Black Women Need More Than Doula Support to Face the Maternal Health Crisis.

STORTZ 1 

This is True Stories in Sound. I’m Tricia Stortz. 

So let’s start with a statistic. A pretty scary one actually. 

According to the New York City Department of Health, “Black women are nine times more likely to die from pregnancy or childbirth than white women in New York City” …. And, racial bias among medical staff is, in part, to blame for many of the preventable deaths within city hospitals. 

That’s why back in March 2022, Mayor Eric Adams launched something called the Citywide Doula Initiative. A doula, in case you don’t know, is a birth worker that provides practical and emotional support to women during pregnancy and postpartum. They also act as advocates on behalf of their clients’ needs in the delivery room.

In the last two years, the mayor has broadened his initiative even further. 

[ARCHIVAL] ADAMS 1

This expansion will provide free access to doulas for birthing families and focus on 33 neighborhoods with the greatest social needs… and we are going to continue to expand so it will become citywide.

The plan set out with three goals in mind… 1. to provide racially and financially equitable hospital care… 2. to expand the doula workforce and 3. to create partnerships between doula agencies and hospitals. 

All of which, given that scary statistic I mentioned, sounds great. But, the question is… are there really enough doulas to meet the needs of black women in New York City? And are they even equipped for the scale of this crisis? 

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STORTZ 2

Devena Smith was 30 years old when she gave birth to a son last December. After doing a lot of personal research, she hired a doula.  

SMITH 1 

As someone that lives with anxiety// I decided to have a doula based off of fear. 

As a black woman in America, there isn’t the best statistics on how treatment goes for us in the hospitals prenatal or during the birth or even postnatal to be honest. So having a doula was a big, big priority for me.

I wanted to feel like I had someone there who knew more than I did and would advocate for me no matter what happened.

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She says having a doula lived up to its promise during her pregnancy. It gave her techniques to ease uncomfortable physical symptoms and also helped her develop a birth plan that aligned with her preferences. 

SMITH 2 

She was easy to work with. She was flexible. She always answered the calls, always answered emails. Everything felt kind of natural and, um, easy. And my partner as well, uh, I think would agree that we liked her.

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…and then, um…   

Things changed when it was actually showtime.  

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So on December 8th, it was 3am and that’s when I experienced  my first contraction.

At the time I didn’t know what it was, I just thought I had a little stomach ache. It was bearable. And again, I’m a first time mom. I don’t know what to expect. I don’t know what contractions actually feel like. I’ve only read about it and I’ve heard other people’s experiences, but I’m not 100 percent sure what’s going on.

But I know something is happening.

It’s 7am and I reached out to my doula and I said, hello,  I’ve been experiencing what I believe are contractions, um, since 3am. This was the first time when she was just like, Hey, okay. Um, just try to rest and relax. And, um, I’ll, I’ll text you in a couple hours.

STORTZ 4

Smith texted her again and again as her contractions were intensifying…

SMITH 3

And she pretty much tells me the same thing, and that probably happened every couple hours, like two or three more times. 

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Smith then sent a message asking her doula if it was time to go to the hospital.

SMITH 4

Now I’m at a place where I’m confused because hours have gone by, it’s the late afternoon… evidently I’m in some kind of labor and my doula is not by my side, which is contractually, where she’s supposed to be.

But because she keeps kind of saying, Hey, just hit me back in this amount of time. At one point, she even said, Hey, I’m going to take a nap so that I can be ready for you.

STORTZ 6

Panic set in. 

   SMITH 5

What’s going on? I don’t really understand.  I feel like I’m in labor, but I’m not showing any other signs. I asked her, is this a false labor? And she said, yeah, it could actually be. So now I’m believing that I’m not actually in labor…I’m just in pain. So now I’m like, okay, I just have to bear this for as, as long as it lasts. 

I think I just grew very frustrated that every time I reached out to her, it was always, Oh, Let’s check back in in a couple hours, try to get some sleep while I’m in pain. Um, that’s just not the,  uh, attitude that I was expecting and that’s just not the way she had treated me throughout my entire pregnancy.

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Smith says her experience was extremely disappointing… and looking back makes her think about all of the things that could have gone wrong.

SMITH 6

What if it wasn’t the doctor that we wanted? What if they did try to force a C section on me that wasn’t necessary? Or what if they were using a bunch of languages that I didn’t, understand and I didn’t feel comfortable. I didn’t feel safe. What if I was feeling something and I needed somebody to speak up for me? And you know, all those things just, they run through your head.

