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When Lennise O’Dwyer had her first daughter nearly three years ago, she felt pressured by medical providers to have a cesarean delivery because the baby was expected to be large.
This March, while working with a doula who is Black like her, she went into labor with her second daughter, hoping for a vaginal delivery. She ended up having another C-section, but this time it was her choice.
The doula, or birth coach, “did a good job of making sure I felt empowered,” said O’Dwyer, 33, of Madison.
Yenny Juarez Reyes’ first daughter was stillborn last year. After she became pregnant again six months later, her Latina doula connected her with a psychologist, helped her practice mindfulness and guided her through the birth of a healthy girl this April.
“I had so many questions, and she was always willing to answer them,” said Juarez Reyes, 24, of Madison.
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Doula Maricela Martínez Munguia, right, uses a doll to discuss breastfeeding techniques with expecting parents Yenny Juarez Reyes, left, and Bryan Antimo at the Madison office of Roots4Change, a cooperative of Latina and indigenous doulas. A week later, the couple had a healthy daughter.
Infant mortality, which has long been more of a problem among Black babies than white babies in Dane County and throughout Wisconsin, continues to present a racial and ethnic disparity. The county’s rate of babies who die before their first birthday declined somewhat among Blacks in the past decade, but the decrease is not considered statistically significant. Among Latinos, or Hispanics, the rate has increased, in a statistically significant way.
Both groups now have infant mortality rates more than double the rate for white babies, a problem community organizations, medical providers and health officials are trying to address through multiple efforts, such as connecting pregnant women with doulas before, during and after birth.
“We look at infant mortality as kind of a barometer or thermometer of the health of the rest of the community,” said Sarah Hughes, a supervisor at Public Health Madison and Dane County. “When it’s hitting certain pockets of our community so much more than others, that’s really alarming.”
‘Saving Our Babies’
The Madison-based Foundation for Black Women’s Wellness and the Dane County Health Council last year launched a care coordination program to link high-risk pregnant Black women with doulas and other services, including support for food, housing, employment, transportation and mental health counseling.
The effort, called ConnectRx Wisconsin, screens patients for socioeconomic needs at clinics through Epic Systems electronic medical records. It is part of Saving Our Babies, an initiative started in 2018 by the foundation and the health council, which includes Madison-area medical providers and other partners.
Lennise O’Dwyer said working with a Black doula during and after her pregnancy with daughter Alyssa helped her feel empowered by the process. “I feel like I got spoiled,” she said of doula Tracey Russell. “She was very hands-on from the beginning.”
“We are seeing promising outcomes,” said Lisa Peyton-Caire, CEO of the foundation. But, “it’s not shocking that we don’t see major changes in the (infant mortality) data” yet, she said.
“To see the data change, structurally and systemically, we’ve got to make bigger shifts in the things that drive economic security, which then drives family stability and security, which then drives better health outcomes,” Peyton-Caire said.
The county’s Black infant mortality rate, which had long been higher than for whites, dropped nearly 70 percent from 1990-2001 to 2002-2007, a dip that gained national attention as a possible success story. But the rate went back up starting in 2008 and generally has remained high, leading to renewed efforts to reduce it.
In a 2019 report, the foundation and the health council said stressed families, economic struggles and institutional racism are key reasons Black babies in the county are twice as likely as white babies to be born with low birth weight, a key factor in infant mortality.
Safe sleep campaigns, breastfeeding programs, support groups for Black pregnant women and home visits by nurses to pregnant women and new mothers have helped, Peyton-Caire said. A Fetal Infant Mortality Review process by the city-county health department also analyzes fetal and infant deaths to identify patterns.
Doulas Maricela Martínez Munguia and Aída Inuca are members of Roots4Change, a cooperative of Latina and indigenous doulas in Madison. At a recent visit, they worked with Yenny Juarez Reyes, who was 38 weeks pregnant, and her partner, Bryan Antimo, on what to expect during the birthing process.
ConnectRx goes a step further by examining the non-medical needs of every pregnant woman getting care, Peyton-Caire said.
“It has shifted the way we are addressing perinatal care delivery to Black women,” she said. “We expect and hope to see the data begin to demonstrate to us how this may start moving the needle over time.”
Helping Hispanic families
Roots4Change, a Madison-based cooperative of Latina or indigenous doulas that started in 2018, has received grants from the state and the UW School of Medicine and Public Health to expand its services, train new doulas and help medical providers better understand various Latino cultures. Another UW medical school grant has helped families get fresh food.
