Women

A Black mother found her calling as a doula after losing her baby

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HOUSTON

The first encounter Mimi Bingham had with the untoward experiences Black women face giving birth was her own pregnancy, 18 years ago.

That was long before she knew what a doula was — let alone considered becoming one.

Long before years of research and hundreds of encounters with women giving birth taught her that the loneliness, disrespect and neglect she recalled experiencing were not isolated to the West Virginia hospital where she delivered.

Long before she joined a coalition of Black birth workers in Texas who decided they must confront the national crisis of rising maternal deaths and critical complications because the price of waiting on government and medical systems is too high.

At seven months pregnant, Bingham said, she started leaking fluid and went to the doctor. Her blood pressure was through the roof, and an ultrasound showed the placenta was detaching from her uterus. “I was sent home and basically told to just wait for her to come,” Bingham recalled, but not before being asked, repeatedly, if she was doing meth.

She wasn’t.

“In hindsight, I know for sure it was due to stress. No proper nutrition. I didn’t have a regular OB,” Bingham said. She was uninsured and couch-surfing with friends in an unfamiliar state after her relationship soured.

Bingham turns emotional recalling the loss of her daughter in 2005. (The Washington Post)
Kaiyia Marie Bingham, whose ashes sit at her mother’s home near Houston, did not survive the night of her birth 18 years ago. (The Washington Post)

Two weeks later, Bingham was back at the hospital. “I just sat there, in labor, by myself,” she remembers. “When she came out, no one was in the room.”

Scared and afraid to touch her tiny daughter who was struggling to breathe, Bingham said she pushed the call button and waited for help. Hospital staff arrived and whisked the newborn away.

Minutes later, her friend Detria Waller walked into the room and found Bingham dazed and alone. Waller received a phone call from Bingham just before she delivered, asking her to come to the hospital. “I knew it wasn’t time for her to have the baby, so I threw on clothes and flew up there,” Waller recalled recently through tears.

Soon after she arrived, Kaiyia Marie Bingham was placed in her mother’s arms, wrapped in a baby blanket and deceased. “She just cried and held her for hours,” said Waller, now a mother of three. Except for the occasional whisper from Bingham about the infant’s beauty, Waller said, the two sat in silence until the next morning when she left for work.

Waller never asked Bingham about the sequence of events surrounding Kaiyia’s delivery, saying she “didn’t want her to relive that, so I just made assumptions.” And Bingham never shared.

Nearly two decades later, Kaiyia’s ashes sit in a tiny white box on an altar in the bedroom of her mother’s home near Houston.

The experience of that birth — and the loss — was a step on the path to Bingham becoming a doula. And now, here she was, exhausted and at a crossroad, wondering whether she should walk away from hospital births, where, too often, she felt like a combatant instead of part of the care team.

A disproportionate burden

Bingham sees doula clients in a home office that resembles a spa relaxation room, with its plush purple chairs and natural light. Hers is a career informed by personal experience and by research showing Black mothers and babies suffer more than most in a nation that is the worst place to give birth among high-income nations.

Black women in Texas — the state that accounts for 10 percent of the nation’s births — die at more than twice the rate of their White counterparts in connection with childbirth and at more than four times that of Hispanic women, according to a preliminary review in the state’s most recent Maternal Mortality and Morbidity Review Committee report. The state experienced a dramatic increase in grave medical complications during in-hospital deliveries, with severe morbidity jumping about 25 percent between 2018 and 2020, the state report released in December 2022 shows. Black women, the report said, disproportionately shoulder the burden of those near misses.

[For some Black women, the fear of death shadows the joy of birth]

That report provides a snapshot of the state’s maternal outcomes. The committee, which includes physicians, epidemiologists and nurses, found that 90 percent of pregnancy-related fatalities in 2019 were avoidable.

“Inadequate clinical skill and quality of care at provider, facility, and system levels led to preventable death,” the report said, recommending continuing education for maternal health workers and the diversification and expansion of that workforce. There’s no way to pinpoint the transgressors because identifying information — such as the names of hospitals and physicians — is removed before medical records are provided to the committee because of privacy concerns.

