The thing about Black History Month, is that it’s rendered completely useless if we don’t use it to create a better Black future. At the most foundational level, that should start with better Black maternal care. The Black maternal mortality rate in America is three times as high as that of white women, and that includes Afro-Latina moms who identify as Black. There is, simply put, no excuse or valid reason for these sobering statistics. According to a number of studies, the disparity is due to access to quality healthcare and structural racism. This is where systemic change needs to happen. It’s not a problem caused by Black women, it’s a problem caused and perpetuated by healthcare providers. And yet, our healthcare system is struggling to close the gap, despite being well aware of the issues.
“The actualization of an equitable health care system which serves all people can only occur through acknowledgement of the historical context from which modern health inequities grew, including reproductive injustices,” a statement from the American College of Obstetricians and Gynecologists issued in February 2022 reads. “We have an obligation to work to overhaul currently unjust systems that perpetuate unacceptable racial inequities in health outcomes.” And yet, we’ve seen little change. Black women are still dying during and shortly after childbirth at an alarming rate.
Now many Black and Afro-Latina moms enter their pregnancies in fear and some are looking outside of mainstream healthcare options for solutions. The popularity of midwives and doulas is growing, especially in the Black and Latinx communities in the U.S. As expectant mothers who are at a disadvantage simply because of the color of their skin attempt to find individualized support before, during and after their pregnancies, they are turning to other women of color (WOC) — women who are devoting their lives to what’s becoming known as birth justice.
A doula is an individual trained to provide expert advice, guidance, and support throughout a healthcare-related experience, according to DONA International. There are both birth doulas and postpartum doulas. In the past few years, more and more women of color are devoting themselves to this practice, which largely harkens back to childbirth being something that was tended to collectively by the women of a community or village.
Afro-Dominican doula Eugenia Martinez is the founder of Mujer Fuerte Doula in New York City. She shares with HipLatina that the death of 26-year-old Sha’Asia Washington on July 3, 2020 was her introduction into birth justice. Washington died at Woodhull Hospital, in a predominately Black neighborhood in Brooklyn, after the anesthesiologist botched the standard procedure of administering epidural. The catheter to deliver the anesthesia should have gone about four inches into her lower back yet he continued threading it in and up more than 13 inches, a state medical review board later found, The New York Times reported. The publication added that nearly 1,500 women give birth at Woodhull each year, about 85 percent of them Black or Latina and under 10 percent are white. The majority of patients have Medicaid. Though this incident may be uncommon, it’s often WOC who are affected when mistakes like this happen.
“At the height of the pandemic, I decided that I would pursue birth work,” she tells HipLatina. “It changed the course of my life. I couldn’t understand how someone who was looking forward to having the best day of their life could end up having the worst day, and actually the last day of their life.”
Through her own research she came to the conclusion that the disparity in healthcare standards and outcomes between Black women and white women, stems from “the eradication of midwifery and the institutionalized approach to birth,” which has made birthing more dangerous across the board, but particularly for Black people and people of color.
From the start, Martinez noticed that even doula training for certification lacked the much-needed perspective of women of color — those who are disproportionately affected by the failures of our healthcare system. It was a realization that ultimately led her to forgo doula certification. Instead she is certified as a childbirth educator and a lactation specialist.
For doula, Athena Gabriella Guice, who is the founder of Hija del Sol Birth Services in South Florida, there was no one wake-up moment. She noticed the discrepancies in healthcare for people of color from a young age, and tells HipLatina that she felt the desire to nurture and support her community beginning early in her life. She started college early and studied biology, but quickly realized she had no interest in working in a clinical setting. It wasn’t until she became a young mom in 2015 at age 18, that she fell into the role of postpartum doula, after offering lactation support to her peers.
“I originally found that there was a large need for women of color in my community [of South Florida] to have a Black and Puerto Rican peer lactation support counselor and began my journey more focused on postpartum and motherhood,” Guice says. Now, she works as a full-spectrum doula, having received her certification in 2017, and has also created her own doula training program.
Like Martinez, she is certain that the issue is rooted in this country’s history of racism and exploitation of women of color. “The Black maternal mortality rate has been our reality before we ever had specific language about this crisis. Much of this crisis stems from the way our ancestors were kidnapped and forced into slavery for centuries.”
“Afro-Latinas and the Latinx community are directly impacted and if we don’t see the relevance, we will continue to suffer and face scenarios where our voices, our stories, and our struggles are silenced. We cannot afford to be silent or unaware,” she adds.
While it’s important to know exactly what we are facing as Afro-Latinx birthing people, neither Martinez or Guice wanted to go into statistical detail about the Black maternal mortality rate. The words they used say it all though. “It would be sickening for me to do so,” says Guice. “It is devastating,” says Martinez. Instead, they want to focus on uplifting Black women and sharing useful resources and stories of joy, which they both do on social media.
To that end, they urge Black and Afro-Latinx birthing people and their healthcare and support providers to fight for legislation intended to combat health disparities.
“I believe a large part of making a difference to close the gap would be for doulas and midwives nationwide to work to bring important legislation and policy to legislatures everywhere that aim to address health disparities,” Guice suggests.
“In addition, if we work to build a mutually respective culture with doctors and hospitals, we may be able to bridge that gap,” she says. “Education is also a large aspect of helping the public understand how to navigate this increasingly political— and what seems to be an unsafe — journey.”
They also urge expectant mothers and those planning to get pregnant to build their support systems thoughtfully and early on. “Find and build your tribe. Talk to your tribe about your fears, what motivates you, how they can support you. Have your people also take a childbirth education class,” Martinez says.
Guice also emphasizes the importance of planning ahead and engaging with healthcare providers every step of the way and to build your birthing team from the start.
“My biggest advice would be to actively prepare by speaking with healthcare providers and doulas to understand what you may navigate throughout this journey. Do not wait until the last minute to consider building a birth team and do not attempt to transform your amazing family into your birth team in hopes of getting the preparation you need,” she tells us. “Practice using your voice in uncomfortable situations and if you don’t feel as if being vocal is your strength, hire advocacy support like a doula.”
Above all though, is education. Although we as Black and Afro-Latina moms should not have to be held responsible for fixing a problem we didn’t cause, we can protect ourselves and our babies by educating ourselves.
“People usually fear the unknown right. There is so much about birth [that] can feel like the unknown but there are ways to educate ourselves about the physiological process of labor and make folks more comfortable about the process and help advocate for you when the time comes,” Martinez explains, suggesting childbirth classes for the expectant parents as well as anyone on their birth support team. “Education is also a large aspect of helping the public understand how to navigate this increasingly political and what seems to be, an unsafe journey,” Guice concurs.
Enlisting the help of a doula can be an important part of that education. Research has shown some of the benefits of having a doula include decreased maternal stress, lower rates of cesarean sections and medical procedures during birth, lower odds of postpartum depression or anxiety, and improved trust with the birthing process.
Guice says doulas can help birthing parents learn about what to expect during childbirth and the postpartum period including perinatal mood disorders, stress management and pain relief techniques to use during pregnancy and birth and information related to lactation, among other things.
“Doulas and midwives are doing everything we can on the ground to support, uplift and empower birthing people to make the best decisions for themselves,” Martinez says. Evidence indicates doulas can help Black and Afro-Latina mothers feel more confident and safe throughout their pregnancy and after. Also, the educated and informed presence of a doula, may even incite healthcare professionals to take their concerns and needs more seriously when, in many cases, WOC experience dismissal of their concerns from their doctors.
For that alone, doulas in the Black and Latinx communities are a resource that seems to be resurging in popularity and one that may just help turn the tides towards a better future for Black mothers and their children in America.