Missouri doulas are taking action to bridge maternal health gaps | State News
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When a person has a baby, their health outcomes can be impacted by a variety of factors. And in the U.S., where rates of maternal mortality are higher than in other high-income countries, race is one of those factors. Missouri doulas are aiming to do something about this.
In 2023, the Centers for Disease Control and Prevention concluded Black women in the U.S. are three times more likely to die during or shortly after pregnancy than their white counterparts. This disparity has raised alarms for many people in the field of maternal health — including LaKisha Redditt, a full-spectrum doula and owner of Virtuously B’Earthed Doula Services in St. Louis.
“I just think people need to understand that there is a gap between the care that is received from one group to the next,” Redditt said. “Stop treating it like it doesn’t exist. It exists. That’s why you’re hearing about it.”
In Missouri, gaps in healthcare access can impact maternal health outcomes from the start of pregnancy through the postpartum period. According to the most recent data, more than one in three Black women in Missouri do not receive prenatal care in the first trimester of pregnancy. On the other hand, almost 90% of white women started their prenatal care in the first trimester. Missing benchmarks like early prenatal care can make it harder for providers to assess risk factors in the late stages of pregnancy and in the delivery room.
Redditt said it is crucial for providers and patients to be aware and informed of these disparities and how they can impact health outcomes — if not properly addressed, lack of care can lead to missed risk factors for birthing parents. She believes this awareness can give parents the tools to advocate for themselves in the birthing space. Redditt said she works hard to inform clients of potential risks and communicate with providers about her clients’ medical histories and specific needs.
“I think that’s my goal as not just a doula, but a Black doula serving [the] Black community,” Redditt said. “That is like, literally my goal for you to know that this is your right. These are the things that are happening in the world of birth, and you need to be — unfortunately — you need to be hyper vigilant.”
Experiences with the healthcare system can impact an individual’s willingness to seek care. And for Black patients who often have vastly different experiences within the healthcare system than their white counterparts, building trust between patients and providers is that much more important.
Redditt has been a practicing doula for seven years. Throughout that time, she has attended countless births and said many of her clients come to her after having negative or traumatic past birth experiences. She has learned that being educated on how these negative experiences can stem from racial trauma is an essential step to providing culturally competent maternal healthcare — and that doesn’t just apply to doulas.
“It’s imperative that even if you don’t hire a doula, that at least your persons that are going to be in this space with you are educated on what can happen,” Redditt said. “So that way, there is some level of advocacy being done for the birthing person.”
In Columbia, Brittany Fatoma has been working as a doula since 2021. She is part of the Mid-Missouri Black Doula Collective — a group working to improve maternal health outcomes in their everyday work. Fatoma specializes in caring for unique clients that do not fit under the umbrella of perinatal health. Because of this, many of her clients have prior risk factors or other special conditions that may impact their pregnancy.
In her work as a full-spectrum doula, she has seen firsthand how health disparities Black birthing people face can impact their experiences and outcomes during and after pregnancy. For example, Black women receive cesarean sections, or c-sections, at a rate 5% higher than their white counterparts. And although c-sections account for nearly a third of all deliveries in the United States, they are still considered major surgery and carry a risk of severe maternal morbidity that is 2.7 times higher than vaginal delivery.
“A c-section should really just be left for medical emergencies. And that’s not always the case, which is why our numbers are so high,” Fatoma said. “Our Black maternal mortality is so high because our c-sections are so high.”
In Missouri, more than 2.1% of Black mothers experience a serious health impact from their pregnancy, known as severe maternal morbidity. That’s compared to only 0.9% of white mothers. With high rates of maternal mortality that disproportionately impact Black patients, Fatoma believes it is crucial for providers to be culturally mindful.
“I think what we’re seeing in those numbers, specifically in the state of Missouri, is that lack of,” Fatoma said. “The fact that someone’s culture, or their identity, is not taken into consideration.”
In order to provide culturally mindful care for all birthing experiences, Fatoma gets to know her clients and their cultural backgrounds by having interview-like conversations. These conversations explore an individual’s experiences and specific health needs, helping her see the client beyond their medical history and understand them as a person with a complex and valuable story. Fatoma said this kind of culturally-informed practice is what brings many of her clients to seek out doula care.
Fatoma said she believes getting to know a client’s lived experiences is a necessary step in order for all maternal health providers to offer equitable and mindful care. But in order to truly change the system, she is adamant providers must first look within themselves.
“In order to have this culturally competent maternal health, you have to first acknowledge that you’re not culturally competent, right?” Fatoma said. “And I think it begins with the person first.”
Full-spectrum doula Nkenge Miller, owner of Doula’s Intuition, lives and works with clients in the St. Louis area. Although she cares for clients from all walks of life, she often has Black clients who specifically seek out her care as a Black doula. In her experience, it can be extremely important for clients to have access to a diverse pool of providers that match their cultural backgrounds — especially in an area as intimate as a birthing space.
“This person is going to see you in your rarest, most vulnerable moments,” Miller said. “You don’t want that to be someone that you’re not comfortable with and that your family may not be comfortable with.”
Miller is proud to be a Black doula offering comprehensive, culturally competent care to all of her clients. She believes having doulas like her to represent the specific needs of Black birthing people is critical — but it doesn’t stop there. As awareness for maternal mortality and racial impacts on health grows, Miller imagines a future where people from all cultural backgrounds can find equitable care from providers that represent their communities.
“We need a doula rainbow for every type of person,” Miller said. “You know, because you want everyone to have the same support.”
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