The reason why you hired somebody to be there and support you and get you through this time, you know, they failed to do that. They missed the main event.   

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STORTZ 8

It’s unclear why Smith’s doula was a no-show. But, it is clear that she was neglected by the woman hired to protect her. And, while she still feels that doulas are a good resource, she strongly believes they’re not the only form of support that Black mothers need. 

Aside from its physical health risks, pregnancy and new motherhood can be taxing on a woman’s mental health. And, for women of color, the potential of facing neglect in medical settings can bring about its own form of anxiety.

Pamela Skop is a licensed therapist who specializes in maternal health… She’s also a doula. She says while doulas provide emotional support to their clients, they’re supposed to refer them ==out to a therapist if they encounter mental health issues that exceed their training.

SKOP 1

 We know statistically that black women are treated more poorly in hospital settings and not listened to as much.

 If you’re a doula supporting a family and you’re noticing that The birthing person can’t do certain things or they’re like really, really concerned and worried to the point that it’s impacting their life and their ability to function you definitely want to get a professional therapist in there to help support them.

It’s hard to go into therapy because most clinicians like myself are white. You know what I mean? It’s harder to find someone who represents you… and I think there’s fear and less safety in that for people.

STORTZ 9

And, racial bias within mental health settings carries its own set of concerns. 

SKOP 1

One of the most common things that we see when it comes to maternal mental health postpartum is actually postpartum OCD intrusive thoughts. And sometimes that is the thought of… it’s not that someone wants to harm their baby, but there are some intrusive thoughts saying that they’re going to hurt their baby. 

And if you don’t understand what this is, you would be afraid that you might go to someone and then they would be like, you’re going to hurt your baby. I’m going to call the police, I’m going to call CPS. So I think there’s a lot of fear of is this person really going to understand, or are they going to judge me as a parent and not actually support me? 

STORTZ 10

There can also be financial barriers that prevent women from hiring a therapist. So, leaning on a doula who is already there to provide emotional support can, in a lot of cases, feel like a more convenient, affordable and trusted option. 

Monique Jaques is one of the CityWide Doula Initiative Leaders partnering with The Mayor’s Office. She works for the Mama Glow Foundation, a prominent doula agency in the city. She says the Mayor’s decision to invest in doulas is a great one, but it has come on suddenly and increased the demand on her agency almost overnight.

JAQUES 1

There’s a lot of data coming out now about how doulas are so key in health outcomes, but there is a lack of doulas.

All of a sudden, oh, doulas are effective. Let’s use them. But it is a lot easier said than done. Not only training doulas, but keeping ’em in the workforce, providing them, supporting them, giving them community is really important. 

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She says doulas are struggling with their own mental health due to the shortage. 

JAQUES 2

It is a very high stress job. Birth worker burnout is a really big issue as well. Folks in our program can do anywhere between two to three births a month. So that’s a lot of time you’re kind of on call. 

STORTZ 14 

Jaques is working to find resources to support her staff so they are not overscheduled as frequently. And, she is encouraging the city to expand its initiatives even further to include supportive resources for doulas themselves.

In the meantime, both doulas and the women they support have been left in need… which has opened a bigger discussion about whether or not doulas are being overly relied upon as a solution to the crisis. Smith certainly believes that the city needs to offer more kinds of resources.

SMITH 7

I feel like doulas are almost like a safety net for Black mothers… like they feel like a safety net.

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But as her own birthing experience showed, they are an imperfect safety net at best. 

SMITH 8

I don’t think that doulas are going to be the answer and the solution to what’s going on with black women in the medical system. I don’t, I’ll be honest, there’s only so much that they can do. They only have so much of a voice in the same way that you only have so much of a voice, it’s just really somebody extra in the room that can bridge the lines of communication between what the hospital wants and what you want. But, I do think it’s helpful to provide the extra support for us black women.

STORTZ 16

In January, the Mayor announced that citywide doula services will now be covered by Medicaid in an effort to expand access to the resource. And, pending federal approval, the Medicaid reimbursement rate for doula care will increase. The hope is that higher reimbursement rates will lead to greater participation in doula training programs and address the understaffing issue across partnered agencies. 

This story was reported, written and produced by me, Tricia Stortz, and edited by Daniel Alarcón. Music from Blue Dot Sessions. Special thanks to Devena Smith for her trust and vulnerability in sharing this story. To hear more deeply reported stories from around the world, visit truestoriesinsound.org. Thank you for listening.