Black and Native doulas are already addressing maternal and post-partum healthcare inequities through their community work.
Disclaimer: At various points throughout this article, the author uses gendered language. This is because most studies done about birthing people only include or refer to cisgender women. Whenever possible, gender-neutral language is used.
By Nylah Burton
For Black and Native people, childbirth can be an extremely dangerous event. Black women in the U.S. have a maternal mortality rate three to four times higher than white women. And compared to the general population, Indigenous women are twice as likely as white women to die in childbirth, according to the Centers for Disease Control and Prevention (CDC). However, doulas can help reduce maternal mortality rates for Black and Native people, leading to healthier communities.
Doulas are trained professionals who assist parents at various stages of the birthing process, providing physical, emotional, psycho-social, and informational support. A doula may help the birthing parent with massages or breathing techniques while they’re in labor, or they may advise the birthing parent on ways to address postpartum depression once their child is born. Although often seen as an expensive luxury mostly reserved for white, rich, cisgender, and heterosexual women, doulas are crucial to increasing positive health outcomes for everyone giving birth, regardless of income level or identity.
Research confirms the positive birthing outcomes that doulas can help ensure. A 2013 study published in the Journal of Perinatal Education showed that doulas make babies healthier. Babies of doula-assisted mothers were four times less likely to have a low birth weight. Doula-assisted mothers were also two times less likely to experience birth complications, and they were more likely to (be able to) breastfeed their children. That’s critical, because breastfeeding can benefit both parents and their children.
Although delivering with birthing professionals like doulas and midwives is commonly perceived as “less safe” than delivering with conventional doctors, many doctors feel the supplemental use of doulas in childbirth is necessary. A March 2014 statement by the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine, called doula-work “one of the most effective tools to improve labor and delivery outcomes.”
Doulas are most effective when provided to people who have the least access to them. A 2013 study showed that doulas were most beneficial to women of color, low-income women, women experiencing homelessness, LGBTQ+, intersex, two spirit people, and those who “were giving birth in a hospital without a companion, or who experienced language/cultural barriers.”
For this reason, doulas can help save lives for Black and Native birthing parents and their children, especially in the United States.
Those high maternal mortality statistics among Black and Native women are even more alarming when you consider the 2019 USA Today investigation into maternal health care, which concluded that the U.S. has the “highest maternal death rate among the world’s developed nations.” This means that U.S. Black and Native people are experiencing some of the highest rates of maternal mortality in the world.
These frightening disparities in positive health outcomes aren’t random, nor do they suggest that communities of color are inherently “less healthy” than white communities. These disparities arise from systemic racism that has caused Black and Native birthing people to be discriminated against by their health providers, to have less access to life-saving resources, or to be more predisposed to medical conditions that may complicate birth. Resources like doulas are desperately needed in this crisis.
Black and Native doulas are already addressing these inequities through their community work.
For Re.Wire News, Mary Annette Pember reported on the ways that Native women are reclaiming Indigenous birthing practices, with the aid of Native midwives and doulas. Midwife Nicolle Gonzales (Diné – Navajo) told Pember that “Indigenous peoples share a worldview of connection to the land. We view birth and motherhood as ceremony,” she said.
Pember wrote that despite this worldview, too often, Native birthing parents were “cut off from traditional diets, support networks, and community midwives due to colonization and assimilation,” which can result in “chronic health conditions that mean giving birth is a high-risk activity — and one that requires travel to well-equipped hospitals.”
And many of those hospitals actually ban or restrict the ceremonies and practices that Gonzales said are at the center of many Native birthing traditions, like eating during labor, the use of open fires, and ceremonial food preparation.
Also, Native Lactation Consultant Camie Goldhammer (Sisseton-Wahpeton) says that breastfeeding is a form of food sovereignty for Native and Black communities, as it involves the reclamation of a practice discouraged by colonialism and slavery. A post-partum Indigenous and/or Black doula that understands the unique barriers to breastfeeding, as well as culturally sensitive solutions, can help many families.
