With advancements in technology and healthcare procedures, giving birth should not be an imminently fatal experience — and yet, Black mothers across the U.S. are putting their lives on the line when they step into a hospital.
Black women experience maternal mortality two to three times more than their white counterparts, according to the CDC, with 43 Black women dying per every 100,000 births. But the CDC admits that 60% of mortality and morbidity birth outcomes for all women were preventable. Nicha Cumberbatch, a Black doula, physician's assistant and director of population health curriculum at virtual primary care provider, Spora Health, knows firsthand what’s at risk for Black women giving birth in a healthcare system that does not train against biases.
“We know it trickles down from systemic racism,” says Cumberbatch. “But it’s not someone inherently saying, ‘I am going to provide racist care.’ It’s implicit bias that leads to assumptions and judgments about a group that doesn’t look like you. And because of your negative assumptions, you’re not listening to them or accounting for the pain and symptoms they’re experiencing.”
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For Cumberbatch, having someone to guide and advocate for Black mothers throughout their pregnancy can often feel like a necessity — that’s where doulas come in. Doulas provide techniques and comfort measures to help pregnant women get through labor with minimal medical intervention, while also setting a plan for the birthing experience itself. Essentially, doulas prepare expecting moms to know what they want and don’t want from their healthcare experience. They do not provide medical care, diagnose or deliver the baby.
“A doula’s role is to support the mother, her wishes and her desires, reminding her of the things that she would like to advocate for in her birth experience,” says Cumberbatch. “In the typical healthcare setting, there’s a river between the birth experience and medicalization of birth. There are lifetimes of findings on ways to move the body and how to use herbs to support the birth without much intervention. Your doctor won't mention that to you.”
For example, if a woman is going through a contraction, a doula may ask her to sit on a birthing ball while the doula presses down on what they consider “sacral bones,” allowing certain ligaments to stretch and offering relief to the mother, explains Cumberbatch. Doulas can also remind mothers of their healthcare needs or concerns as interventions are thrown their way by doctors. If a mom did not want an epidural during her birth and one is offered, a doula can remind her and guide her through a pain management tool instead. Cumberbatch believes that not all medical intervention is bad; rather, some of it may be avoidable.
“From working in healthcare, I have seen how sometimes things are just part of a routine,” says Cumberbatch. “If this person has been laboring for ‘X’ amount of hours, then we go to the next step and offer something. If that didn't work, then we have to offer this. Suddenly, we're here at a C-section.”
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A doula’s biggest role is to ensure a mother can speak up for herself — and be heard. Cumberbatch recalls how during many birth experiences, she notices moms trying to say something, but not having their needs met or listened to because everyone is focused on the baby. This could be a death sentence, especially for Black women who are likely being treated by a provider with little knowledge of the
Only 5% of healthcare providers identify as Black, according to the Association of American Medical Colleges. This means the majority of those providing care will not inherently understand or relate to the Black women they’re treating. Not to mention, the medical schools these doctors train at have limited experience learning about health equity. In some cases, this can translate to blatant discrimination, Cumberbatch says, as many Black women have shared how their pain or concerns were ignored leading up to giving birth, as well as while they were in labor. On the other hand, many medical care professionals may just be ignorant of certain health conditions and risks that disproportionately impact Black people.
Black women have higher rates of diabetes, hypertension, and heart disease than any other group of women in the U.S. — and these health conditions can complicate pregnancy. Cumberbatch points out a study by Arelene Geronimous, who theorizes that exposure to racism alters Black women on a cellular level. Geronimous’s research found that despite being the same age as white women, Black women’s fertility score reflected that of someone 10 years older.
“Weathering [racism] changes the way our body composition holds up to things,” says Cumberbatch. “It makes you more susceptible to things like chronic conditions that can also spill over for birthing women.”
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To prevent these outcomes, Cumberbatch hopes to see doulas and midwives become more accessible to the public, and advises employers to provide an out-of-pocket benefit for their workers. Doulas can cost between $500 to $3,000, depending on their experience level and service package. And since most health insurance plans do not cover doulas, having a benefit that gives workers the money to hire a doula would be potentially life-saving, explains Cumberbatch.
When it comes to picking the doula the mother will work with, Cumberbatch encourages moms to shop around and interview multiple doulas before coming to a decision. It’s crucial the mother likes the way the doula communicates, says Cumberbatch.
Regardless of whether a mom decides to hire a doula, Cumberbatch asserts that Black women still need advocates in the healthcare space. As a doula herself, Cumberbatch knows advocacy can make a difference, even if she can only work to close the mortality disparity gap one mom at a time.
“Even if we make a difference for a small percent of [moms], we are giving someone a better birthing experience — we are saving a mom’s life,” says Cumberbatch. “Those are people who get to go home to their family. That's all that matters.”
