Indra Lusero, founder of Elephant Circle, speaks to a gathering of people as they celebrate the historic passage of a package of laws in Colorado that push forward equity in the birthing process, with a focus on reducing health disparities for Black women during and after pregnancy, in Denver, June 30, 2021. Elephant Circle led advocacy efforts to get the legislation passed. (Kevin Mohatt for Colorado Newsline)
When an elephant goes into labor in the wild, its herd quickly surrounds her in a tight circle, standing ready to fight any threats that come her way. The births, as with humans, can extend for many hours or even days.
“It’s this incredible vision of defense and protection,” said Indra Lusero, founder and director of Elephant Circle, a birth justice organization based in Colorado. “I think humans need that, too. We need that circle during vulnerable times that’s tuned in and supportive but also protective and a wall of defense.”
Lusero’s organization, which was founded in 2009, was one of the driving forces behind two Colorado bills, which were recently signed into law, that seek to improve maternal health care throughout the birthing process.
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Senate Bill 21-193 aims to provide protection and safety for pregnant people in the perinatal period, including for people who are incarcerated. The second bill, Senate Bill 21-194, seeks to minimize barriers that prevent health-care providers such as birth doulas and midwives from getting reimbursed for their professional services and allows them to be present during a birth.
The maternal health bills signed into law this year were sponsored by state Rep. Leslie Herod, a Denver Democrat, and Sen. Janet Buckner, an Aurora Democrat — both members of the Black Democratic Legislative Caucus of Colorado.
Approximately 700 people die every year in the United States as a result of pregnancy-related complications — a rate much higher than in other developed countries around the world. Black mothers die at a rate that’s three times greater than white women, according to a 2019 report from the Centers for Disease Control and Prevention.
The long-standing racial disparities are due to an array of interconnected factors, including barriers to high-quality medical care before and after childbirth, gaps in insurance coverage, disproportionate prevalence of chronic illnesses, racial bias in the health care system and delayed diagnosis of complications by medical professionals, according to the CDC. Members of Congress are also considering a package of 12 bills, called the Black Maternal Health Momnibus Act, that would chip away at the long-standing disparities in maternal health.
“The blame for these gaps in care are not solely placed on physicians,” Herod said. “The issues that lead to maternal health disparities are widespread and deep-rooted.”
Improved protections for pregnant people who are incarcerated
When 37-year-old Kristina Fedran was arrested on false allegations on Sept. 29, 2019, in Commerce City, she was still breastfeeding her youngest son, who was 12 months old. Her requests to the officers and jail staff for a breast pump went unanswered.
“I became painfully engorged,” she told state lawmakers while testifying in support of SB-193 in May. “I did my best to compress my breasts with my hands and a wet towel. I was not given pads and leaked through my shirt several times.”
By the time she got out of jail, her son had been forced to feed from a bottle and she was no longer able to produce milk. “I cannot bear the thought of another nursing mother having to go through this,” she told lawmakers.
The bill establishes minimum standards for the care of incarcerated pregnant people, including access to providers who understand pregnancy and birth, mental health treatment, education and essential supplies such as breast pumps. It also requires jails, private contract prisons, and correctional facilities to report annually when they use restraints on pregnant people.
Though Lusero is pushing for better conditions for pregnant people who find themselves incarcerated, they are clear that they don’t want people incarcerated in the first place.
“But if you are going to, at the very least, you should be humane,” they said. “These bills just set a very basic, humane level. Nothing fancy.”
More institutional support for birth doulas
Briana Simmons, Black women’s health, healing and joy coordinator for the Colorado nonprofit Soul to Soul Sisters, said there is still a lot of confusion in the public sphere around what the role of a doula is in the birthing process.
“Doulas are highly trained, skilled, nonmedical professionals who really just journey alongside a person through any reproductive health experience,” Simmons said. “They’re providing physical, mental, emotional, spiritual and informational support so that a family can get as close as possible to their desired outcome.”
She said the pandemic highlighted both the importance of birth doulas and how much they have been historically undervalued by traditional health care systems.
“With the limitations of visitors that were necessary during COVID, doulas often weren’t recognized as part of the birth team,” Simmons said. “So you had this vulnerable family who has anticipated that they would have this support person that they built a relationship with by their side during their birth, and many people had to choose between their partner and doula, their mom or their friend, and it really uncovered the lack of respect for the role of doulas.”
The new law solidifies that every person giving birth is able to have a companion or doula during their birth in addition to their partner or spouse.
“Part of my role in that was using my expertise and privileged position as a doula working directly with families to be an advocate for the things that they were experiencing, for the gaps in resources, for the lack of support that were made available to them, and really just speak to those issues,” Simmons said.
New legal reporting requirements
The bills add new reporting requirements for both the Colorado Civil Rights Commission and the state Department of Public Health and Environment.
The CCRC is now required to accept reports from people alleging maternity care that does not maintain the person’s “dignity, privacy, and confidentiality.”
Lusero said this is an important step to better understanding the breadth of the issue. “More needs to be done in terms of accountability for what happens to people but this is an important first step to have a place to submit these complaints,” they said.
The legislation also directs the state’s health department to study perinatal health disparities and propose recommendations for improving the health outcomes.
“I think that’s important and it’s going to be particularly important for advocates,” Lusero added. “We want that data to be public, because then we can use it to keep pushing.”
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