The Doula Movement: A Growing Response to America’s Maternal Mortality Crisis

Maternal mortality, or death that occurs during pregnancy or shortly after, is used by the World Health Organization as an indicator of how healthy one country is compared to others. A common misconception is that maternal mortality is a public health issue reserved for developing nations. The United States, however, has the worst maternal mortality rate of any nation–despite spending more money on hospital-based maternity care than any other country in the world. Ranking 47th globally for maternal mortality, the United States also fares worse than many developing countries in protecting women from death during childbirth.

When looking at the factor of race, we see that black women are three to four times more likely to die as a result of childbirth than white women. According to the Centers for Disease Control and Prevention, this is one of the widest racial disparities present in women’s health, which is driving the international disparity for the United States. Furthermore, racial disparities in maternal mortality persist across income and educational levels for black women, revealing that traditional social protectants are not effective for black women in the maternal mortality crisis. In New York City, college-educated black women are twice as likely to die from childbirth than white women who never finished high school. One study demonstrated this ideology as well by demonstrating that race/ethnicity was the strongest predictor for maternal death or near miss, with Black women suffering disproportionately from maternal death across income lines. [1]

Black women are three to four times more likely to die as a result of childbirth than white women.

The Serena Williams’ story, among others, help us to put a face to this reproductive injustice. Williams’ narrative paints a picture of how medical providers are not listening to women of color during the deliveries of their babies.

Many black women have turned to doulas to assist during their birthing process so that they can receive culturally competent care that is tailored to them. A doula is defined as a person who is trained to provide advice, emotional support, and physical comfort to mothers before, during, and shortly after childbirth. A doula is not to be confused with a midwife, who is a medical provider who helps to deliver the baby. Doulas and midwives, however, can and often do work together to support women during pregnancy. For many black women, it is the difference between life and death.

Darline Turner, physician assistant and certified doula in Austin, Texas, took matters into her own hands when responding to the pressing human rights concern of disproportionately high rates of maternal mortality affecting black women. She was startled by the nonchalance and lack of urgency surrounding the issue. So she started Healing Hands Community Doula Project, an organization that provides pregnancy care and support to black women of all economic backgrounds. When discussing her vision for Healing Hands Community Doula Project, Turner said, “Any black woman who so desires will be able to have the support, resources, information, education to have a healthy full-term infant and to live to see that infant grow up to be an adult.”

There has been a surge of community health solutions like Healing Hands Community Doula Project that have increased culturally competent care for black women, which has been proven by research to be more effective than the medical system’s traditional approach. One such study focused on the impact of doulas on healthy birth outcomes and reveals that expectant mothers matched with a doula had significantly better birth outcomes compared to women who were not assisted by a doula. Doula-assisted mothers were four times less likely to have a low birth weight baby and two times less likely to experience a birth complication involving themselves or their baby. [2] These results show that there is hope that the maternal mortality crisis can be resolved. Doulas actively listen to mothers throughout their birthing process and provide them with emotional support so that the pregnancy process is tailored specifically to the needs of each individual mother.

The research and experiences documented the doula movement signal that more solutions outside of the medical system may be effective in reducing racial disparities in maternal mortality. When speaking about the maternal mortality crisis, medical ethicist Harriet Washington looks to the past. She notes that “trying to understand a historical problem without knowing its history is like trying to treat a patient without eliciting their medical history—you’re doomed to failure.” Washington claims that the American medical system is still haunted by the history of slavery, which involved medical experimentation on enslaved African women to create the modern practice of gynecology and obstetrics.

The doula movement and other community health initiatives provide an alternative to the institutional racism that all black women face when entering the medical system, regardless of their level of education or income status. The State of New York has expanded the use of doulas to reduce childbirth deaths. Americans can only hope that the federal government or other state governments will take similar action because women of color cannot continue to wait for this urgent issue of human rights and reproductive justice to be addressed. Their lives literally depend on it.

References

1. Goffman, D., Madden, R. C., Harrison, E. A., Merkatz, I. R., & Chazotte, C. (2007). Predictors of maternal mortality and near-miss maternal morbidity. Journal of Perinatology, 27(10), 597-601. doi:10.1038/sj.jp.7211810
2. Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of Doulas on Healthy Birth Outcomes. The Journal of Perinatal Education, 22(1), 49-58. doi:10.1891/1058-1243.22.1.49