was there. Although some women may make that decision by choice, I made that decision out of necessity. The truth is, I believe without someone there to advocate for me I would have been harmed or have faced death. Having a knowledgeable person in the room with my best interest at heart made a huge difference.

Years later, I offered to be a labor support person for my friend during her pregnancy, knowing how much it helped me. After witnessing all the ways she was made invisible during her birth journey, questions like "What can I do?" and "How can I prevent this from happening again" swirled in my head.

I decided right then that my family, friends, and community would always have someone there to support and advocate for them during their pregnancies. I decided to become a doula.

That was 17 years ago. My doula journey has led me into many hospital rooms, birth centers and living rooms to support the sacred moment of birth. I have walked with families through their pregnancy journey and learned from their pain, love, trauma, and hardships.

When I consider all the experiences my black community has endured — the cultural nuances, trust issues, unaddressed trauma, and stress we encounter in our lifetime — it's difficult to suggest any one solution. Differences in healthcare are a result of big social issues. But there's one thing that results in better outcomes across the board.

Making doula care readily available may help improve black maternal health in pregnancy and delivery.

Black women are 36 percent more likely to have a C-section than women of any other race, reported one 2015 study. Prenatal doula care gives women additional prenatal support, provides a delivery room advocate, and, according to a 2016 review of studies, has been shown to reduce C-section rates.

Center for American Progress reported on a recent case study from one nonprofit organization in Washington D.C. whose mission is to support mothers of color. They found that when low-income and minority women were provided family-centered care from a midwife, doula, and lactation specialist, they had zero infant and maternal deaths, and 89 percent were able to initiate breastfeeding.

It's clear that providing black women with support in pregnancy and postpartum increases their chances of a healthy birth for both mom and baby.

Prepare yourself

The truth is you cannot control what someone else will do or attempt, but you can prepare. Being informed about the culture of the place you choose to birth is important. Understanding policies and procedures makes you a knowledgeable patient. Knowing your medical history and any contraindications can provide great peace of mind.

Strengthening and solidifying your support systems offers a sense of grounding. Whether you hire a doula or midwife or bring a family member or friend to delivery, make sure you and your support system are on the same page. Checking in throughout the pregnancy makes a difference!

Lastly, get comfortable advocating for yourself. No one can speak up for you like you can. Sometimes we leave it up to others to educate us on what is going on around us. But we have to ask questions and hold healthy boundaries when it comes to our bodies and birth experiences.

Black maternal and perinatal health are affected by many factors. Having a strong birth support team that is invested in positive outcomes for your family is imperative. Addressing systemic bias and cultural incompetence is a must. Ensuring that mothers of all backgrounds have access to thoughtful, comprehensive care must be a priority.

I wish my story was rare, that women who look like me were treated with respect, dignity, and care when giving birth. But we're not. For us, birth is a matter of life or death.

Life or Death: The Role of Doulas In Improving Black Maternal Health
Life or Death: The Role of Doulas In Improving Black Maternal Health
meet the author

Jacquelyn Clemmons

Jacquelyn Clemmons is an experienced birth doula, traditional postpartum doula, writer, artist, and podcast host. She is passionate about holistically supporting families through her Maryland-based company De La Luz Wellness.


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