“When we started our work supporting mothers to assure they had healthy births, we were often asked, What’s a doula? Now most people know a doula is a trained professional who provides extended, intensive peer-to-peer support to mothers and families throughout pregnancy, during labor and birth, and into the early postpartum period.
“Even with this greater understanding, we are still a long way from achieving equity in making sure all women have access to care. It is shameful that the United States has the highest rates of infant and maternal mortality of any developed country. These appalling statistics are due in part to the disproportionate number of women of color, particularly black women, who experience poor maternal health outcomes.
“To improve these outcomes, we need greater investments in maternal and child health from philanthropy and the government. Policy makers, public-health officials, and philanthropists need to understand that for our nation as a whole to be healthy and to thrive, we need to ensure that every baby, mother, and family has access to support for healthy pregnancies, births, and childhood development.
“Every day, we hear stories of black and Latina mothers and babies who die or experience near-fatal complications during childbirth. More often than not, these mothers tell us they experience blatant disrespect and disregard from medical staff. To add to the health detriments, they are typically discouraged from breastfeeding their children, even though breastfeeding has been shown to boost infants’ immune systems, protect them against allergies, and provide critical skin-to-skin contact.
“Increasingly, as public figures like Serena Williams and Beyoncé have spoken out about their own harrowing experiences with pregnancy and childbirth, more people have become aware of the diminished maternal-health outcomes mothers of color are more likely to experience.
“Black mothers are three to four times more likely to die from pregnancy-related causes than white women. And black babies are more than twice as likely to die during their first year of life than white babies . . . ”
Published by the Chronicle of Philanthropy, April 2019
Moms and Babies in Michigan Receive the Gold-Standard of Care Through Black Mothers’ Breastfeeding Association’s Community-Based Doula Program
DETROIT, MICHIGAN – Black Mothers’ Breastfeeding Association (BMBFA) in Detroit, MI has successfully received national accreditation through HealthConnect One’s (HC One) Community-Based Doula Accreditation Program. BMBFA underwent a rigorous process in which the HealthConnect One Accreditation Team reviewed the organization’s existing Community-Based Doula Program to ensure high-quality implementation. Community-based doulas play an important role in helping decrease maternal and infant mortality rates and increase breastfeeding rates. These women are trained to provide peer support to other women in their communities throughout pregnancy, birth, breastfeeding, and early parenting.
BMBFA’s accreditation from HealthConnect One comes at a time when maternal and infant mortality is skyrocketing in the African-American community due to racial disparities in the healthcare system. According to the Centers for Disease Control and Prevention, “the risk of pregnancy-related deaths for black women is three to four times higher than those of white women.” This is impacting the health of African-American women at an alarming rate and has created a maternal health epidemic. The accreditation means that BMBFA is providing Detroit mothers the highest quality care.
“The accreditation gives us a boost towards creating a sustainable program with the ability to build a labor market for community-based doulas. We continue to positively impact our community, providing respectable service and honorable care to Detroit families,” said Kiddada Green, BMBFA Founding Executive Director. “We understand the level of intimacy involved in pregnancy and birth and we are honored each and every time that a family allows us join in their birth experience.”
BMBFA’s Community-Based Doula Home Visiting Program has assisted in more than one hundred births. Their data from 2015 to 2017 demonstrates the importance of their program in African-American communities. The program boasts 1100+ prenatal and postpartum encounters, 100% breastfeeding initiation rate, 100% regular prenatal care, 99% healthy birth weight, 99% full-term babies and 0 infant deaths.
“I believe that any services offered in the community should be dedicated to the whole family, not just the individual. My Community-Based Doula from Black Mothers’ Breastfeeding Association not only assisted me, but she also supported my partner, my mother and even my sisters during my birth experience,” said Cherry Tolbert, Community-Based Doula program participant.
The transformative effect of doulas in communities has been spotlighted in a federally funded study in 2014. The study found that 87 percent of community-based doula clients were breastfeeding at six weeks, compared with 61 percent of a similar sample; 72 percent were still at it when their babies were three months old, compared with 48 percent of the broader sample.
