As research shows, Black women across all wealth categories have a higher prevalence of stress than do other groups, is measured by exposure and coping. This phenomenon is noted as the “weathering” theory, which then connects exposure and adaptation to stressors (most likely caused by socially imposed race-consciousness, racism, marginalization, and/or tensions related to discrimination) with deteriorating health, despite wealth and its related indicators.
In America, black women are twice as likely to have a severe illness during pregnancy, and almost three to five times more likely to die from childbirth and pregnancy-related causes than their healthier, less melaninated, White counterparts. Hispanic women are also more than twice as likely to die from childbirth compared to the healthiest population– white women. Black and Latinx women are also 2.6 and 2.4 times as likely as white women to report negative childbirth-related experiences related to race, ethnicity or cultural background, respectively. These women are also 2 to 3 times more likely than white women to be diagnosed with postpartum depression, after which more than half live without care for their mental wellbeing. Research has yet to thoroughly discuss impacts of this theory on other vulnerable populations. Still, it has become increasingly clear that something has to change.
Enter the doula.
A doula is a guide charged with supporting, educating, and advocating for a family (with a particular focus on the new mother) before, during and after the birthing process. They serve as a source of physical, emotional, and intellectual support throughout any and all aspects of a new mother’s journey. They are wisdom keepers for childbirth, involving themselves in doctors appointments, and general activities of learning along the way. They are present for empowerment of the mother (the patient), ensuring that key concepts are not left without explanation or clarification to her and her partner. With the involvement of this birthing coach, women were two to four times less likely to experience cesarean section or other medical interventions during childbirth, extended-length labor, low birthweight (4 times less likely) and postpartum complication (2 times less likely).
Doulas are poised to impact health inequality as we know it. With great disparities existing in birth weight, cesarean section and infant and maternal death across the US, doulas stand to make an incredible difference for vulnerable women in childbirth in particular, and for new parents in general. Their ongoing roles of coach and educator before, during, and after childbirth, and determined health advocacy can stand to shrink the gap between othered women and encourage positive birth outcomes for women and children across the socioeconomic spectrum. As women enter the birthing process with greater knowledge of their anticipated treatments, fully aware of critical milestones and the implications of each medical intervention, and proceed to guide and further othered advancement.
States are also beginning to recognize the potential impact of doulas on health outcomes for othered and disadvantaged women. Minnesota and Oregon have extended access to Doula care to Medicaid recipients. These actions have been followed by New York, and a handful of major insurers, who have also recognized the potential impact of this community health care worker on their respective low-income populations. As the world waits to see the impact of this extended access, we recognize the drastic impact it could make for these families across the life course.
The relationship with the doula can also drastically impact the confidence of these women, encouraging them to take charge of their health, advocate for themselves, and actively participate as members of their own healthcare teams. Beyond that, these interactions impact the health of these newborns from birth, which can drastically improve their chances for success throughout their lives. What is better, these doulas treating othered women are potentially othered themselves, better understanding various cultural intricacies and social perspectives and integrating this knowledge into their interactions with the new parents. An increasing number of formerly incarcerated women and women of color are becoming doulas, sharpening expertise in the social conditions surrounding vulnerable populations and, by nature, incorporating a social determinants of health perspective into both the medical team and approach to health education.
How have doulas impacted childbirth for you and your family? Has having this relationship influenced the way you interact with teams on your health and wellness?