Doulas Seen As Key To Battling Maternal, Infant Death Among San Diego's Black Community
The nightmares hit Sharavyn Johnson not too long after a pink line on a pregnancy test told her she was with child. Johnson and her wife, Nasira, were elated that the reciprocal in vitro fertilization was a success, but that was quickly followed by Johnson's terrible dreams she or their baby would die during birth.
"It was haunting," Johnson said.
The fear is not uncommon during pregnancy, but data confirms the nightmare is more likely to become reality for Johnson. Because she's black, federal statistics show she is three times more likely to die during childbirth than a white woman, and her child faces twice the risk that white babies do. Two San Diego groups are addressing the disparity by increasing access to a pregnancy and childbirth aide known as a doula.
Pregnancy-related deaths per 100,000 births
American Indian/Alaska Native: 29.7
Asian/ Pacific Islander: 13.5
Source: CDC, Sept. 5, 2019
Infant deaths per 1,000 births
American Indian/Alaska Native: 9.4
Native Hawiian / Pacific Islander: 7.4
Source: CDC, 2016
Johnson said she was so worried about becoming one of the rare but worrisome 700 annual maternal deaths in the U.S., she wrote a letter to her unborn child.
"I remember saying that I loved him, and that if anything did happen, I tried my hardest to hold on," Johnson said.
But Venice Cotton, a doula, helped put Johnson and her wife at ease. She is trained by the nonprofit For the Village to provide emotional support and information before, during and after childbirth.
"They trust us to be able to explain to them what’s going on and let them make the right decision," Cotton said.
Limited research shows a doula, a Greek term for women's servant, can reduce the risk of complications and low birth weights and increase the likelihood of breastfeeding, but hiring one is pricey and not typically covered by insurance. The health-focused nonprofit Project Concern International, or PCI, partnered with For The Village this year to train and compensate doulas for supporting black moms-to-be.
PCI's long-running Healthy Start program typically serves only low-income families, but recently removed that requirement for black women in an effort to counter the high rates of maternal and infant mortality. The five-year, $5-million federal grant for the program also covers midwives to support the doulas and provides families with a health consultant for 18 months after the baby's birth.
However, doulas aren’t without controversy. They don't have medical licenses, so their training and experience vary. Plus, Cotton said medical professionals may feel doulas get in their way.
"We come in not with medical training but knowledge and experience and a more natural way to do what they do with medicine," she said.
For Johnson, Cotton’s support was what she and her wife needed.
"Having a partner there was nice — a spouse or family member — but someone to guide that family member and to tell me what to do and to tell her how to help me — it was comforting," Johnson said.
That comfort wasn’t just during labor. Johnson had prenatal check-ups, but Cotton was keeping up with her while she was at home. She made sure Johnson was resting and drinking enough water and even requested proof.
"I would have to send confirming pictures that I was laying in bed with my big jug of water," Johnson said.
The Healthy Start program offers the same support after birth. Other doulas like Cotton visit moms at home before their first postpartum check-up, which often takes place six weeks after birth. The additional attention already helped two black moms get to the hospital for life-threatening issues they didn’t even know they were experiencing.
Johnson said Cotton's continued presence not only assuaged her fears but also helped her achieve a positive birth experience with son, Asir. For her first child, Makayla, now 5, Johnson had labor induced and reluctantly agreed to an epidural. She wanted a drug-free delivery at a birthing center for her son, but needed help getting through the final hours of painful contractions.
Cotton, Johnson and her wife, Nasira, laughed together as they remembered what was then a tense time.
California Dignity in Pregnancy and Childbirth Act
This year, California passed a new law that requires perinatal health care providers to receive implicit bias training. The high rate of maternal death among black women can't be explained by education, income or lack of prenatal care, leading some to believe it's caused by unequal health care.
"Nas was getting frustrated. Nas was just like, 'You know what, I’m going to sit over here.' And Sharavyn? She was being more than stubborn," Cotton said.
Cotton said Johnson didn’t show signs of complications, such as hemorrhaging, and the birthing center's midwives didn't raise concerns, so she pushed her on. For that, Johnson is grateful.
"Having him naturally and allowing my body to do what it’s made to do, is the best thing ever. Definitely," Johnson said. "I would do it again. I would. I would risk it all again."
She now plans to do that for other moms to be. Johnson completed doula training at For The Village earlier this month.