HC One’s Community-Based Doula Accreditation Program (CBDAP) is designed to help organizations implement a high-quality Community-Based Doula program. “The goal of accreditation is to build greater fidelity to HC One’s evidence-based community-based doula model; therefore, improving quality of service and outcomes for program participants,” said Tikvah Wadley, HC One Program Manager. HC One’s first accreditation was Open Arms Perinatal Services in Washington State with the goal to provide mothers with the quality care they deserve.
This unique, innovative program model works because it provides extended, intensive support to families throughout pregnancy, during labor and childbirth, and in the early months of parenting in communities that face high risks of negative birth and developmental outcomes. Recently, HC One’s program model was profiled in the 2018 Home Visiting Yearbook. The publication compiles early childhood home visiting key data and presents a comprehensive picture available at the national and state levels.
Upon accreditation with HC One, BMBFA’s Community-Based Doula program is recognized publicly as setting the standards for high-quality doula care. Accredited organizations are positioned to attract the attention of funding sources which are committed to high-quality implementation of Community-Based Doula Programs nationwide, and BMBFA will gain additional exposure as a leader in their field through training and collaborative opportunities with HC One.
The Black Mothers’ Breastfeeding Association Community-Based Doula program is generously funded by the following foundations: W.K. Kellogg Foundation, March of Dimes Michigan, The Jewish Fund and Michigan Health Endowment Fund.
# # #
About Black Mothers’ Breastfeeding Association
BMBFA is focused on reducing racial inequities in breastfeeding support for black families. Since 2007, BMBFA carries out its mission by way of direct service, training/education & advocacy. For more information, visit http://blackmothersbreastfeeding.org/
About HealthConnect One
HealthConnect One® (HC One) is the national leader in advancing respectful, community-based, peer-to-peer support for pregnancy, birth, breastfeeding and early parenting. Organizations can contact HC One about their highly successful approach, replicating their program, or to collaborate in other ways to address birth equity. For more information, visit www.healthconnectone.org.
Editor’s Note: Loretha is such an inspiration to everyone she meets in her journey as a community based doula. Her knowledge and strength has continued to help women around the world since her start in community based doula work nearly twenty-two years ago. HealthConnect One extends our deepest gratitude and congratulations to Loretha on receiving the 2018 Durbin CHW of the Year Award.
Loretha Weisinger’s story as told by herself.
I became community-based doula in 1995. There were a lot of different things that inspired me to become a community-based doula, but the main thing was I was here at the Marillac and I was volunteering. I volunteered here for ten years. They were continuously asking me what it is that I wanted to do for my future, and I wasn’t coming up with anything. They would bring different ideas to me like culinary arts. Once I graduated from that, I was about to be a chef, and then the opportunity came along to be a doula. I became involved in the Marillac house because I was taking some assistance with finances , and I heard of a place that was doing a lot of different things for people, making a difference in their life, so I wanted to be involved in that.
I was halfway through classes when I went on a birth, and it was too soon before I knew what I was supposed to know. I didn’t know how a baby looked when it was being pushed out or what the body had to go through so all of that was traumatizing to me.
When I came to class and told them about the birth everybody was putting their arms around me and holding me like a baby and telling me everything is going to be okay and it was normal. I was like the guinea pig to them because they were hiring different people and they were quitting because there wasn’t any money in it. I just said that no matter how hard it is, let me just try to stick with this.
I am now a prenatal educator, meaning I teach the young ladies how to go through the pregnancy by first starting off with healthy eating, moving around during the pregnancy and keeping fit. We have nurses from U of I that come help us with breastfeeding, and we went from a 3% breastfeeding initiation rate to now about 70%-80%. A lot of these things help the mom get a visualization of what is expected, what they’re supposed to be doing, what is not acceptable and all that.
