When Melissa Davis was a pregnant Black teenager in Baltimore more than 30 years ago, she felt that no one was interested in making sure she had an ideal birth experience.
Such traumatic experiences are common among Black parents, research suggests. Davis mourned the birth experience she could have had — and decided to help other parents-to-be secure the births they deserve. Now a doula who’s assisted around 400 births, Davis and other Black doulas are focused on serving Black families — a demographic that has long battled higher maternal mortality rates yet has struggled to find advocates to address their specific birthing needs and concerns.
“I was rushed and dismissed,” said Davis, a mother of eight children. “I know what a mom is going through … I’m the one that’s standing in the gap.”
The United States has the highest maternal mortality rate in the developed world, with Black women faring the worst: They are three times more likely to die of a pregnancy-related cause than White women, according to the U.S. Centers for Disease Control.
Giving birth in the District, compared with other parts of the United States, is particularly dangerous for Black people. In 2018, one analysis showed that about 41 people giving birth in D.C. die for every 100,000 live births — about twice the nationwide rate. Last year, a group established by the D.C. Council to study this problem found that 90 percent of those pregnancy-related deaths were of Black people.
Giving birth is intimidating when there’s the chance you will become a statistic, according to Kindra Hunter, one of Davis’s clients. Hunter, in her late 30s, decided to find a doula to guide her through the birth of her first child after hearing horror stories from friends about difficult births.
Hunter wanted someone who would help her calm her anxiety, she said. She wanted someone who wasn’t dogmatic about what a birth should look like — one who wouldn’t object to the use of painkillers, for example.
And she wanted a Black woman.
“As a Black female, I wanted to be able talk to someone who had been through this journey,” she said. “Not just for themselves but with other Black women.”
With Davis’s support, Hunter gave birth to her son Kaden two months ago after three prenatal appointments with Davis. Not only did Davis explain how to a pack a labor and delivery bag, she showed up to the hospital with a laminated birth plan and has remained in contact with the new family since, hosting stroller walks to build community among new parents and offering advice on diaper changing.
“I can’t think of something where my money was better spent — and I don’t say that lightly,” Hunter said.
The cost is one of the major obstacles to hiring doulas for communities that lack the means. Dawn Smith, who became a doula at the suggestion of a nurse after she attended a friend’s birth, said many people aren’t even aware such services are available.
“There’s not a lot of knowledge [about doulas] in the Black community,” she said. “When I had my son and daughter I did not know anything about a doula. That was for the rich and famous.”
Tracie Collins, CEO of the Atlanta-based National Black Doulas Association, said she founded the organization in 2017 after working as a birth professional for most of two decades. Earlier in her career, there wasn’t much talk of Black doulas.
“Everything was White-centered and White-focused, but we were the ones that were dying,” according to Collins.
Getting doulas in the birthing rooms of Black parents-to-be means taking on financial and cultural battles, Collins said. Insurance may not cover the cost, which can run into thousands of dollars depending on a birth’s length and complexity. Hospitals, obstetricians and nurses may resist working alongside doulas they see as uninformed outsiders. Families may not understand the need for them, either.
The results are stark disparities in maternal mortality that are part of a pattern as old as slavery, according to Collins. Black bodies have been disrespected — bought and sold, used in medical experiments — for centuries.
“Everywhere that there is a Black or Brown birthing body is somewhere where a Black or Brown birthing professional needs to be,” she said. “We see resistance everywhere.”
Darshal Smith, a doula operating out of Prince George’s County, said she was exposed to birth work from a young age by her grandmother, a nurse. After studying biology in college, she left a career as a clinical research manager last year to become a full-time doula and has assisted at approximately 80 births.
People able to find Black birth care providers often breathe a “sigh of relief,” Smith said. Without an advocate in the birthing room, parents-to-be may be subjected to a lower standard of care based on misconceptions about Black bodies — the assumption that Black people have high blood pressure, for example. Such assumptions may lead care providers to induce labor before they would with other patients.
“I think it’s important for any woman regardless of how you identify to have a doula,” Smith said. “When we’re talking about an African American person, a Black person, or a person of color, it’s being able to understand where we come from — the struggles we’ve had to face.”
Ta-mela Joseph, another one of Davis’s clients, got pregnant before the coronavirus pandemic. She said she looked for a Black doula because “Black women look for other Black women in these type of situations because there is such a bad history of us not being believed.”
Though the 18-hour home birth Davis guided her through is a memory — her son Stephen turns 3 next month — Joseph remains in touch with her doula and other parents. On a recent rainy Sunday, some of the families Davis brought together strolled through Annapolis Mall.
Their births were over, but they were still hanging out.
“We’ve made our own community to help each other out,” Joseph said.