Black Doulas Matter: Why Minority Representation Matters in Birth Work
Martin Luther King, Jr., once said, “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane”(9). The relationship between Black women and healthcare has been strained for centuries. History tells us that physicians were the hired guns of slave owners. Physicians would accompany potential buyers to attest to the value of a slave, based on their ability to perform work.
Physicians’ disbelief of African American pain and illness has dated back for centuries as well. Many slave owners would provide whippings and lashings as a “treatment” for the ailments of African Americans. This was believed to be effective, under the assumption that slaves would fake illness to evade work.
Thus began the phenomenon known as Black Iatrophobia or African Americans’ fear of doctors and medical professionals. In The Medical Apartheid, Harriet Washington writes that “the tragedy of illness at present is that it delivers you, helplessly, into the hands of a profession which you deeply mistrust”(9). Centuries of botched experiments by White physicians and researchers—for example, The Tuskeegee Syphilis Study—, created a ripple effect resulting in a climate where Black Iatrophobia is alive and well today (5).
Current Social Climate: African American Health Disparities
Black Maternal Mortality rates are significantly higher than that of other races. Non-Hispanic Black Infants have an 11% mortality rate, which is 2.3 times higher than their White counterparts (4). Data overwhelmingly shows that racial and ethnic minorities receive lower-quality healthcare than other races, even when insurance, income, age, and risk factors are accounted for (1). It’s clear that racial biases still run rampant in the healthcare system.
Black Doulas: Bridging the Gap
Tracie Collins, the founder of the National Black Doulas Association, said in a recent Fertility Doula Training that “Black women don’t hire doulas for luxury — they hire doulas because they want to live.” The role of any doula is to provide emotional support, to help the birthing parent advocate for themselves, to establish a trusting relationship, and to co-create an environment that feels safe for the birthing parent.
It’s necessary to create a safe laboring space — where the birthing parent feels as though they have full autonomy over their own body, where they feel heard, and where they are trusted to make well-informed decisions about their birth process. Lauren McClain explains the importance of mom feeling safe in her birthing space, saying “an environment of love and calm that makes the uterus contract, it should come as no surprise that the same environment protects the laboring person from added difficulties and from trauma.” Specifically, we know through experience and study that external cues of safety allow birth to work optimally and protect the brain from experiencing trauma.”(3) Black Doulas can see the pain, acknowledge the health disparities, and hold space for the birthing parent on a deep, ancestral level. There’s a wholehearted and guttural understanding.
Doulas help to level the playing field caused by racial bias and healthcare disparities. By providing education for the birthing parent, fostering a trusting relationship, and offering prenatal, as well as postpartum support, doulas have been shown to reduce emergency cesarean births and reduce the need for medical interventions during labor.
Catherine Pearson and Lena Jackson explain, “I think we need more providers of color across the board, so women have the option of working with a person of color if that’s important to them.” They go on to say, “Teaching providers to really listen to women — especially black women — can save lives.”(6)
It’s imperative to recognize that the goal for Black birthing parents shouldn’t be merely to survive. We deserve to thrive through labor and beyond. Because of skin color, many of our foremothers were not given this opportunity. The work lies in providing the resources and a healthcare system that allows Black birthing parents to thrive.
BS Communication, M.Ed Advanced Teaching Practices, BIRTHFIT Coach, ISSA CPT, RYT-200, EMT-Basic
- Bridges. (n.d.). Implicit Bias and Racial Disparities in Health Care. Retrieved August 25, 2020, from https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/
- Clemmons, J. (2020, April 29). Life or Death: The Role of Doulas in Improving Black Maternal Health. Retrieved August 25, 2020, from https://www.healthline.com/health/parenting/black-maternal-health
- McClain, L. (2018, December 11). Lauren McClain. Retrieved August 25, 2020, from http://www.specialbeginnings.com/2018/12/19/birth-feeling-safe-matters/
- Office of Minority Health. (2019). Retrieved August 25, 2020, from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4
- Nix, E. (2017, May 16). Tuskegee Experiment: The Infamous Syphilis Study. Retrieved August 25, 2020, from https://www.history.com/news/the-infamous-40-year-tuskegee-study
- Pearson, C., & Jackson, L. (2019, February 28). Why We Need More Black Doulas. Retrieved August 25, 2020, from https://www.huffpost.com/entry/why-we-need-more-black-doulas_l_5c6aff56e4b0b9cc78ff2b3f?guccounter=1
- Rab, L. (2019, December 16). The Secret to Saving the Lives of Black Mothers and Babies. Retrieved August 25, 2020, from https://www.politico.com/news/magazine/2019/12/15/black-mothers-matter-079532
- Racial and Ethnic Disparities in Obstetrics and Gynecology. (2015). Retrieved August 25, 2020, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/racial-and-ethnic-disparities-in-obstetrics-and-gynecology
- Washington, Harriet. A. (2006). Medical Apartheid.
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