Amid hospital closures and significantly high rates of pregnancy-related deaths in the District, the community-based birth workers known as doulas have increasingly appealed to Black expectant mothers.
Though doula work has become increasingly popular, some people in the field said medical institutions have some way to go in supporting doulas as they guide Black expectant mothers along the birthing process, including pregnancy, childbirth and postpartum.
“[Doula work] takes a lot of stress off of doctors because they wouldn’t have to be as hands-on in the earlier stages of labor, [but] there are some in some hospitals who are not as friendly or welcoming to doulas,” said Muneera Fontaine, a doula of 11 years who practices in the District and currently manages four clients. “I’ve definitely seen things where a doctor did something to a client without their consent. Those situations have become a bit harder to navigate as a doula.”
Fontaine and other doulas have some support in the Wilson Building. If legislation introduced by Council member Robert White (D-At large) passes, expectant mothers in Wards 5, 7 and 8 would have greater access to doulas, also known as perinatal workers, living in their communities. The bill, touted as the Perinatal Health Worker Training Access Act, would fund perinatal worker training programs.
A growing body of evidence suggests that continuous support from doulas can increase birth weight and cause a reduction in cesarean sections. Researchers have also cited cost savings in Medicaid disbursements.
Such amenities could benefit Black expectant mothers in the District. Last year, the Centers for Disease Control and Prevention recorded 36.1 maternal deaths per 100,000 births in the District, compared to the national rate of 20.7. Nationally, Black women, regardless of social status or education level, are more than three times likelier to die from pregnancy-related complications than their white counterparts.
Key causes of maternal mortality include postpartum hemorrhaging, high blood pressure, infection and pulmonary embolism. Public figures such as Serena Williams have brought this issue to the forefront, telling their stories of near-death childbirth experiences and stressing the need for support for expectant mothers with limited means.
Since the 2017 closure of maternity wards at United Medical Center and Providence Hospital, expectant mothers in affected communities, many of whom are of African descent with limited means, have had to travel long distances to meet their health care needs. During its existence, UMC’s maternity ward garnered a reputation as one of the least safe facilities for pregnant women, accumulating reports of improper patient care — including not telling an HIV-positive patient the risks of vaginal birth.
In April, the D.C. Council confirmed members of a maternal mortality review committee. This group under the chief medical examiner would be charged with determining the causes of, and making policy recommendations to address, maternal deaths during pregnancy and up to a year after childbirth. Earlier this month, Mayor Muriel Bowser (D) formed the Mayor’s Commission on Healthcare Systems Transformation, which would compile recommendations about how to improve the District’s health care system in its entirety.
Some city residents, including Council member Robert White, a husband and father of two, have a personal stake in the passage of the Perinatal Health Worker Training Access Act.
“Months ago when I was reading articles about outrageously high maternal mortality rates for Black women in D.C., my wife was pregnant with our second daughter,” White said. “The statistics scared me to my core. Hours after she gave birth, I started working on this bill with my staff from the hospital. Excellent care is available, just not to everyone. We can mitigate this disparity with high-quality, culturally responsive support to women throughout pregnancy and after birth.”