VIDEO We Can Make Birth Safer for Black Babies and Mothers: Here's How!
Check out the Afro-centric Pregnancy Fair: Birth Works for Black Women on Saturday June 25
By Helen Silvis of The Skanner News
June 22, 2011
Intensive campaigning by health advocates from Portland’s communities of color, scored one significant victory in Salem this session. The legislature passed a bill, sponsored by Rep. Tina Kotek, that directs the Oregon Health Authority to study the value of doulas in reducing infant mortality rates.
Next February, when the report is complete, advocates hope that legislators, state health administrators and hospitals will work together to find funds to pay for doulas to work with pregnant women, especially women of color, and women in underserved rural areas.
“We thank all the legislators who helped pass this bill,” said Shafia Monroe, president and CEO of the nationally-recognized doula training nonprofit the International Center for Traditional Childbearing. “It’s exciting that this bill passed when so many others didn’t. Now comes the hard work of making sure we get a 'Yes' in February 2012.” The Skanner News Video: Shafia Monroe
What’s a doula? Doulas are community health workers, trained to help mothers through pregnancy, childbirth and in the weeks after birth. Usually doulas belong to the communities they serve, giving them the cultural knowledge necessary to win the trust of mothers.
“Doulas give emotional support to women during pregnancy and birth,” says Monroe. “They are not clinicians; they don’t deliver babies and they don’t give medical advice. But a doula is not just your friend, she’s a professional who has been trained to understand the emotions and the normal signs and discomforts of childbirth. And the research shows that doulas do make a difference.”
Find out more about doulas and ICTC at the Afro-centric Pregnancy Fair "Birth Works for Black Women". The Fair, will run from 4 to 7 pm, Saturday June 25 at Fern Hill Park, NE 37th Avenue and NE Ainsworth. The free event will feature: 15-minute massages, henna, baby wearing demonstrations and more.
African American Babies are at a Higher Risk of Death
At the moment, Black and Native American babies born in Multnomah County, Oregon, are twice as likely to die in their first year as White babies. But that’s not all. Black babies are almost twice as likely to be born underweight as White babies. They are more than two and a half times as likely to have a teen mom. And they are less likely to be breastfed, a known protective factor.
“We need women of color to be doulas in our community,” Monroe says. “If we can find a way for the state to pay for doulas, then this would make a great difference.”
If Portland’s African American and Native American babies were a country, they would rank 49th in the world for infant mortality, sandwiched between Martinique and Bahrain. The United States as a whole ranks at number 34, right behind Cuba. But it’s not just babies who are at risk, it’s also mothers. A 2010 report by Amnesty International, ‘Deadly Delivery’ noted that the USA is a more dangerous place for women to give birth than 49 other countries. And African American women are four times more likely to die in childbirth than White moms.
A research brief by the Urban League of Portland points to race-related stress as one crucial factor, along with poor housing, economic uncertainty, unsafe neighborhoods and lack of education. It recommends a community-led, hospital-sponsored doula program to combat the problem.
“The lifelong stress of dealing with racism can have a physical impact,” says Midge Purcell of the Urban League of Portland. “Even African American women who are so-called middle-class, have higher education degrees and relatively well paid jobs, still tend to have lower birth-weight babies.
“We felt it was very important to advocate for policy that made a difference for mothers and babies. And in reproductive health as well as in other areas of healthcare, the issue of culturally specific services kept rising to the top as we searched for an effective intervention.”
Research Supports Use of Doulas
The Oregon Coalition to Improve Birth Outcomes, which includes Multnomah County Healthy Birth Initiative, Regence Blue Cross Blue Shield and ICTC, sees doulas as a first-line resource for preventing infant deaths, especially in communities of color, but also in rural areas where women may have to travel miles to see a doctor.
“The research shows that to the extent that the healthcare workforce is trained in culturally competent service delivery then the outcomes are better for communities of color,” Purcell says. She notes that the Latino community has used community health workers very successfully, as ‘promadoras’, or health promoters.
National research has shown that using doulas or similar community health workers, reduces the use of medical interventions such as caesarian deliveries (50 percent reduction), speeds birth, and lowers depression rates in new mothers.
The ‘Listening to Mothers Report,’ a national study created by Boston University School of Public Health for the nonprofit Childbirth Connection, reported that, “Doulas and midwives were the most highly rated providers of labor support, yet were used for this purpose far less frequently than other types of providers.”
“In the United States we are not as baby-friendly as we say we are,” Monroe says. “Most of our mothers feel afraid, and undervalued. They don’t go to childbirth classes. African American women don’t go to (mainstream) childbirth classes. But our doulas do empowerment childbirth classes. They make sure mothers have resources and they support women through the pregnancy right through to helping with breastfeeding and after the birth.”
Trained, Certified and Out of Work
Monroe points out that doulas trained through ICTC must pass tests, meet benchmarks and certification requirements, and attend continuing education classes. Their services are in demand. In fact, local hospitals often refer women to ICTC’s Full Circle doula services. But because the profession is not a recognized part of the medical care system, health insurance doesn’t cover their services.
The low-income and minority women who really need doulas don’t have money to pay for them, Monroe says. And while doulas often do volunteer, because they know their communities need them, they can’t afford to work for free.
“I see doulas leaving the profession to take other kinds of jobs because they need to be paid,” she said. “We’re losing experienced doulas because they just can’t attend a birth and work 18 hours, two or three times a month with no pay.”
Monroe is pleased that the door has now been opened for doulas to be recognized and funded, but she said that to be successful the effort will need backing from a wide range of community members.
The doula bill was just one of several healthcare bills backed by the Urban League that tackled this crucial issue of cultural competence. A coalition of minority health advocates had hoped to make cultural competence training a requirement for licensing in the medical professions. Purcell said advocates are disappointed that their efforts failed this time around. Still, they will continue to push for improved training for medical professionals, and also for the state to recognize community health workers as a necessary and integral part of the healthcare delivery system.
“We have seen through testimony, time and time again, that the specific needs of communities are often not understood and that they are overlooked,” Purcell said. “There’s a place for community health workers to take on part of that health promotion and prevention. They are trusted and that’s really important.”
PHOTOS from top: Doulas support women and babies, courtesy of Shafia Monroe: Shafia Monroe, photograph by Helen Silvis; Minority health advocates packed committee rooms in Salem on the Urban League's legislative day of action, photo courtesy of The Urban League.