Many people have inspired me. Rachel and I went to Japan together to talk and educate women there about becoming doulas, Wandy held my hand and took me to classes in different cities to teach and learn different things. Gerrie McKinley oh my gosh, she would put her hand on my shoulder just to tell me that I don’t need to be stressed.
Community health work has impacted my life in such a way that it’s helped me to think about a lot of different things that people are going through and how grateful I am for what I do have. The sky’s the limit, well really there is no limit rather. Just the mere fact that I’m able to help nurture and help the moms bring life into this world and how their faces are glowing when they see their babies. And involving the dads. Since that’s a really big thing of mine, involving dads in the programs.
Moments that really stand out to me are when moms and babies are running around and they talk to me and tell me they love me. I feel like a super doula because I helped them through their pregnancy, delivery and postpartum. I have the opportunity to be trusted enough that some of the young ladies that are still around who have their children in daycare ask me to pick up their babies and everything. You know, that is love. I am so grateful for what I do.
“Every year at this time we celebrate mothers and fathers for the important role they play in supporting our families. And yet as a society we don’t do enough to truly help mothers who face unique challenges on the road to birthing and raising children.
“Between 700 and 1200 mothers die during childbirth in the US every year, the highest maternal mortality rate of all developed nations, and roughly 50,000 more mothers face near-fatal complications. That is: An estimated 50,000 mothers come close to death. These figures are outrageous, and they can be prevented.”
Published by MomsRising, June 12, 2018
HealthConnect One is proud to partner with MomsRising to promote equitable support for moms, babies, families and communities.
It was a scene that would be familiar to any Birth Doula: a team of 2 Doulas, a massage therapist, a supportive spouse, surrounding a woman as she worked incredibly hard to push her baby out. This was a VBAC (vaginal birth after cesarean) and one fraught with emotion and deep meaning for the family in question. She was determined to achieve her goal, and the clock was ticking, counting down the moments until the doctor would declare “time’s up.” We had privately declared this doctor a “2-doula doctor” meaning that we thought two of us were needed to provide sufficient support and buffering against his bedside manner.
“Come on, you can do this! Push!,” we would call out encouragingly, every fiber of our beings saying “We are here with you!” The contraction would end; the doctor would come in, stand at the end of the bed and remind us that he was watching the clock. We would stop. Turn. Look at him. Listen. Nod. Then turn right back around to our client and resume exactly what we had been doing. “Come on, you can do this!”
And she did. She had a triumphant VBAC. We rejoiced with the family. And six weeks later, when she had her postpartum visit, the “2-doula doctor” said, “please tell your team I said hello.”
This scene has meant a lot to me over the years, capturing so much of what I know, have learned, and love about working with families. We were the container, the springboard for her discovering her own strength and abilities. Together, we shifted an internal narrative, a story that she had been telling herself that she was not worthy, not capable, on some level, not strong enough to do what needed to be done in her life. She felt, perhaps for the first time, convinced that she was good enough, a grown-up, capable of good decisions, able to be an advocate for herself and her family. We supported the birth not just of a baby, but of a strong family, two parents committed to each other and their children. And we did it in spite of pressures from the total institution around us, represented by the doctor standing at the foot of the bed, tapping his watch, saying, in effect, “I am in charge.”
Like so many people in my community, I have recently been struggling with my feelings of anger and frustration over the current political climate. I have despaired daily over what seems like an impossible task, pushing against an avalanche of legislation, decisions, and an agenda that is counter to everything I hold dear.
And then I remembered this scene, this birth, where despite the incredible pressure and gravity pulling us in one direction, we turned things around and achieved our goal.
This was a real “aha” moment for me. I suddenly understood that I have been doing social justice work for over 20 years. And that just like that birth, all the births, where I have acted as a springboard and container for my clients and their families, I can get up today and do that very same thing. And that I have allies and a whole team of people working with me. I am not alone, and have never been alone in doing this work.