On Tuesdays, Bingham, left, and son Ahmaad have dinner with family friend Brittne Arcemont and daughter Audrey. The weekly dinner gives the single mothers a chance to decompress because “we just kind of understand each other,” Arcemont says. (The Washington Post)
Ahmaad reads next to Bingham at their Houston home in January. (The Washington Post)
Bingham joined a coalition of Black birth workers who decided they must confront the crisis of rising maternal deaths and complications. (The Washington Post)

Amid worsening maternal outcomes, calls have come from the White House, federal health agencies and grass-roots maternal health advocates for doulas to play a larger role, with the Health Resources and Services Administration awarding millions in grant funding to train the next generation.

For Black women, who research shows are more often scolded, dismissed or pressured into unwanted interventions, the need for greater access to doulas is considerable. About 30 percent of Black women reported being mistreated while receiving maternity care and 40 percent said they experienced discrimination, according to a recent survey from the Centers for Disease Control and Prevention.

“The fact that nearly half of the survey respondents said they held back on discussing concerns or asking questions because ‘their health care provider seemed rushed’ or they didn’t want to appear ‘difficult’ demonstrates that we must work harder to provide patient-centered care,” Verda Hicks, a gynecologic oncologist who is president of the American College of Obstetricians and Gynecologists, said in a statement.

Tamika C. Auguste, an obstetrician and gynecologist who is chairwoman of Women’s and Infants’ Services at MedStar Washington Hospital Center, said doctors must better communicate with patients, including explaining possible risks.

“There is something else now that I think we are finally dealing with,” she said: “disrespectful care,” which can lead to traumatic experiences.

The need to do more is acute: Doulas, nonclinical health workers who serve as a safeguard by being advocates and educators who provide physical and emotional support, attend only about 6 percent of the nation’s births, and because most insurance doesn’t cover their services, access often is limited to those who can pay out of pocket.

Maternal health advocates say the high stakes, high demand and short supply mean burnout among birth workers is on the rise.

“Doulas are not meant to be emergency triage care in every situation — not your lawyer, not your ER doc, not your social worker, not your therapist — and that’s what we’re expecting of doulas right now,” said Kanika Harris, senior director of maternal and child health at the Black Women’s Health Imperative. “Now, I have to train doulas on hospital policies and human rights. It can’t just be the training I took on birth.”

Harris embarked on doula work in 2006 as a student at the University of Michigan, where she graduated with a doctorate in health behavior and education eight years later. Now, Michigan is implementing Medicaid coverage of doulas, in part because of the advocacy of Black women who said it was “discriminatory for it not to be,” Lt. Gov. Garlin Gilchrist II (D) said in an interview. But when Harris started, she said, “it was a very White space. Black people were forever asking me, ‘What is a doula?’”

Bingham didn’t know the answer herself until about six years ago.

It was while pregnant with her youngest son, Ahmaad, that Bingham decided she wanted something different — not the isolation of Kaiyia’s birth or the pressure to consent to a Caesarean section, which she experienced with her second child, Rashaad. She found it in an elder midwife who helped build a diverse movement of women in Houston who say they are unapologetic about seeing Black pregnancy through the lens of power, potential and promise — not pathology.

‘The pain was ridiculous’

In Texas, more than a dozen of Bingham’s clients described fraught pregnancy and birth experiences — or their desire to avoid such situations — during interviews with The Washington Post.

They described the liters of blood pooled on delivery-room floors. Blood clots and inflamed incisions. Allergic reactions treated with morphine instead of antihistamines.

“The whole thing was just trash,” Alyse Hamlin said of the unexpected Caesarean delivery of the second of her four children. She described it as “the most traumatic birth I had.”

At the hospital, doctors gave her Pitocin, telling her the synthetic hormone would help labor progress. What the medicine did, she said, was make the contractions feel like “elephants were stepping on my body. The pain was ridiculous. You could feel it in your fingertips.”

