Doulas Make a Difference for Culturally Competent Care and We Need Them in Delivery Rooms

My obstetrician listened to me. She asked me questions about my pregnancy concerns. When I called her about my worsening second trimester back pain and pelvic pressure, she didn't dismiss me and tell me it was common. She trusted that I knew my body enough to know something was different. When my morning sickness never went away, she did not send me off with a list of home remedies. She diagnosed me with hyperemesis gravidarum—a pregnancy complication that causes severe vomiting, nausea, and dehydration—and a short cervix. Being Black is a risk factor for both hyperemesis gravidarum and short cervix, which can cause premature birth. My Black doctor acknowledged my concerns and took actions that saved my life and my baby's during pregnancy.

The morning my water broke and I went into labor several weeks early, I prayed and hoped that my doctor would be the one on call. Who would listen to me if she wasn't there? Who would trust that I understand my body's needs and was informed enough to help guide my birth experience? Thankfully, my obstetrician was on call that day. For many Black women, who are faced with a higher risk of mortality and morbidity during childbirth, there is no Black doctor in the room listening to their concerns and empowering them to be an active part of their birth experience.

Megan Carolan, the director of policy research at the Institute for Child Success, says this is where governmental policy and skilled community care come in. "There's a way that both top-down and grassroots can come together, and that's an exciting development in the field. One example is doulas."

Doulas are trained to support mothers before and during childbirth to improve their experience. "We basically are like pregnancy and birth cheerleaders," says Isis Rose, sociocultural anthropologist and private doula. "So we're there for you during your pregnancy to guide you through the process and to make sure that whatever concerns you have, you have the language to ask your provider questions about your care. You understand what's happening to your body." The support role doulas play is especially important for providing culturally appropriate maternal health care to the women carrying the burden of the high maternal mortality rate. Rose considers herself a "full-spectrum doula," working with all women regardless of race and other statuses and at all stages, from preconception to postpartum.

As a Black woman herself, she also invests heavily in the birthing experiences of Black women. "We doulas show up for our clients, especially our Black clients, in ways that acknowledge their full humanity as thinking, feeling beings who may need information, reassurance, or rest," she says. "We have the cultural knowledge and understanding that birth in the U.S. has never been equal and we take obstetric racism as a given. We don't argue with Black women about the validity of their experiences. We know because we are these women."

It's important to the health of the pregnant person that medical professionals respect their birth plan, be it using a midwife, having a hospital birth, or entrusting a doula in the delivery room. This is similarly important for members of the Native community, who have a tradition of working with non-medical birth supporters throughout pregnancy and the postpartum period. Native women often face barriers to receiving standard prenatal care in the first trimester, so expanding their access to health care providers can help determine any risk factors earlier and increase healthy birth outcomes.

"We need to ensure that those types of people are there and that they receive a salary of some kind," says Abigail Echo-Hawk, member of the Pawnee Nation of Oklahoma, chief research officer at the Seattle Indian Health Board, and director of the Urban Indian Health Institute. "We need to ensure that the systems are holistic and are not just based on what Western medicine says is the only way that people who birth are supposed to give birth."

Studies support that the continuous support provided by doulas decreases negative childbirth experiences. The March of Dimes even supports increasing access to doula care. "Maternal mortality is such a complex and heartbreaking problem, and it is going to take an approach from all angles to reduce our rates into anything close to what we see in peer nations," says Carolan. Doulas, obviously, must get paid for their work, and federal funding needs to provide women insurance via Medicaid or trickle down into state-funded programs. Federal funding directly into programs that are "tried and true" to help improve maternal health outcomes, she says, are a part of the solution to get and keep doulas in the delivery room.

Parents.com investigates why we face a maternal health crisis and what can be done to lower the risk for thousands of expecting mothers. Read more here.