I could not have made the link between doula work and social justice work without the wonderful people of HealthConnect One. They taught me about race and class and birth. They gave me a health equity lens through which to view my biases, my assumptions. They taught me how to zoom out and look at the bigger picture. They pushed me, made me go outside my comfort zone, and then held my hand and said you are not alone. We are doing this together.
And together, we stand at the bedside, in the birth room, in the living room, at the side of those who needs us to be their springboards. We help them find their voices, articulate their own visions, and then do the hard work to achieve their goals. It takes all of us, just as it took more than one doula at that VBAC birth so long ago. I could not have done what they needed me to do by myself. I needed those other support people myself – we held each other up, even as we were supporting the family.
So thank you, HealthConnect One for all that you do. Thank you to all the people in your network who are standing strong, continuing the good work. We need all of you now, more than ever.Editor’s Note: Georg’ann emailed us on Thursday morning to say, “I have an essay that I wrote this morning, that I want to share with you, for you to use if you like . . . And it is perfectly okay, if you don’t want it, too. Just accept it as a love letter.” We accept! And we are sharing. Because really, this is a love letter to you, too. <3Georg’ann Cattelona is a DONA International Birth Doula, Birth Doula Trainer, Lamaze International Childbirth Educator, and a Maternal-Child Health Advocate in Bloomington, Indiana.
Flat on her back
Legs spread far apart she lays
And no matter how uncomfortable
Still and fearful she humbly obeys
I cannot even begin to tell you the numerous occasions I’ve seen this
The countless times this image has played in my head
Back and forth…forth and back
But somehow this particular scene I can never seem to lose track of
I’ve tried completely erasing it from my mind
But how could I when deep down inside I knew…
I knew this is only the beginning of a long journey
With the same script different cast of a mentally enslaved woman
Whose fate was in the hands of her slave masters
With a role simply of domination
And they gave code words such as sedation, starvation, and augmentation
Then one day I suddenly realized that fear not only possesses the ability to institutionalize, but that it specialized
In causing her to become completely mentally paralyzed
See, the funny thing about history is that it has a way of repeating itself
You know, Harriet Tubman freed a thousand slaves and would have freed a thousand more if only they knew they were enslaved
While I cannot free every mentally enslaved woman
I can indeed show her how to break this vicious cycle of mental imprisonment
As she brings life into this world
And like Rosa Parks, I simply refuse to take a back seat on this issue of African American mothers and babies dying at 2x the rate of their white counterparts
No, I’m certainly not trying to pull the race card here
But in the cards that we’ve been dealt, RACE is written in Black Bold letters
So I promise, I promise to remain committed to boldly joining a coalition with doulas and health workers in my community
We will educate, nurture, and support marginalized women which in turn will foster unity
Reducing racial disparities through empowerment
Taking voices back, no longer being subjected to birthing while lying flat, but in fact…
Standing strong and firm with birth plan in hand,
Using visualization and a gentle massage as sedation
We will take birth back, no longer sitting on the sidelines
But right in front holding space until one day
These disparities will eventually be completely erased
And we start one community at a time
one birth at a time
one mother at a time and
one baby at a time.
Ebony “Milkah” Jackson is the CEO and owner of In “2” This World Birthing Services. Being the mother of 8 caused her to realize her purpose in life. As a doula, Milkah’s mission is to serve women and their families by providing sincere and qualitative birthing services. She strongly perceives her role as nurturing and believes it is of utmost importance to preserve the mother’s birthing experience. She is also a founder and board member of Bold City Doula Coalition, which is a nonprofit organization that provides pro bono doula services for marginalized women in the Jacksonville, Florida community.
For Black History Month 2016, HealthConnect One invited partners and allies to share how they have been influenced or inspired by Black women who made history.
We hope you will share with us, too!
We invite you to join the conversation on Twitter by using the hashtag #BlkHerStory.
The Community-Based Doula Program provides low-income mothers with someone from their community who can help make breastfeeding easier, and guide them toward a healthy pregnancy and a baby who has the ultimate nutritional advantage. This study shows that community-based doulas can change the way our country cares for our most vulnerable moms and babies, and it can save taxpayer dollars.
