Doulas help birthing individuals bring new life into the world. They’re also working to save lives here in Douglas County, where Black infants are twice as likely to be born prematurely or at low birth weight than white babies.
To help improve this outcome, a collective of Black, Indigenous or People of Color (BIPOC) doulas is providing no-cost prenatal, postpartum and parenting support to BIPOC parents as a means of protection for local Black and Brown birthing bodies and their babies. Doulas of Douglas County hopes its message will be heard in the marginalized communities bearing the emotional scars of past and present racism, injustice and health care disparities.
Alex Kimball Williams and Christina Gentry, of Lawrence-Douglas County Public Health, presented information on Black maternal health outcomes during a December 2020 study session with the Douglas County Commission. Their grant-funded research, which has been slowed somewhat due to the ongoing COVID-19 pandemic, sheds light on health disparities in low-income communities and among local BIPOC.
Focus group research the duo conducted in 2019 and 2020 showed Black women in Douglas County experiencing pregnancy and childbirth often felt unwelcomed and stereotyped at their doctor’s office, rushed by doctors and nurses who didn’t take adequate time to address questions or their needs, and uninformed and coerced into agreeing with proposals by medical personnel. The focus group participants remembered past mistreatment, and their birth experiences signified trauma related to race and class perception by health care providers.
Gentry, community liaison for LDCPH, told commissioners all focus group participants said their pregnancies were stressful. “Increasing data suggests that racial stress is a huge contributor to the persistently higher rates of low birthweight, infant mortality and small gestational age infants observed in African-American/Black women compared to white women.”
Kimball Williams, health equity planner for LDCPH, said participants who had out-of-state birth experiences in addition to their local birth experiences alerted researchers to geographical differences in Black maternal and infant care. “A lot of them indicated that the care here was in some way worse than where they had a different birth experience … a lot of them experienced being gaslit, (encouraged) not to listen to their bodies in some major way.”
A brochure by Kimball Williams shared during the study session provided national statistics on Black maternal health outcomes and chronic diseases. “Black parents with uteruses are two to three times more likely to die from pregnancy-related causes than their white counterparts. Black parents over the age of 30 are four to five times more likely.”Black-Maternal-Health-Statistics-with-logo_-flyer1
Even famous athletes can’t escape the dangers of Black maternal health, Kimball Williams told commissioners. Tennis star Serena Williams nearly died after suffering a pulmonary embolism and subsequent abdominal hematoma after her daughter’s 2017 birth via Cesarean delivery. Her history of pulmonary embolisms and self-awareness of her own body just weren’t enough to convince her medical team to listen to their wealthy celebrity patient.
Bulaong Ramiz provides doula services in the Doulas of Douglas County network, in addition to her job as director of the Emily Taylor Center for Women and Gender Equity at the University of Kansas. She’s also on the board for Success by 6 Coalition of Douglas County, which administers the grants and donations that help fund doula services for birthing individuals in the BIPOC community.
Ramiz said the educational support she received from her own doula influenced her interest in the work. “I had a really amazing experience, and I attributed a lot of that to the education I received from the doula. While I didn’t have a doula present at my labor and delivery, I did do all my birth education classes with a doula that provided a really holistic look at birth, at the medical industry and really helped me make some decisions about the kind of labor and delivery that I wanted to have.”
Ramiz then trained virtually with the National Black Doulas Association during 2020 as the COVID-19 pandemic swept the country. She called training an “amazing and powerful experience.” Putting the skills to work proved interesting with hospital restrictions on in-person support, leading doulas to conduct their services creatively in mostly virtual formats.
Ramiz called the merging of her passion for higher education and doula work rewarding. “Luckily for me, I work in a women’s center, so I support a lot of student-parents. I have a lot of students who come to me when they’re pregnant not realizing that I’m also a doula. So that knowledge really helps me provide as much support as I can to them and also let them know about the community resources that exist here.”
First-time parents Timmia Hearn-Feldman and Pere DeRoy were matched with Ramiz. The couple meets regularly with their doula for education and support. A rainbow of balloons leftover from their baby shower hovered in the corner of their living room on Tuesday as the couple and Ramiz discussed whether they’re prepared. Hearn-Feldman and DeRoy feel excitement about their baby’s impending arrival — likely later this month — and another project they’re working on: recording a docuseries about their parenting journey.
