How doulas address maternal and child health disparities

Orlando, Fla. — During a late October prenatal appointment, Keshia Lockett chatted with Brittney Castro and her husband, Anthony, about the couple, about what they could expect when Brittney went into labor.


what you need to know

  • Research shows that a doula, a person employed to support a pregnant woman during labor, improves infant and maternal health.
  • Doulas can serve as advocates in the delivery room—a particularly important service for black women, who report poor communication from doctors and less trust in health care settings during labor than white women.
  • “Black women are often not heard from, and therefore are at greater risk of pregnancy complications,” said Carolyn Valencia, director of maternal and child health initiatives at the March of Dimes.
  • A Spectrum News analysis of maternal and child health outcomes reported by the Florida Department of Health found deep disparities in birth outcomes for black children.

,[I’m] Totally here to educate, advocate, support you guys — both of you — during labor,” Lockett told Castro. In her practice, called Empowered Black Doulas, Lockett coaches pregnancy, birth and Expecting parents after delivery.

Lockett joined the profession in 2019, at a time when growing awareness of maternal and infant mortality had put the doula in the spotlight — as an answer to maternal and child health disparities across the country.

,[Doulas] work with the mother during her pregnancy, giving her some evidence-based information, or giving her direction on where to find it, for things like birthing positions and things they usually don’t know about The OB provider is not spoken with,” said Carolyn Valencia, director of the Maternal and Child Health Initiative at the March of Dimes.

Doulas may work with their clients to develop a “birth plan,” prompting clients to identify in advance such things as who they want in the room during labor and whether they will be present during the birth. Want to use pain medications.

Before Castro gave birth to their child, Lockett helped her and her husband practice assisted delivery positions and taught the couple how to use a rebozo—a long cloth—to lift Castro’s abdomen and relieve the pain of contractions. wrap – how to use .

Beyond physical, emotional, and educational support, doulas can serve as advocates in the delivery room—a particularly important service for black women, who report poorer communication from doctors and during labor than white women. Have less trust in the health care setting.

“Black women are often not heard from, and therefore they are at greater risk of pregnancy complications,” Valencia said. “There are stories that have national presence, like Serena Williams’ condition and knowing that her blood would clot, and her telling providers after she was born that something was wrong, and they weren’t paying attention to that.”

A Spectrum News analysis of maternal and child health outcomes reported by the Florida Department of Health found deep disparities in birth outcomes for black children. 13.3% of black babies in central Florida were born with low birth weight between 2018 and 2020, versus 6.9% of white babies. Similarly, 13.8% of Black births were preterm during that period, compared to 9.2% of White births.

Neonatal mortality, that is, infant deaths recorded within the first 28 days after birth, measured per 1,000 live births: while the neonatal mortality rate for white infants in central Florida was 3.2, the black neonatal mortality rate was more than twice that, 7.45 per 1,000. (This analysis is based on data from Orange, Brevard, Osceola, Flagler, Lake, Marion, Seminole, Sumter and Volusia counties).

Lockett works mostly with women of color and says 90 percent of her clients are black. She sees herself as an advocate for women in labor, making sure their concerns are addressed by having doctors on-call and asking clarifying questions before a procedure.

“If the provider comes into the room and they want to do certain things, I’ll be like, ‘Hey, what is this, what are the risks, what are the benefits?’ Lockett said. “I’m kind of that middle man, and sometimes I have to be the person who says, ‘Hey, I know her birth plan and she says she doesn’t want to do this, or she doesn’t want to do that. .'”

Research suggests that having a doula present during childbirth improves infant and maternal health. A study published in the Journal of Perinatal Education found that babies were four times less likely to be born with a low birth weight and experience a complication giving birth to themselves or their baby when a doula was present for prenatal care. was twice as likely to occur. during delivery.

Other research shows that people who receive doula care experience lower rates of postpartum depression and anxiety than those who give birth without the assistance of a doula.

“I struggle with anxiety, so I knew I needed a doula,” said Castro, who gave birth to her child in November. Having someone knowledgeable to talk to about pregnancy eased her fears about labor and birth.

As the demand for doula care increases, some states’ Medicaid programs have begun to recognize and reimburse the service. In 2018, Florida became the first state in the South to expand its Medicaid program to reimburse doula care, although on a limited basis.

Meanwhile, networks of Black doulas are growing to meet the interest in their services.

Evergil Rookwood said, “I really enjoy having a group of peers who culturally understand what it means to provide doula care.” In addition to her doula practice, Rookwood consults with health care groups to make hospitals more “dula friendly” and lobbies employers to adopt doula benefits that private insurers may not otherwise provide. In Central Florida and the Gulf Coast, Lockett has created an annual summer event called Black Doula Tours – led by doulas and attended by expectant parents.

“We’re here for a reason,” Lockett said. “You don’t need to wing your birth.”

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