“Providers sometimes really don’t understand the community, the families,” said Mariela Quesada Centeno, Roots4Change coordinator. “Families, many times, are afraid of providers. It’s a highly hierarchical relationship.”
Pilot programs through Dean Health Plan and Group Health Cooperative of South Central Wisconsin pay for doula services for patients on Medicaid, Quesada Centeno said. Access Community Health Centers has covered doula services for some high-risk Latina pregnant women, and the United Way of Dane County has supported doula and mental health services, she said.
For other people on Medicaid or those with private insurance, it can be difficult to get reimbursement, she said. The state has funded pilot programs for doula coverage, including one involving Harambee Village Doulas in Madison that has finished. Gov. Tony Evers has proposed expanding doula coverage through Medicaid statewide in his last two budgets, but such proposals have not been approved.
Yenny Juarez Reyes, left, and partner Bryan Antimo had a stillborn baby last year. During their subsequent pregnancy, at visits with a doula, they worked on mental health and mindfulness. Their healthy daughter, Helina, was born in April.
Another challenge is understanding why Dane County’s Hispanic babies of mothers born in the United States, who account for about 40% of the Hispanic births in the county, are more likely to die than the 60% whose mothers were born outside of the U.S. In 2019-2021, the infant mortality rate for Hispanic babies of U.S.-born mothers was 13.8 per 1,000 births, compared to 5 per 1,000 for those with foreign-born mothers, according to Nicole Morales, an epidemiologist with the city-county health department.
Foreign-born Latinas might be coming to Wisconsin at an older age, while there might be more higher-risk teen pregnancy among U.S.-born Latinas, Quesada Centeno said. Also, new arrivals may be less exposed to the stress of American culture, she said.
Breastfeeding rates are high locally among Latina mothers immediately after birth, but there’s little data on how many continue to breastfeed for the recommended six months or more.
“There are many barriers” to breastfeeding, such as being without extended family and needing to return to work, said Aída Inuca, another doula with Roots4Change. “When they go back home , they need support.”
Empowering mothers
O’Dwyer moved to Madison in September, shortly after becoming pregnant, because her husband Curtis started working on his doctorate in education at UW-Madison. With no family in the area, some financial stress and the challenge of raising her 2-year-old daughter, O’Dwyer connected with doula Tracey Russell through ConnectRx.
Tracey Russell, with Russell Family Doula Services, right, listens to client Lennise O’Dwyer, who holds her daughter, Alyssa, who was born in March.
Russell visited O’Dwyer, accompanied her to medical appointments and called to check in. When O’Dwyer became exhausted near the end of the pregnancy, Russell encouraged her to start maternity leave a couple of weeks early instead of waiting until she went into labor. O’Dwyer works as a patient care coordinator at SSM Health.
Russell helped O’Dwyer attempt to have a vaginal birth after her previous C-section, which can be difficult to do, and plan for when she might need to opt for another C-section instead. After hours of labor with little cervical dilation, perhaps because of scar tissue from the previous C-section, O’Dwyer chose another C-section. But it didn’t feel forced like before.
“I felt confident in that decision,” she said, “because we did everything we could.”
Her healthy girl, Alyssa, was born at St. Mary’s Hospital in Madison on March 15.
Juarez Reyes and her partner Bryan Antimo were still mourning the full-term stillbirth of their first daughter when she got pregnant again. Juarez Reyes had developed a bad case of COVID-19 two weeks before the stillbirth, but she said doctors aren’t sure why the baby didn’t survive.
The uncertainty led to anxiety during the subsequent pregnancy, as the couple worried about another stillbirth. Maricela Martínez Munguia, their main doula through Roots4Change, connected Juarez Reyes online with a psychologist in Mexico for several visits. Martínez Munguia and Inuca, their back-up doula, led the couple in mindfulness sessions, which helped reduce their angst.
Doula Aída Inuca, shown with client Yenny Juarez Reyes, is helping to train Latina community health workers who might become doulas, through Roots4Change, a cooperative of Latina and indigenous doulas. “As the community is increasing, the needs are also increasing,” Inuca said.
“When you’re in the grieving process, it’s something you need to work on because your mind can control you instead of you controlling your mind,” Juarez Reyes said.
An office manager at Literacy Network, Jaurez Reyes came with her family from Honduras to Madison when she was 6 years old. Antimo, a program manager at the Tenant Resource Center and a native of Mexico, came with his family when he was 5.
With the birth of their healthy daughter Helina on April 22 at Meriter Hospital, they’re happy to be starting their family here.
“We’re pretty excited … and exhausted,” Juarez Reyes said. “We’re ready to be the best parents we can be.”
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