Alyse Hamlin, shown with son Khai, 11, says during her second pregnancy, it felt like “elephants were stepping on my body” after receiving a medication to speed labor. (The Washington Post)

A nurse admonished her for yelling too loudly, she said, telling her: “You’re scaring other moms.”

It remains the worst pain the 35-year-old said she has experienced, and she has given birth without pain medications — twice.

Clinicians and public health experts said these are the private pains that underscore the magnitude of harm hiding in plain sight. As Auguste listened to the stories gathered by The Post, she instinctively recognized what she called the disconnect between “normal medical interventions” and the “bad experiences” they can breed.

For doulas like Bingham, there is nothing opaque about the scale of the problem. In fact, Bingham said she has begun to feel overwhelmed, questioning how she should continue helping people avoid life-threatening complications before, during and after birth. Because, she said, continuing with the status quo is too much to bear.

“You’re not just fighting to get the baby here safely. You’re fighting a war, a battle,” Bingham said. “Even when you want a true emergency C-section, you’ve got to fight for that, too. You shouldn’t have to go into a hospital and feel like you’re on a battlefield.”

With one woman, Bingham recalled witnessing hospital staff try to slow labor because the doctor had simultaneous deliveries. Her client was dilated seven centimeters — pushing typically begins at 10 — when a nurse came into the room saying, “We’re going to give you some terbutaline.”

The drug is used to delay labor and can cause tremors and nausea in the person giving birth and tachycardia — a racing heart rate — in the baby. Bingham said she has seen patients needing to undergo C-sections “just from administering that medicine. Granted, when it’s needed … the benefits outweigh the risks.” But, she said, that was not the case here.

After Bingham privately shared her concerns with the family, who then relayed them to the nurse, the drug wasn’t administered. And the woman delivered a healthy baby.

Speeding up, slowing down

It wasn’t always this way.

There was a time when the idea of hurrying labor along, let alone slowing it down, would have been regarded as heresy if there wasn’t a lifesaving reason to do so, public health experts say.

Not anymore.

Medically intervening in labor and delivery has become too common, according to federal researchers who found the length of pregnancy in the United States shrank between 1980 and 2006, a shift they attributed to greater use of C-sections and inductions before pregnancies reach full term.

In 1990, about 9.6 percent of all births were induced, according to the CDC. By 2012, the rate had more than doubled. Eight years later, a third of all labor was induced.

“I could write a script the way they start pushing for induction for moms,” planting seeds about scheduling that intervention or a C-section, Bingham said.

Bingham, training to become a midwife, performs a prenatal exam on Ana Lopez, who is 20 weeks pregnant, with midwife Frances Jones-Coleman in February. (The Washington Post)
Bingham trains to be a midwife at Full Circle Family Services in Houston. “I felt a calling to provide a different experience from what I’ve experienced,” she says. (The Washington Post)
Bingham decided to pause her doula work and focus exclusively on training to become a midwife so she can be the person directing women’s care. (The Washington Post)

There remains “a big debate” in the medical community about choosing to induce labor at full-term — 39 weeks — said Elliott Main, professor of maternal-fetal medicine and obstetrics at Stanford University.

There is a misconception that kick-starting labor speeds things up when it actually slows things down, Main said. And the decision to “throw up your hands and say, ‘She’s not making enough progress, we should do a C-section,’” is more subjective at community hospitals, which tend to have less stringent protocols than academic centers, potentially leading to more frequent use of the procedure than needed, he said.

C-sections keep increasing: By 2022, they accounted for 32.1 percent of all U.S. births — and nearly 40 percent of deliveries by Black women. Most were performed on women with low-risk pregnancies, which a federal report released just before the coronavirus pandemic said represented “an overused procedure that has not led to better outcomes for infants or women.”

The report concluded that increased use of C-sections is one reason maternal morbidity rates have worsened.

For every maternal death, research shows there are as many as 100 women who experience severe maternal morbidity, which is often less scrutinized than fatalities.

“I don’t think we’ve even scratched the surface of understanding the trauma that’s happening,” said Rachel Hardeman, director of the University of Minnesota’s Center for Antiracism Research for Health Equity. “As amazing as doulas are, they are not going to save us.”

