Black women are three times more likely to die from pregnancy-related causes than white women. There are several reasons for that disparity: Black people are less likely to have access to quality healthcare. And Black women are more likely to have chronic conditions that can complicate pregnancy and childbirth (think: hypertension and heart disease). Though there are national efforts to reverse these trends, Black pregnant people still need more support. Enter: Black doulas.
Black birth workers have long held a prominent position in their communities. Even after the Middle Passage and throughout enslavement in the US, Black midwives served as healers and spiritual leaders. After Emancipation, “granny midwives” continued to work with Black and white women in rural parts of the South. Their role changed with the advent of medical obstetrics, but Black birth workers never went away. More recently, they have trained as doulas. Doulas are birth workers who don’t give medical advice. Instead, they offer mental, physical, and emotional support to mothers. Research has shown that mothers who work with doulas have better birth outcomes. And for Black women, especially, doulas may make a critical difference.
We asked four Black doulas to share what their work entails and how they’re helping to address the ongoing Black maternal health crisis. Here’s what they had to say.
These interviews have been edited for length and clarity.
Birth and postpartum doula, Eve Birth Services, Dallas
How do doulas help improve outcomes in Black maternal health?They can step in and say, “I’ve seen this. Here are the benefits and risks of having this kind of procedure.” Often, not just as Black women, but for sure as Black women, we're intimidated when we go to the doctor because we just don’t know. We assume the doctor is the expert. The doctor has all the answers. We've also been pegged as dramatic. And having a high pain tolerance but a low tolerance for instruction. And so when Black women say, “I'm hurting, something's uncomfortable, this doesn't feel right,” we’re dismissed. Doulas make sure they’re seen and heard.
How do you situate your work in the rich tradition of Black birth support? Having a doula is like bringing your sister with you to your birth. Or your mother or your aunt that knows you well, that is well connected with you, that's close to you, and that you feel safe with.
It’s really going back to when we were a village, when we were a community as a people. The midwives served in the community and knew all of the babies and the mothers and the families. It’s taking us back to our roots and trusting our bodies and birthing the way that we were designed to birth. It's ancestral work.
You’ve called for more OBGYNs to partner with Black midwives. Why is that important? Black midwives are in the community. OBGYNs can shadow an appointment and see how the midwife engages with her clients. What are they doing that's different that maybe we could learn from one another?
The best way for you to learn how to serve Black women is to go out and see Black women being served by other Black women. You can learn about our nuances, traditions, and culture.
How can people access your services?I offer birth and postpartum doula services, as well as childbirth education. And a postpartum recovery kit. My standard doula packages range between $1,800 - $2,000. I also offer pro-bono or discounted options.
Birth and postpartum doula in Atlanta
How do doulas help improve outcomes in Black maternal health?Education is a really big form of advocacy. I’m providing education and evidence-based research to our clients around their options. And we’re accessible. Whereas a doctor unfortunately may only have 15 minutes to sit with you in a prenatal [checkup], I'm sitting here for two hours.
Being able to have someone who is there for you in a system that is not always supportive of you is life-changing. Someone who understands your culture, where you're from, what your fears are, your family dynamics, and you as a person. That improves the physical, mental, and emotional experience of a Black birthing person.
How does your work echo the role of “granny midwives”?The great thing about doulas is that we tend to be more accessible to communities that need us, specifically marginalized Black communities. And we’re trained more traditionally. We're broadening the education that granny midwives were once in charge of. Nothing medical, but providing more of an [access] point for the current Black parents who are impacted by the maternal care inequities that are happening.
What would make the biggest difference going forward for Black maternal health?First we all have to evaluate our relationship with racism and discrimination, because we are all a part of the system. We have to ask ourselves “What is my personal responsibility in this problem?” And then take personal action.
The second thing is that we need to improve the medical system. And part of that is increasing accessibility to care. Structures need to be in place to facilitate not only accessible doula care to clients but also making sure doulas are getting paid enough and compensated on time in order to be able to continue their work, specifically Black doulas.
