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By Hannah Critchfield
A new program through the University of North Carolina seeks to boost the number of Black people working as doulas in North Carolina.
Its founder hopes these doulas will help address a national crisis in maternal mortality by reducing birth risks for expectant Black parents within the state.
“People tend to like to have people on their care team that look like them, but unfortunately, there’s not a whole lot of people of color as care providers, OBs, midwives, or nurses,” said Venus Standard, a professor at the UNC School of Medicine who will lead the pilot doula training initiative. “This is a way that I thought to ‘infiltrate the system,’ so to speak.”
New Black mothers are three to four times as likely to die of pregnancy-related complications than whites nationally, according to the Centers for Disease Control and Prevention. These trends bear out regardless of socioeconomic status or education level — a Black person with a college degree is five times as likely to die in childbirth than a white counterpart — suggesting implicit bias in the health care system may play a role.
The last time North Carolina’s State Center for Health Statistics looked at the maternal mortality data for North Carolina was in 2016, when the agency analyzed data from 1999 to 2013, which showed a narrowing gap. More recently, however, the America’s Health Rankings 2019 report used CDC data to calculate that in North Carolina, Black women have a maternal mortality rate 2.8 times that of whites.
Doulas may help alleviate some of that risk. These trained companions are not medical professionals, but instead provide emotional and physical support to people undergoing a significant medical event — in this case, childbirth.
There is not enough existing research to know if doulas definitively have an impact on reducing maternal mortality. However, evidence suggests birth doulas may help combat some of the risk factors associated with death due to pregnancy-related complications. People who are supported by a doula when giving birth are significantly less likely to need a cesarean section, which Black people experience at higher rates than all other racial groups.
Culturally appropriate doula support is additionally believed to boost rates of breastfeeding among Black parents who receive Medicaid services.
Accessing a doula who shares your racial background can be challenging, Standard says. White people appear to be overrepresented in the birth doula community.
“Cost is the biggest barrier,” she said. “Doula training is not cheap. It will cost approximately $1,250 to $1,500 for your basic doula certification. Not everybody can cover that.”
The price of doula services can also be a roadblock for many expecting Black parents or for people on publicly funded insurance such as Medicaid parents. These birthing mothers are more likely to want, but not have access to, a doula than parents who are white or who have commercial insurance.
In the 2020 legislative session, Sen. Natalie Murdock, a Democrat from Durham, proposed a bill that would have allowed doula services to be covered by Medicaid. The bill never received a hearing.
Standard hopes her initiative will help rectify some of that gap.
“Maybe you couldn’t afford to [become a doula] for whatever reason – because you have to pay your rent, you have to feed your children, or you have to pay for your schooling,” said Standard. “If your barrier was financial, this grant takes that part away.”
The program will train 20 Black women within the Triangle area as birth doulas, using funding from the C. Felix Harvey Award to Advance Institutional Priorities, a $75,000 grant.
The women will be certified through the first and largest doula certifying organization, known as Doulas Of North America (DONA) International, which is often considered the “gold standard” for doula training.
Each Black doula will be required to attend three births – meaning 60 Black people giving birth in North Carolina will also receive access to free doula services under the initiative.
“All of the people that are involved – what I call my “dream team” – will be Black, including our trainers,” said Standard. “I think from that perspective, they will be able to give culturally appropriate, culturally sensitive information that may not be given from a trainer that’s not.”
Culturally appropriate care means providing support that respects the diversity in childbearing people’s experiences and preferences, and the cultural factors that can impact health care, including communication style, practices around giving birth, and attitudes toward Western health care systems.
Birth is not equally experienced by all people in the United States, and historical treatments of people of color have played a large role in shaping the health landscape of today.
“I have to teach women that are not Black to be culturally sensitive,” Standard said.
“With a Black doula, you don’t have to teach it, but you have to hone in on it – she will be of the same race, but she might not have the same background, experiences or challenges. She may, but she may not,” she added. “Culturally appropriate training is necessary, and that’s what we feel that we’ll be supplying.”
These Black doula trainees will have almost all aspects of their training and certification covered – however, they will need to have access to reliable transportation.
“That’s the one requirement,” said Standard. “If a mama calls at three in the morning, you can’t wait for an Uber, you just can’t. You have to jump in your car and you have to be there for her. Because birth does not run on a clock, so it could be two in the morning, it could be six in the morning, it could be two in the afternoon, and you have get there within a reasonable amount of time of her call.”