‘Us versus them’

Bingham’s breaking point came at the end of last year, when a first-time mom received three different induction methods to kick-start labor despite Bingham’s advice that none seemed medically necessary.

After almost two days without progress, Bingham tried to gently persuade the 31-year-old with an Ivy League education to go home and wait. “Your baby will come when the baby wants to come,” she said.

The woman giving birth said she was bombarded with multiple perspectives — from Bingham, nurses, the hospitalist, her primary obstetrician. It felt like a “crisis of my own making,” the mother said, speaking on the condition of anonymity to discuss detailed medical information. She expected Bingham “to be an advocate in the room,” she said. “What I didn’t expect is for the nurses and the doctor to disagree.”

Often, she said, nurses would tell her privately, “These are the things you need to look out for with the doctors that are on call. This one is impatient. This one is going to talk really fast. It felt like us versus them.”

Texas accounts for 10 percent of the nation’s births. (The Washington Post)

But the new mom said she stayed at the hospital, making progress only with drugs — one hormone called Cytotec, the other, Pitocin — and a saline-filled balloon catheter inserted into her cervix.

The problems persisted once labor began, as the exhausted mother endured excruciating back pain, saying each contraction felt like the baby was ramming against her insides, unable to push past a certain point.

“Something’s not right here,” Bingham recalled thinking.

Mom and Bingham said the baby was in what’s called occiput posterior position, or sunny side up, meaning she was facing mom’s abdomen instead of her spine. Babies in this position are more likely to get wedged against the pubic bone.

As Bingham and the nurses put the mother in different positions to help the baby flip, the mother said she spiked a fever but delivered vaginally — more than three days after first being induced.

Then, she hemorrhaged more than a liter of blood. Two days later, she was discharged and told everything was okay. But after being home for three days, she said, she was rushed back to the hospital by ambulance with a severe infection.

Both mom and child survived and thrived.

While the woman said she felt fortunate to have “this underground network of wonderful nurses trying to make sure nothing bad happened to the Black woman,” the fact that it was necessary didn’t make her feel safe.

“I was thinking the whole time, ‘How can this be the case?’” she recalled.

Bingham maintains a list of her clients at her home near Houston. In one corner of the board, she has written the name of her daughter, Kaiyia, who died soon after being born. (The Washington Post)

The episode left Bingham feeling “like a failure,” unable to accomplish her goal of helping patients experience a safe and joyful birth on their terms, she said, the weight of the statement causing her voice to break.

It was time to pause her doula work and focus exclusively on the training she was doing to become a midwife so she can be the person directing women’s care. “For me and my mental health, I just needed to step away from hospitals,” she said.

A whiteboard hanging above her desk with the names and due dates of her last five doula clients served as a countdown clock.

Loss, and hope

About a month and a half later, Bingham was still juggling. Juggling her finances. Juggling her final doula clients. Juggling her clinical training to become a midwife and her feelings about walking away from a place where she knows she’s needed.

So when it wasn’t in Jas Smith’s budget to pay the full $1,800 for doula services, Bingham felt she couldn’t say no. She suggested a reduced rate for reduced services — phone consultations and a 2½-hour prenatal visit — but eventually waived the fee altogether.

Bingham knew overextending herself like that wasn’t sustainable. She was already maintaining an accounting job and occasionally driving for Uber Eats to make ends meet, so she made herself promise to establish firmer boundaries. This can’t continue when she becomes a midwife.

Right now, all she saw was a mom in need, and Bingham couldn’t bring herself to turn away. Bingham asked Smith, 31 weeks pregnant with her third child, whether her doctor mentioned circumstances that might call for induction.

Bingham took on Jas Smith as one of her final doula clients. Smith came to Bingham’s home in February with friend Sharda Blake. (The Washington Post)
Smith receives instruction from Bingham while expecting her third child. (The Washington Post)
Smith remained resolute about not having a C-section. (The Washington Post)

“No, she will not induce,” Smith responded, adding that the doctor said a C-section would be necessary if her pregnancy lasted longer than 42 weeks.

