Projects

For a Latina woman, childbirth is a moment she dreamed of since she was a child. That dream is then shattered in this world that is built by white men who get to decide how their birth unfolds, white women who get to decide what’s “trendy”, and white medicine that diminishes everything any woman of color has to say. The debate on whether a home birth or hospital birth is difficult for many women, and in my opinion there is a solution that helps both: a doula.

A doula or midwife is a woman who helps the pregnant woman with not only childbirth, but also serves as a mental and emotional trainer in all aspects before, during, and after home or hospital delivery. Many times doulas are also medically certified and have a cultural and scientific education or come from a diverse culture themselves. In the modern world with all this technology and many male doctors dominating the world of childbirth, women depend on these midwives to respect their customs, but also adapt the customs that can hold a risk for mothers.

According to one article, 08% of Latina or Hispanic women do not receive prenatal care. The lack of prenatal care can lead to premature births and late neonatal deaths. 53% of women don’t use an epidural during childbirth, which is fine, but in many cases, it’s a belief that pain was a necessary part of childbirth, but they don’t know when the pain is too much to bear. A doula could not only be a literal translator, but a cultural translator. An educator, to teach these women and their families about modern technology and the importance of checking in, while being respectful of culture.

The article “Culture of Childbirth ” says, “Never in all of human history have parents spent so little time with their children as they do now. Never in all of human history have so many children been born through cesarean sections.” This is a huge problem, and it is the obligation of the doula to take care of being the voice of the mother and if you are in the hospital, to be the person she can count on. Not only can they be there for support, but be a third party to fight for the patient if needed in a hospital setting. For instance, a doula can fight for the rights of a Muslim women to get an all female staff or fight for a women who can safely continue her labor and proceed with a vaginal birth and not be shipped off for a C-section because it is quicker.

In many Latin cultures, many new mothers believe in the period of rest of forty days where her family members, or doula, take care of her and prepare homemade remedies, that if the new mother takes, it is believed that their chances of postpartum depression is reduced. The roots of “Cuarentena” are believed to go back to the Bible, where a passage in the Book of Leviticus calls for the need for 40 days of purification after the birth of a woman’s child.

Not only is this period believed to have deep cultural roots, but also is rejuvenating for the mother to spend her time bonding with her new baby, and not feeling isolated. With the help of a doula during this time, she may also be the “blame placer” for when family becomes too much and overstays their welcome. Doulas can not only turn people away, but fill in the places left open if a mother is alone.

For those mothers who are going the journey solo, the lack of support from their own maternal figure can leave them helpless and terrified. The emotional support of a doula provides these women with stability, especially in the religious world of the Hispanic community, many times single mothers are single in not only the sense of a partner, but emotionally orphaned by her family. The original translation from greek culture of a doula is “‘female slave for the child-bearing woman.’Today the word has come to mean ‘One who mothers the mother.’”

A doula is an activist, a protector, a medical professional, a mother, and anything you need them to be – and sometimes, they are the barrier between life and death.

Emily Teixeira is a student at Tufts University. This blog piece was submitted in the course “Our Moms Matter: Exploring America’s Multifaceted Maternal Health Crisis First Year Seminar” led by Shubheccha Dhaurali in Fall 2022.

Originally published on motherlab.org (opens in a new tab).

On April 9th, Dr. Ndidiamaka Amutah-Onukagha, Dr. Bathsheba Wariso and their colleagues virtually welcomed nearly 1,400 attendees to the Fourth Annual Black Maternal Health Conference, hosted by the Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab. Throughout the afternoon, professionals in the Black maternal health field spoke on the topic of doulas and their ever-growing importance to the Black community. The speakers, which included renowned midwife and public health professional Shafia Monroe – better known as Mama Shafia – and Dr. Monica McLemore, drew attention to the Black maternal health crisis and highlighted the significant role that doulas can play in combating maternal morbidity, maternal mortality, and systemic racism Black women face during childbirth.

Embracing the Doula Tradition

To kick off the afternoon, Mama Shafia brought “self-determination” into the discussion of doula care, empowering the Black community to take back, re-define, and reclaim the role of the doula as a practice rooted in Black tradition, instead of in slavery and racism. Mama Shafia promoted the way of the Grannie Midwife and the African Midwife — the individuals in the community who practice holistic, full-scope birth traditions by going above and beyond for birthing mothers by offering not only birthing assistance but postnatal care and supportive childcare. These are the Black traditions that she called upon doulas to embrace to “empower the Black community”. Mama Shafia is the founder of the International Center for Traditional Childbearing (ICTC), and founding member of the Oregon Doula Association.

Dr. Audra Meadows, an obstetrician-gynecologist who holds a leadership role with Massachusetts Perinatal Quality Collaborative, also emphasized the importance of centering on doulas to combat the tragic maternal mortality rate in the United States, which is three times as high for Black patients than their white counterparts. Dr. Meadows highlighted that many of these deaths are preventable and that race should not be used in medicine as a proxy for health outcome differences. There is no predisposition which exists to make Black birthing experiences so lethal. Societies must begin to value the lives of our mothers by instituting systemic change to provide the accessible, safe, and holistic treatment they deserve.

