“A few seconds in I said, ‘I can feel this.’
"The doctor said, ‘No, you don’t, that’s just pressure.’
“‘No, I can feel you cutting me,’ I told her.
“She didn’t believe me. She kept going,” says Ayana Moore, 43, a mother of two in Durham, N.C. She is a scientist with several advanced educational degrees, including a master’s in science and a PhD in physiology and biophysics. She is a by-choice mom with a solid health insurance plan that covered her insemination. She could afford the fertility medications and regular doctor’s appointments.
She was considered advanced maternal age and had one run-in with a pesky uterine fibroid, but overall, she had an uncomplicated pregnancy.
“I could feel her cutting across and it got to the middle, I just started screaming,” she says. One of the nurses finally yelled Stop! and in a blink Moore was out.
“I went from a room full of nurses and doctors to the room being empty except for custodians cleaning up. My mom was sitting there, and I was like, ‘Oh, my God, what happened to the baby?’ I thought the worst,” she said. Both mom and baby recovered from the Caesarean section, but she said the birth of her son was extremely traumatic.
Moore’s account joins the chorus of 50,000 women each year in America, according to the Centers for Disease Control and Prevention, who have suffered dangerous and even life-threatening complications during childbirth. Black women are three to four times more likely to endure these complications and succumb to the country’s mortality-rate crisis. After that experience, Moore hired a local doula, Melanie Patrick, for her second pregnancy. Patrick is the co-owner of Emerald Doulas in Durham.
Doulas have been part of pregnancy, childbirth and postpartum recovery for women of all backgrounds, but specifically women of color, for centuries. It is easy for their grass-roots efforts to get lost in the tragic statistics and stories, but doulas are doing community-based work in cities to give babies and mothers a better chance of survival.
“Our team in general is woke,” Patrick said in a Skype interview. She explained that the majority of her team, three founders and 16 doulas, are white and the majority of their clients are white. She said she believes this racial makeup actually helps her see the disparities more clearly.
While Emerald Doulas aims to serve all women, part of their efforts to reduce the black maternal and infant mortality rate includes having regular team meetings where their doulas are encouraged to speak up about any racial disparities they witness between clients and providers.
“I have doulas come back to me after a birth and say, ‘This provider used the phrase these people in front of her or to her.’ Like, ‘Oh these people, the way they give birth is so dramatic.’ They wouldn’t say that in front of me.”
If Patrick and her team become aware of racism toward a client, discrimination based on marital status, or lack of consent for cervical exams and interventions, they call the provider immediately to set up a meeting. She said in most cases the providers are receptive and attempt to correct the issues. But in some cases they are not. “I’ve had conversations with providers who know their biases and still treat their patients differently.”
Patrick says mandatory implicit bias training could help. In August 2018, Sen. Kamala D. Harris of California and 13 Democrats introduced the Maternal Care Access and Reducing Emergencies (CARE) Act, which would allocate grant money for implicit bias training in hospitals and clinics, specifically for anyone in the obstetrics and gynecology fields. But it is a slow process, so black doulas and midwives are providing more immediate solutions.
“We’re not just talking about the issues. We’re giving real community-based solutions,” said Tru Kellman, the founding director of Jamaa Birth Village in St. Louis and a doula. She’s also working on becoming the state’s first black certified midwife. She started Jamaa Birth Village (pronounced Jah-Mah, which means family in Swahili), in 2015, and the staff provides doula services, midwifery support, childbirth and nutrition education courses, mother and baby donations, as well as a Doulas of Color Collective. All services are provided on a sliding scale.
“It’s very easy for agencies, health professionals and organizations to throw around the statistics and the numbers without actually realizing that these are real people," she said.
Jamaa Birth Village also offers lactation counselors, mental health counselors, support groups for mothers and their families, and community health workers who follow the families for two years and address multigenerational poverty issues, such as access to education and employment. Jamaa Birth Village also provides chiropractic care, acupuncture and yoga for moms and their families. They believe self-care should not be considered a luxury but rather an affordable necessity. “A lot of our clients are women in poverty who are in chronic stress. We know cortisol is one of the biggest factors in prematurity and adverse birth outcomes,” Kellman said.
April Thomas, 28, is an entrepreneur and mom in St. Louis who gave birth just 3½ months ago. Thomas decided early on she wanted a doula, a holistic pregnancy and a home birth.
“In St. Louis there aren’t any black certified midwives. So that’s a downfall for us. And as black women, it’s really hard for us to connect with someone who doesn’t relate to our everyday struggles and the things that we deal with,” Thomas said in an interview.
While pregnant, the staff at Jamaa Birth Village helped her research options for financial support (doula care is not covered by Medicaid in her state). They offered a support group when she had blood pressure concerns and they learned how to prepare her placenta for a lotus birth with fresh herbs.
It would be easy to categorize a place like Jamaa Birth Village as a crunchy, granola place for hippie moms without considering women have been birthing like this for centuries. Historically, women had babies at home with midwives and doulas. A doctor was only involved if the patient had certain risk factors or required surgery.
“We are changing the dynamics in these hospitals where OBs rank supreme. Really they need to be there for high-risk people, not the people who are healthy and okay,” Kellman said.
Joy Long-Vidal, 34, of Durham, N.C., chose to combine doula care with obstetrics based on what she saw in her family. Her older sister suffered a grand mal seizure and was in a coma for several days after a problem during the administration of an epidural. Both she and her baby recovered. Her mother had preeclampsia and survived. Long-Vidal’s paternal grandmother hemorrhaged right after her father was born. She did not survive.
“I believe that was due to her being a woman living in Eastern North Carolina, dealing with things like poverty and racism and not having the resources. She didn’t get the medical treatment and care in time,” Long-Vidal said.
She was adamant about hiring a black doula and felt immediately comfortable around Patrick and the staff at Emerald Doulas. She recognizes doula services can be expensive — they can cost anywhere from $300 to over $1,000 — but she encourages women to try to find space for it, even if it means asking for donations from friends and family.
“This issue is very deep and personal for me, yes as a black woman, but as a black woman with such family history. I just wish she had the support that she needed and deserved,” Long-Vidal said of her grandmother. “I don’t know if it matters, but I believe in the power of speaking names. Her name was Ethel Mabel Long, and she passed in September 1944.”
Sarah Hosseini is an American writer living in New Delhi. She has written for Cosmo, Good Housekeeping, Redbook, Bustle, Romper, Scary Mommy and more. You can read her work at SarahHosseini.com.