Ramiz said services offered to clients vary, depending on a particular doula’s offerings and a client’s needs. Some birthing individuals sign on for birth education, which includes sessions prior to birth, while others only request birth services. An initial consultation will help parse out those details.
“Oftentimes people are super focused on Baby, and not focused on the person that is carrying Baby, and so we care a lot about supporting that human being and making sure they have what they need to have the birthing experience that they desire,” Ramiz said about doulas.
Postnatal meetings are also an option. Ramiz said she offers two at-home sessions to meet a range of needs. In those meetings, some parents ask for lactation tips or advice — like where to buy affordable diapers — and others just need someone to listen. “I will sit with family for a few hours during the day and let parents shower and eat if they need that kind of support. Sometimes they’ll want to just sit and talk about the struggles and cry. It really just depends on the needs.”
A full-spectrum of doula-offered services runs about $1,200 and usually isn’t covered by health insurance, leading some to form the misconception that having a doula on one’s birth team is a luxury.
But survival is not an extravagance.
“The United States has some of the worst maternal health outcomes in the developing world, which is amazing, because we pride ourselves on being the best, and we’re actually not great,” Ramiz said.
The Centers for Disease Control and Prevention estimate 700 women die annually in the U.S. as a result of complications during and after pregnancy. The data shows that members of the Indigenous community experience poor maternal health outcomes similar to Black women. Nationally, American Indian/Alaska Native women are 2.3 times more likely to die from pregnancy-related causes than white women.
Intentional or not, Ramiz said, Black, Brown and Indigenous Women of Color, and women who don’t speak English experience a lot of harm in the birthing world, especially in a system dominated by white care providers who don’t have the knowledge of racism in health care or haven’t learned about their own biases.
“I think a big part of my role as a Black doula is also making sure that my clients — when they’re being told something from a doctor — that that’s not rooted in a doctor’s bias, that’s not rooted in a medical industry that believes that Black folks experience less pain or have more ability to bear a child because our hips are a certain way …” Ramiz said. “Gynecological services in this country and across the world have been developed based on experiments done on Black folks, specifically Black women, who were enslaved, and that continues to show up in our medical industry and specifically in the birthing world.”
Reproductive justice, Ramiz said, is about access and choice, including how and when to parent, but so much more. “Having a doula, specifically having a doula that has some of that knowledge can be life-saving, really. It’s not just about being able to have a healthy baby or a positive birth experience but also after that: Being able to live in safe communities, being able to have healthy food, access to clean water, a place to live, a good education for your children.
“A lot of the work we do just begins in the birthing space and continues after that. We don’t just want to have our children and then struggle, and then have them murdered by police, for example.”
Ramiz said a lot of BIPOC parents ask hard questions about their children’s futures. “Am I going to be able to feed them? Am I going to send them to a school where they’re not going to experience racism or homophobia? The work of reproductive justice is really all of our work, and it’s something that everyone can get involved in, even if you’re not in the delivery room.”
In June, Doulas of Douglas County celebrated a new graduating class of BIPOC doulas. They trained with Hakima Payne, founder and executive director of Uzazi Village, a nonprofit organization in Kansas City dedicated to eliminating maternal and infant health inequities in Black and Brown communities. Uzazi Village also offers a peer-to-peer support network known as the Chocolate Milk Café for Black families who breastfeed. Currently, the group meets virtually on the fourth Saturday each month.
LDCPH has collaborated with Uzazi Village, Emily Taylor Center, Success by 6 and LMH Health to enact solutions for the health inequities Kimball Williams and Gentry recorded in their research on Black maternal health in Douglas County. Gentry told the Times their upcoming report would also include pre- and postnatal experiences of Black women during the COVID-19 pandemic.
To learn more about Doulas of Douglas County or make a donation, contact Traci Dotson, network manager, at firstname.lastname@example.org. BIPOC birthing individuals interested in receiving doula support can complete an interest form here, email Dotson or visit the collective’s Facebook page.