U.S. breastfeeding rates are particularly low in disadvantaged communities, where babies are more likely to face health problems. The World Health Statistics in 2010 revealed that 40 countries had better neonatal mortality rates than the United States and 32 had higher rates of exclusive breastfeeding at six months. Furthermore, according to the CDC1, Non-Hispanic Black babies were almost twice as likely as Non-Hispanic white babies to be born at low birth weight, and Black babies were twice as likely as white babies to die before their first birthday.
Community-based doulas change this trajectory, with an approach that consistently results in high breastfeeding rates and low c-section rates. A community-based doula is a woman of and from the same community who provides emotional and physical support to a woman during pregnancy, birth and the first months of parenting, through home visits and center-based activities. The effectiveness of the program emerges out of the trusting relationship between a community-based doula and her participant, the duration of their relationship, and the continuous presence of the doula during labor and birth.
The study, supported jointly by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC), looked at 8 community-based doula sites around the country assisted by HealthConnect One, and found that 87% of community-based doula clients were breastfeeding at 6 weeks, as compared to 61% of a similar sample. Even at 3 months, 72% of community-based doula clients were still breastfeeding, as compared to 48% of the broader sample.
This guest post was initially part of a series leading up to HealthConnect One’s National Action Summit, “Racial Justice or Just Us? in Birth and Breastfeeding,” intended to encourage open, thoughtful dialogue about finding or not finding, working or not working towards racial justice during the vulnerable time of birth and breastfeeding. It has now become part of a longer reflection – and hopefully dialogue – on racial justice in this country. We hope you will allow Hanifah’s words to stir and motivate you, and we encourage you to share in the comments what brings you hope in the journey toward racial justice.
Last month, I promised you a story. And hope. I promised you that, too. Here goes.
A Common Story
A mother at the end of her prenatal visit in her 38th week of pregnancy is told by her doctor to admit herself to the hospital the next morning at 7 a.m. to be induced, but (s)he omits that it’s a suggestion.
When she questions why, the doctor tells her that she is 2 centimeters and that (s)he thinks that the baby is big. In fact, (s)he has been telling her this since she was 30 weeks pregnant.
During the last few months of pregnancy, women are particularly vulnerable to the suggestion of having their baby before the due date as the baby grows even more rapidly and their bodies become increasing uncomfortable.
This time, the doctor adds that it’s okay if she wants to wait and that (s)he could schedule her for a c-section if she decides to wait until she is full-term.
Scare tactics are also commonly used to manipulate the pregnant woman’s choice in pregnancy and birth. Nearly every pregnant woman has been told, “You want a healthy baby, right?” when making a choice not in line with the doctor’s desire.
1 in 5 births in the U.S.A. are induced. 44% of women surveyed in 2002 reported that their doctor wanted to induce. Only 16% reported medically-indicated reasons.
31.8% of American babies (nearly 1 in 3) in 2008 were delivered by c-section. The World Health Organization recommends a c-section rate of less than 10-15% as acceptable. (Catherine Beier, n.d.)
In fact, the women who were most likely to have cesareans were low-education, Black and Hispanic women (Harrison, 2012)
Roth and Henley, in their article on Unequal Motherhood, said the disparities in the rates of cesareans are important because the procedure is tied to maternal deaths and the cost of health care. They recognize a growth in understanding the “pervasive racial-ethnic and socioeconomic disparities in maternity care (and) health care more generally, yet there has been little scrutiny of how overuse of cesarean deliveries might be linked to these disparities.”
In 2014, we can “choose” where we give birth, “who” will deliver our babies, “if” we will deliver vaginally or surgically; we even allow doctors to “choose” which day our babies will be born. But what we fail to see is that when you are given a choice between bad and worse, what kind of choice do you really have?