How can people access your services, and how much do you charge?People can find me and my services on my website. I'm really flexible when it comes to the financial part. I’m open to discussing fees that best work for my clients.
Cheryl Neufville Etiang
Student midwife & birth and postpartum doula in Salt Lake CityHow do doulas help improve outcomes in Black maternal health?As a doula, the biggest thing I [provide] is confidence and release. I want people to feel confident while birthing and also be able to release any fears and traumas. Because it does come out in the birthing space, and sometimes being in certain environments can trigger that.
A lot of Black women don't feel seen. We don't feel heard. Our complaints or our fears aren't validated in a lot of spaces, and that can affect our birth outcomes. Knowing that there's someone who's supporting you and has experienced the same thing really helps because then you're able to talk through things. You feel safe. And on top of that, they have an educational background.How does your work continue the tradition of Black birth support? My great-grandmother was a midwife in our home village in Liberia. She was very important to our community, and she helped assist in the births of most of the people in our community there. I wanted to continue her legacy of just ensuring that we have safe passage earth-side because that's where we’re preserving ourselves as a race. Midwives and doulas help make sure that we can continue on after birth and that it’s a safe journey.
What would make the biggest difference going forward for Black maternal health?We need to make sure that everyone has affordable access to a doula or to a midwife, whether you want to birth in the hospital or in your tub at home. You should have access to a birth worker that will be able to support you and understand you…without worrying about the price.
There also needs to be more education on what doulas and midwives do, especially in the Black community. And that you can be safe birthing in various spaces. It doesn't always have to be the hospital. I think if people knew what their options [a]re, they would choose differently.
How can people access your services, and how much do you charge?Find me on Instagram. My fees depend on the service, but the range is $950 - $2,150. I offer payment plans to make sure it’s affordable for the family.
Doula and Founder of Womb Ish birth and postpartum doula services in Philadelphia
How do doulas help improve Black maternal health?If we're educated and we know how our bodies work, we're not just nodding “yes” to any [intervention] that comes our way.
Giving women this information and preparing them for birth by way of education first helps women go into the birth room knowing what they should and should not do, what benefits their body, what does not.
How does your work continue the history of Black birth support? By rendering our services, doulas share that knowledge and show us how to know our rights, speak up, and safeguard ourselves. Just knowing how women's bodies flow and function throughout pregnancy, labor, and birth and passing along the good word to another woman.
What would make the biggest difference going forward for Black maternal health?The level of care that Black women are receiving for their pregnancy. And not even just pregnancy, but healthcare in general. Other races [need to] view Black women as actually human. We have feelings, we feel pain. We're not just an experiment. We birth just like any other race, and because of that, we deserve the same level of treatment that other races receive when they get prenatal care.
When I had my first son, it was automatically assumed that because I was 22, I did not want my child. I was asked by my provider what I was going to do with my child after birth, insinuating that I did not want my child. I think if a lot of the stereotypes that are placed over us were removed, and we were just viewed as women, then a lot of that would change.
How can people access your services, and how much do you charge?People can visit our website to see all our services and rates. Services range from a la carte to packages that are $1,000 - $2,500. We have sliding scales, and we travel across the country.
Most pregnancy-related deaths in Black women are preventable. And Black doulas can play a critical role in improving the health outcomes of Black mothers, babies, and families, one birth at a time. Eve Akins said: “I want a generation of people that are saying, ‘We birthed on our own terms, with our own voices.’ And that's freedom.”
Find more doula and birthing resources here:
Ovia Health, creators of the Ovia Pregnancy app, has a doula hub that guides you through advocating for proper and adequate care, building a birth team, and caring for yourself during pregnancy and postpartum.
The National Black Doulas Association has a national directory to help you find a Black doula in your area.
DONA International is the world’s first and largest doula certification org.
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