It’s the desire to help families that spurs many Black and Native doulas to do this work. Erika Davis, a childbirth educator, birth and postpartum doula tells Wear Your Voice Magazine, “I cannot count the times I’ve received a doula inquiry that starts ‘As a Black woman it’s important to me to have a Black doula’ or ‘As a POC I want to make sure my doula is a POC’ or ‘As a queer person having a queer doula is vital.'”
“Marginalized people, specifically Black people who give birth, benefit greatly by having a person who looks like them in a supporting role during the labor, birth and postpartum process,” Davis continues. “Especially in hospital birth where the birthing person may be surrounded by nurses and doctors who are white or may not have their best interests in mind because of internalized and institutional racism and bias.”
And although society tends to perceive doula work as only applying to cisgender women or live births, there is also a deep need for doulas that work with trans men, agender people, and non-binary people, as well as doulas who support pregnant people through abortions.
Devin Michael Lowe, a trans-rights advocate and actor, tells Wear Your Voice Magazine that “practitioners who don’t respect our gender[s], and often don’t want to work with us based on discriminatory beliefs — despite the fact that science clearly supports the existence of trans people — leaves trans masculine and non-binary folks who are interested in giving birth (and there are quite a lot of us, myself included) without resources needed to help maintain a healthy pregnancy or ensure that we are provided with adequate aftercare.”
Lowe says that it’s tragic that this discrimination and lack of resources “often resorts in trans people who want to birth children and would be great parents otherwise, choosing not to, as the current risks are just too high.” For Lowe, this “is why trans rights and inclusivity are a necessary component of discussion when engaging in conversations around reproductive justice.”
Gina Martínez Valentín, co-founder of abortion fund and practical services collective, the Colorado Doula Project, is an abortion doula. She tells Wear Your Voice Magazine that being an abortion doula is “crucial community work, particularly in these times. When we support pregnant people and work towards real reproductive justice, we’re naturally fighting for racial justice, disability justice, and liberation for all.”
That’s why for many marginalized people, it’s critical to have a doula there that shares their identity — before, during, and after birth — to advocate for them and help safeguard their autonomy. It’s this community need that inspires many doulas in their work, despite the difficulties of this career path.
When Rev. Tawana Davis gave birth as a 16-year-old girl in Harlem, New York, she was immensely grateful for her midwife. “[My midwife] was my second mother in the room: rubbing my back, telling me to breathe, walking the halls with me, talking with me — for 23 hours — until I gave birth to a beautiful, healthy girl,” she says.
By the way, midwives are not doulas. They are certified medical professionals — many of whom can perform the same functions as doctors — but like doulas, they also help provide a greater level of support for the birthing person.
And for Sonia Stovall, using a doula — through a sliding scale program she says was funded by Medicaid — helped her connect to traditions in her community and her family. “When I was growing up, my great-grandmother and my grandmother would… talk about midwives.”Stovall also tells Wear Your Voice Magazine that doulas were known and respected by everyone in her family’s Black community in Nebraska. So when it came time for her to give birth, a doula was “the best way to access that kind of resource.”
If you’d like to find a doula of color, the National Black Doula Association has a useful directory. The Groundswell Birth Justice Fund has also compiled a list of their fund recipients, many of which are organizations that are led by people of color and/or LGBTQIA2S+ providers.
Even though the need is there, the use of doulas is not yet widespread among marginalized communities. A California survey of more than 2,500 women found that only about 9% of respondents used a doula during childbirth. Still, there is a demand for this service; 57% said they wanted to use a doula for their next birth, with Black women showing the most interest.
In addition to worries about high maternal mortality rates, these women might want a doula because they’re having more negative experiences. Rates of depression and anxiety — both during and after pregnancy — were higher for Black women in this same survey.
Black women also had a C-section rate of 42%, compared to a 29% rate for white women. Although C-sections can be life-saving and deeply necessary, they also pose some risks. “For mothers who don’t have a risk condition, a Caesarean is actually less safe for mom and baby than a vaginal birth,” childbirth researcher Eugene Declercq, Ph.D., assistant dean for doctoral education at the Boston University School of Public Health told Parents.