“Good,” Bingham said. “So, we don’t have to talk about the methods of induction.”

That changed.

A week later, Bingham got a text from Smith, a 34-year-old who works in quality control for a biomedical company. Once Smith’s pregnancy reached 38 weeks, her doctor wanted to “jump-start labor” so she wouldn’t go past her due date.

“You can say, ‘No,’” Bingham reminded Smith, whose amniotic fluid ended up dropping to dangerously low levels during her third trimester, requiring her labor to be induced at 37 weeks.

But, Smith said, she stood her ground when it came to not having a C-section, and the doctor backed her decision.

Too often, though, clients don’t fight for themselves, physicians and public health experts said.

“We’re socialized to just sort of respect the health-care system and take what’s given to us or what we’re told,” said Hardeman, a University of Minnesota professor and reproductive health equity researcher, adding that doulas disrupt that dynamic by empowering people to ask questions and exercise autonomy in choosing what’s best for them and their baby.

Bingham does so during pregnancy and delivery and in the days and weeks — sometimes months — that follow. Which is how she found herself sitting in the home of Iesha Beal, an Army veteran whose expected home birth ended in an ambulance ride to the hospital. Months had passed since Beal’s daughter, Nyla, was delivered stillborn.

Unlike the usual one-time visit after a woman gives birth, Bingham stayed in regular contact with Beal as she navigated the incomparable grief of losing a child — something Bingham knows all too well. And just like she told the vlogger many times before, Beal gets to decide what to share about the experience. Nobody else.

Beal told The Post she doesn’t blame her midwife for what happened, nor does she regret her decision to labor at home. She started her pregnancy under the care of an obstetrician, whom she said rushed through appointments in minutes — and “didn’t even touch my stomach” — then charged her thousands of dollars.

Iesha Beal is overcome as she discusses the stillbirth of her daughter, Nyla. She wears a necklace pendant with her daughter’s footprints. (The Washington Post)

Of all the scenarios Beal and her husband tried to prepare for, delivering a baby who would never take her first breath was not among them, she said, rubbing the necklace pendant with her daughter’s footprints like a talisman.

Nyla was born at 8:50 a.m. Nov. 16, 2022.

“Nobody really has answers,” she said, noting that the doctor who treated her at the emergency room reviewed medical records from her original obstetrician and her midwife. She remembers him saying, “Everything looked fine. The midwife team, the doulas, his nurses, him — everybody did what they could.”

It would be 10 p.m. when Bingham left Beal’s house to head home and start preparing for the next day at the midwifery clinic where her apprenticeship is in its final phase.

‘I don’t want to die’

Bingham’s last birth as a doula was about two weeks away. Already, it had taken three hours of affirming, encouraging and educating to calm the first-time mom after a physician did an unexpected cervical check, which involves inserting gloved fingers into the vagina to feel for changes in the cervix that occur during the early stages of labor.

So when the mother said she shared the information that Bingham had passed along — that there’s debate in the medical literature about the utility of doing the exams in the last weeks of pregnancy and that patients have the right to say no — her doctor asked why she bothered hiring a doula in the first place.

She remembers thinking, “because Black women are dying during childbirth. Not because I want a natural type of birthing experience,” said the woman, who spoke on the condition of anonymity to describe personal medical information. “It’s because I don’t want to die.”

The obstetrician suggested the patient see a psychiatrist, who recommended medication. “The only time I took it is when I had to go to my OB appointment from 37 weeks on,” she said.

So, when the husband texted at 1:30 a.m. May 14 saying they were at the hospital, Bingham steeled herself for combat.

Then, she said, “the universe did what the universe does” and conspired in her favor.

The woman’s obstetrician wasn’t available, and the on-call physician was patient and kind, delivering a healthy baby vaginally — just like she wanted.

And at 9:16 a.m., Bingham wished her, “Happy Mother’s Day.”

A mother holds her baby, born in December 2022, at the family’s Houston home. When pregnancy difficulties arose, this mother describes how a network of Black nurses sought to protect her. (The Washington Post)

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