Collaborative Care and the Underutilization of Black Doulas
June 10, 2021
Collaborative Care and the Underutilization of Black Doulas
By now I am sure that we are kept updated on the disparities that plague the Black community but more specifically the Black maternal community. However, for the purpose of this article let’s review the current climate of birthing for Black people. Black people are dying at a rate of three to four times more than white women or any other racial group. Within a society that prioritizes equality for all, this mortality rate shows a gap in not only equality but equity as well. Equality tells us that everyone should have the same opportunity and access while equity tells us that everyone should have the same opportunities and access that is specific to the particular person so that advancement can occur. If we know this to be true in definition and fact, why do these rates still exist and what are some ways that we can actively shift the narrative of medical equality and equity?
The traditional process of supporting indigenous birth has always included a familiar person that helped to care for the birthing person emotionally, mentally, spiritually, and physically in anon-medical way. History would call this a birth assistant but we now call them doulas. Doulas have significantly changed the course of birth forBlack, Indigenous People of Color in present day America. Doulas have become part of the birthing person’s prenatal experience and care but the most paramount role being to support and nurture during the labor and birthing process prioritizing with the birthing person’s wants, needs, and desires and remaining in alignment with the quality of their support. In 2012, a survey took place showcasing that 6% of birthing people had used a doula during labor and delivery. A percentage that was up 3% from 2006 (Declerq etal., 2013). The impact of doulas have proven to positively affect pregnant peoples self-confidence, advocacy, and knowledge. Doulas have also proven to help lower the percentage of pregnant people’s use of an epidural and other non-holistic pain coping mechanisms during labor.
"My clients are Black and I’ve noticed them voicing their concerns of feeling ignored... they feel that having a doula there to forcefully but gently advocate for them will help their needs and, when tactfully done, it does.”
Doulas sound amazing, right?! So why are they underutilized within the medical and maternal space? And if proven to help reduce and increase some of the most pertinent things during the most vulnerable moment of a person’s life such as birth, why are they not essential to combating the Black maternal and infant mortality rates? Now we are getting into collaborative care and how emphasis on collaborative care with doulas prenatally and throughout labor and birth can possibly help decrease those numbers.
“My clients are Black and I’ve noticed them voicing their concerns of feeling ignored and their desires of wanting to be heard, as if they felt the nurses did not hear them out,” Krystal explains,“they feel that having a doula there to forcefully but gently advocate for them will help their needs and when tactfully done, it does.” Krystal has been a doula for a year serving families in Jonesboro, Georgia through Wild Birth Partum Care.I asked Krystal about her first-hand experience with supporting her clients through labor pains, “Many pregnant people transition confidently with a doula and our reassurance. From my experience, I’ve helped them get through those surges of discomfort without the need of medical interventions like pain medicine.”
Collaborative care involves looking at the birthing team as, well, a team. This includes the primary care provider whether an OBGYN, CertifiedNurse Midwife, or Certified ProfessionalMidwife. “My OBGYN has been known to be both birth and doula friendly. He was very welcoming of my doulas and I had very positive natural birth experiences with my two births.”Kayla recounts, a mother of two and birth photographer residing in Anniston, Alabama. “The person giving birth should be the person in control and this should be looked at as a team approach and patient centered care,” Explains SciHonor,“Doulas can benefit in an enormous amount of ways including during the antenatal, intrapartum, and postpartum periods especially to navigate systemically racist systems.”
Since knowing the fact that doulas help the pregnant person feel less alone and more informed during the pregnancy process and beyond, it could be said that tapping into the birth team as the primary care provider could help decrease the chances for biased care and medical interventions. Black birthing people are mostly impacted by biased and racist care within maternal spaces. Leading to an astounding number of cesarean sections, preterm birth, missed preventative measures, and most alarming, maternal and infant death. This is driven by the known fact that race and racism affects the maternal and public health field.
“A doula is there to assist the birthing person in any way possible so that they can make decisions about their care that work best for THEM. We assist with achieving the birth they desire while being educated, respected, heard, and supported.” Says SciHonor Devotion, a certified lactation counselor, doula trainer, and owner of Earth’s Natural Touch: Birth Care and Beyond, the largest Black-owned and centered training organization and collective based in New England.
Without the presence of a doula and knowing that they can provide the confidence of comfort, agency, and educational component that most primary care provides cannot, how can we have an honest conversation about equity and how is it that we keep missing the mark by underutilizing doulas as a tool to combat Black maternal and infant mortality? I wonder if a future where there is evidence of the benefits of doulas for Black birthing people would shift this. I am forced to leave the medical and public health system with questions such as, “How is it that we can implement collaborative care practices and start actively utilizing doulas within these systems that have benefited from the study of Black bodies for everything else for so long?”
Article written by Kayla Bitten, full-spectrum doula, student midwife, and owner of the first Black-owned lactation clinic in Alabama.