State of Black Maternal Health: Q&A With a Doula

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The state of pregnant people in America is dire. The United States is the only developed country in the world with a rising maternal mortality rate. Even more alarming is that Black women are three to four times more likely to die from pregnancy-related complications than white women. Many of these complications are preventable.

We all understand racism is a driving force behind this disparity. Recently, U.S. legislators have introduced the Mamas First Act to combat these issues and expand Medicaid to include doulas and midwifery. We talked with certified doula, doula instructor and chemical engineer Michelle Gabriel-Caldwell with the National Black Doulas Association to discuss Black maternal health and what individuals can do to protect themselves. 

This conversation has been edited for length and clarity. 

What’s the situation with Black maternal health right now?

It is pretty abysmal, to be honest. Despite all of the myriad of programs that have popped up in the last five years with respect to trying to mitigate these issues, we're not changing the systemic racism that is part of the foundation of the medical community. We're not putting programs in place that hold the medical providers accountable. Instead, we are adding black women, doulas to solve a problem. (Medical community is saying) it's your issue. Throw some black people out there and solve it. So this is what we're seeing. 

This is why we feel the pendulum will never go back or never, ever get to a state where there's extreme safety. Because we're still dealing with systemic racism, but they want to make it our fault, right? They want to tell us that we're the ones who are weathered, and damaged and stressed out and full of cortisol and all of those things.

And this is why we have the outcomes that we have, when we're not addressing the issue head on, which is the fact that obstetrics has been built on the backs of black women since its inception. And as a result, we have never been seen as equals, and more so just vessels of carrying the baby, under the guise that they actually care about our babies too.

What are the experiences you’ve heard from Black mothers in this medical system?

It's different for a lot of people depending upon socioeconomic status and access. So, yes, we do have systemic racism across the board. However, there are some people who are a little more privileged than others, depending upon what they can acquire, in terms of the health insurance that they have, whether or not they're on private insurance or Medicaid. 

In general, what I would say is that they are just not given the same level of options as their white counterparts. So for instance, if someone were to have been previously pregnant and had a cesarean section and wanted now for their second pregnancy to obtain a vaginal birth after cesarean, they may not be offered that. So we’re seeing some of that in terms of just choice and options that are not available for a lot of black women.

And it goes across the board as well. So you can start off with fertility options - maybe it has not been offered to them versus their white counterparts. So it comes from the beginning to the end, right? And then even from postpartum - they've survived that. But now what are the options for what to do with the placenta? They don't even know that they get to keep it or they get to consume it or bury it or whatever it is that they want to do - just the basic things of body autonomy in this space. 

So options are usually never fully discussed with black women as they are with white women. Because the assumption is that we are not as healthy, that we don't know, we don't care and that we're not interested in these different things. The assumption is also that we don't have partners, or we don't have long lasting partners, and so our care and support at home will be terrible. So they're making decisions for us based on assumptions. So without education, there isn't the understanding of informed consent and what true informed consent looks like.

What can people do to protect themselves during this process?

Certainly, we have a wonderful thing right now that is access to the internet. So finding resources that make sense for them locally. So if it is about lower income, just type in “lower income birth support,” right? Or “low income childbirth classes.” It is about getting the information so that they can make better decisions within their birth journey from soup to nuts, even prenatal care.

And people should also know that if you're not feeling warm and fuzzy with the physician, you can change that. You don't have to be stuck with this person who doesn't even look at you, when they're talking to you. This isn't okay and that can be changed. If you're finding that you're not heard, you're not listened to or your voices are not amplified in any of those spaces, it's okay to say “I need to find somebody who's going to do better for me.” 

And we actually do more research right on buying a car than we do on our physicians, right? So when we put the priority in place that this is important, my health is important, the health of my baby is important. How am I going to give birth? Where am I going to give birth? All of those things need to be discussed as a family together. And then what are we going to do? What's the next step?