By now, thanks to Serena Williams, Beyonce, and other Black mothers who are pop culture icons, the disparity that Black women and women of color face in regards to maternal mortality, infant mortality, and birth outcomes due to racism has become general knowledge. Black women die of pregnancy-related conditions at three to four times higher rates than their white counterparts due to experienced racism. We also know by now that doulas are making childbirth safer for women of color.
Doulas come in the form of an aunt, a grandmother, a friend, or a certified doula. Either way, they are versed in birth and know how to care for a laboring person — and they do it in a way no other trained professional does it. They are incredibly important for providing culturally responsive pain management and emotional support. Doula assisted mothers were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication, and more likely to initiate breastfeeding and have better birth outcomes in general, according to a 2013 study. Doulas are incredibly valuable. I have worked with hundreds of them as a previous midwife.
Recently, CNN produced an article stating that Black infants die three times more often under a white physician or pediatrician. Families know they need advocates in the birth room for the sake of themselves and their babies. Doulas serve as a cornerstone in maternity care — yet they have not been successfully integrated into the current maternity care system everywhere. There are some hospitals, like Denver Health or Rose, that have doula programs, but they are hospital-specific and doulas themselves — are not covered by Medicaid or private insurance.
Doulas save maternity dollars when they are used. They improve cesarean section rates, they improve the incidence of artificial labor augmentation or induction, and they create better birth outcomes. A study in 2016 shows us that there is a high incidence of false, racist beliefs about pain tolerance in Black people — among white medical practitioners. Doulas serve as one of many solutions to advocate for a mother in labor who may not feel that her voice is heard or that she can communicate while in active labor.
Because of COVID-19 hospitals have changed their internal protocols on how many people are allowed in with a laboring woman, often leaving family and desired support people outside.
I heard a lot from the community doulas on not being allowed into the birth room in the Denver metro area. In April 2020, organizations that lead on birth equity in the state, like Colorado Organization for Latina Opportunity and Reproductive Rights and Elephant Circle, wrote a letter to Gov. Jared Polis’ office on the importance of doulas in the birth room among other solutions to the inequities we are seeing in birth in Colorado. Raise Colorado Coalition amplified those same concerns and wrote a letter to the Office of Health equity on the importance of having doulas in the birth room to advocate for families, who may not feel heard, or maybe laboring and birthing alone.
Yet, I have heard from community doulas, many are still not let into the birth room. Many are questioned about their certifications throughout their client’s labor — stressing out both the doula and their client. We know that doulas increase the likelihood of better birth outcomes for families of color. With racial health disparities being exacerbated we need doulas in the birth room for families who particularly are faced with the experience of lived racism.
Any hospital that values maternal health and addressing inequitable disparities will design internal protocols that support birthing people having the support people of their choice in their birth room. Regardless of certification. Hospitals across Colorado should be admitting doulas for birthing families and creating internal protocols to address perinatal racial disparities. The Office of Health Equity with the Colorado Department of Public Health and Environment should uphold the guidance of why, and how, using doulas saves lives and maternity dollars for all birthing Coloradans.
For families, providers and advocates who are pushing for safer and equitable birth in light of COVID-19 please see Elephant Circle’s COVID-19 resource page.