This suggests that Black people were given less autonomy over their birth plan, with doctors insisting on risky C-sections even in cases where they may not be needed. This may be because the doctors perceive the Black birthing person as more high-risk or because they want to be done with the birth more quickly. A C-section takes about 45 minutes, according to The California Health Report, while labor can last for hours or even days.
After a harrowing experience where tennis player Serena Williams almost died because doctors and nurses ignored her, Williams wrote a CNN op-ed about the dangers of birth for Black women, writing that “Every mother, everywhere, regardless of race or background deserves to have a healthy pregnancy and birth. And you can help make this a reality.”
There is hope that the reality Williams speaks of may soon be realized, and doulas will likely play a critical role in that. But with doula services often carrying a hefty price tag of $3,500 or higher, those who need doulas the most often don’t have access to them.
There are many volunteer organizations across the country that provide this service for little to no cost. But high demand and distance might make that difficult as well. Doula-care is not universally covered by Medicaid, so this life-saving service isn’t accessible to low-income people if they can’t find a volunteer program that works for them. However, Minnesota and Oregon allow Medicaid reimbursement for doula services, and that’s had positive results. In an initiative aimed at reducing maternal mortality and racial disparities, New York Governor Andrew M. Cuomo, will also allow Medicaid funding to be used for doulas.
However, these reimbursement rates are low, well under the $1000 per birth that Regina M. Conceição — founder of New York City doula collective A Passion For New Beginnings— told the Huffington Post that doulas with five years or more of experience should get.
This presents a barrier for getting involved for doula work, especially for Black and Native people , who have significantly less wealth compared to white women. Some doulas of color supplement their income by taking on white or wealthy clients who can pay the full amount, but becoming a community doula is still a difficult career path, financially.
For people of color, community doula work is immensely fulfilling. Still, it can be exhausting, due to low pay and the constant need to address systemic inequities, as well as provide support for the mothers. And with higher rates of maternal and infant mortality, some doulas who serve Black and Native birthing parents find they need to take a break, as seeing their patients die leaves them in need of rest and healing for themselves. Perhaps precisely because of these hardships, many Black and Native doulas feel the work they do is sacred.
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So, they’re plunging in, regardless of the barriers. Part of what motivates them may be their own desire for a doula. One of my close friends just gave birth to twins, but she was not able to find a doula of color in the overwhelmingly white city of Denver. This experience made her consider becoming a doula herself.
As for me, if I give birth or have an abortion, I plan on using a doula as well. And because I recognize the deep need that I myself have for this service, I’m determined to become a doula at some point in the near future.
If this is a career path you feel drawn to, there are myriad of ways to get started. First, you have to obtain training. Tewa Women United provides doula training for members of Northern Pueblos, as well as any person who lives within Santa Fe and Rio Arriba Counties of New Mexico. They waive all fees for their participants. Located in Brooklyn, New York, Ancient Song Doula Services offers a Full Spectrum Labor & Postpartum Training. One lasts for 3 days, and the other — which is more comprehensive and allows you to become certified faster — lasts for 7 weeks. Certification isn’t required to work as a doula, but make sure to ask about each specific program’s path to certification.
Mamatoto Village in Washington D.C. offers several trainings, including a Perinatal Health Worker Training and a Lactation Specialist Training. The ReByrth Doula Training Program shows Black women how to support other Black women through childbirth, and their training program has a cost of $777. They also specialize in affirming LGBTQ+ birth.
“More people of color need to be trained as birth and postpartum doulas; lives depend on it,” Davis says. But putting more doulas of color in the field will require the government to allocate more resources towards training and hiring. This is a priority, not a luxury. Because every parent and every child deserves a safe, supportive birthing experience.
Nylah Burton is a DC-based writer with bylines in New York Magazine, ESSENCE, Bustle, and The Nation. You can follow her on Twitter, at @yumcoconutmilk.