The illusion of choice between lesser ills leaves medical providers believing that poor outcomes experienced by black women are due to:
their choice to be poor, and
lack of access to healthcare early in pregnancy, and
diets high in processed foods.
If you as a black woman ask too many questions, you are classified as non-compliant . . . and the belief that one woman who asks questions during her pregnancy is a “nuisance,” while another — whose only difference is her skin color — asks the same question and is “fully engaged in her healthcare” is a form of hidden racism. (Anderson, 2012)
If you are younger, older, Black, Latino, Lesbian, or White delivering at the same hospital depending on the state and/or community in which you live, one woman can have the luxury of a water birth with a low-intervention midwife in a hospital setting and a doula in attendance. In the room adjacent to her, there may be another woman who isn’t allowed to move from her bed because she is being “monitored” and is attended by a student doctor who has never seen a woman laboring out of bed. Four rooms down in this same hospital, there may be another woman who was arrested for her inability to pay traffic tickets and is now serving time while pregnant. She may find herself shackled to the bed during labor and unable to touch her baby who is removed into state custody immediately following birth.
If policies are to work for the benefit of communities of color, those communities must have the power to define, advocate for and then be engaged in their implementation. (Sen, 2013)
What do we want? Justice! When do we want it? Now!
These organizations are providing health education opportunities for young people and empowering untapped community leaders, creating cohorts of promise. The idea is to create a “new normal” in birth and breastfeeding that removes roadblocks to care, that refuses to allow racism to proliferate, and stops fear from ruling the choices we make during pregnancy, birth and beyond.
We should be moving towards justice, but not for just us…“As the U.S. is a powerhouse of marketing, more impressionable regions are adopting these practices, despite the overwhelming evidence that the U.S. approach to childbirth is seriously flawed.” (The “Business” Of Birthing, n.d.). If we want to see changes in the health of our communities any time soon, we are going to have to take responsibility to save ourselves!
Justice looks like…
Midwives like Sondra Abdullah, CNM who provide trainings in countries like Ghana . . . women like Kathryn Hall Trujillo, MPH, founder of the Birthing Project: The Underground Railroad for New Life, which improves birth outcomes for women of color, and is gathering equipment for communities in Belize and beyond . . . Reproductive Justice Movements working to remove shackling laws for incarcerated women and obtaining justice for those sterilized without their knowledge . . . Mobile Midwife in Miami, expanding birth justice with storytelling, popular education, and community organizing to improve access to midwifery care . . . new organizations like BeautifulOnes GA, a non-profit community-based doula program serving metro Atlanta, providing supportive services for the whole family.
There are new coalitions of birth workers bringing together doulas, public health professionals, midwives and doctors of color, each developing programs to improve health and birth outcomes for women in their respective communities … and although we still have lots of work ahead, I am excited for the future and the promise it brings.
I am hopeful, knowing that one person can have a lifelong impact on a community at the very moment that a family is being born, and that there are now cohorts of young women birthing without fear, who are breastfeeding their babies. These young women will carry the knowledge they acquired and share it with their children, family and our community!
Their success is all of our success!
Connect with us on Facebook or Twitter and tell us: What makes you feel hopeful? Where do you see success?
Hanifah Rios trained as a Direct Entry Midwife at Maternidad La Luz and has provided support to families who consider home birth as a viable option. Hanifah worked as Lead Doula and Program Manager of a Community-Based Doula program at Families First in Georgia until 2012. She played a valuable role in normalizing the “non-medicated birthing experience” for many young women.
It has always been Hanifah’s mission to advocate for and support women and children of all ages who have been traditionally denied equal access to care, free from judgment, regardless of age, race, sexual orientation, education and/or socio-economic status.
She believes that when the new mother feels loved, supported, and validated she will feel confident enough to ask for support and guidance as needed in her new role as mother, and doulas are excellent at providing just that to young women in the communities we serve.
Editor’s Note: Hanifah Rios shared her thoughts on Racial Justice with us in three parts. Click here for Part One and Part Two.