Listening to Mothers

Both Fatima Diankeh, the Learning and Development Manager at She+ Geeks Out, and Dr. Nakeitra Burse, owner at Six Dimensions, embrace the power of narratives and understand that change happens by giving a voice to those most affected by reproductive inequity. Similar to Mama Shafia, who empowers women to take control of their birth experience, Fatima empowers birthing women to speak out. Fatima’s film, Stories of Black Motherhood depicts mothers speaking about pregnancy and healthcare experiences, the joys of being a mom, and their hopes for their childrens’ futures. Dr. Burse’s film, The Power in Labor: There is Hope, highlights the inequities in care between Black and white birthing experiences through her family’s recounting of the loss of their aunt, Kim, after her delivery.

Jennie Joseph, a British-trained midwife, women’s health advocate, and the founder and executive director of Commonsense Childbirth Inc, has used her experiences to advocate for Black mothers by creating The JJ Way®, an evidence based maternity care model. The JJ Way is a midwifery-based, culturally relevant care model aimed to improve both birth outcomes and access to care for women of color. Midwife Joseph discussed the impact of doulas through one of her patient’s birthing experiences where her patient received a lack of support and protection at a hospital. Joseph also demonstrated the effectiveness of community-based models where the birthing outcomes of pregnancies and deliveries involving doulas and midwives had fewer preterm and low birth weight outcomes.

Building the Doula Village

Quatia “Q” Osorio, a doula trainer-activist, shared a powerful and energetic framework for fellow doulas looking to build their practice and their network. She highlighted the importance of creating a long-term plan, envisioning impact, and staying true to one’s own foundational values. She dropped valuable gems for fellow doulas and filled a void that several attendees seemed to have been feeling regarding mentorship and coaching. Q’s energy was felt by attendees, with comments firing away in the Zoom chat such as: “You are hitting every point I need in this stage of my life! Your energy is so appreciated [right now]!” To connect with Q, follow her on Twitter: @journ3i

Dr. Monica McLemore, a public health nurse and researcher of inequities in maternal health, shared another actionable framework to tackle perinatal health disparities and a broken healthcare system: The Three R’s, Retrofit, Reform, or Reimagine. Identifying one of the conceptual pillars, and engaging in authentic conversation with stakeholders strides toward positive and sustainable changes. Chanel Porchia-Albert, Founder and CEO of Ancient Song Doula Services, also addressed tackling disparities on a systemic level. Porchia-Albert discussed the importance of justice and equitable policy involving doulas. She asserted that they are central to the US healthcare system and should be treated as such, especially in Black communities. As doulas become more prominent and accepted members of the healthcare support system in traditional settings, it is important to take heed of Porchia-Albert’s message that doulas will help mend a broken system, but there will need to be equitable policies set in place that ensures they will do so without limitations.

Overall, the MOTHER Lab gathered over 1,400 attendees from a diverse array of disciplines and provided a space for learning, discussion, and action. Both presenters and attendees shed light on the importance of centering on doulas to re-establish traditions and rituals for Black birthing bodies in order to promote safer birthing experiences. The opportunity to use this platform to spread awareness and educate attendees on topics is central to the MOTHER Lab’s mission. The lab will continue to empower Black mothers through research, advocacy and mentorship utilizing skills, connections, and knowledge gathered through the conference.

Acknowledgments

The Black Maternal Health Conference was an event hosted by the Maternal Outcomes for Translational Health Equity Research (MOTHER) Lab by Founder and Principal Investigator Dr. Amutah-Onukagha. Several MOTHER Lab members were integral in the organization of the conference.

Thank you to all of our speakers and sponsors for supporting and participating in our wonderful and highly successful Black Maternal Health Conference. Sponsors include Tufts University School of Medicine, Pathfinder International, the Massachusetts League of Planned Parenthood, Brigham and Women’s Hospital, and Howard University Hospital. So much gratitude to our conference keynote speakers Shafia Monroe and Dr. Monica McLemore, our featured speakers, as well as Chanel Porchia Albert, Dr. Audra Meadows, Fatima Dainkeh, Dr. Nakeitra Burse, Tariana Little, DrPH, Quatia Osorio, Jennie Joseph, and Marlene Boyette. Finally, a huge thank you to our conference organizers for the dedication and hard work; and to our nearly 1400 attendees, thank you for your time, attention, and dedication to the future of Black maternal health.

Originally published on motherlab.org (opens in a new tab).

America’s Healthcare Conglomerate was built on the bodies of Black women. Major modern medical innovations and research can be accredited to their pain, suffering, and imprisonment. The stains of slavery still persist today in the US’s medical system as Black women are three-four times more likely to experience pregnancy-related deaths and maternal health complications than white women. Structural racism and discrimination are major drivers in maternal health disparities and are prominent social determinants of health. Due to COVID-19, these disparities have only been exacerbated, but innovative solutions such as the use of telehealth services alongside community-based support models could be promising in preventing the deaths of Black mothers.

The US is one of the wealthiest, developed countries in the world, yet rates of pregnancy-related morbidity and maternal mortality have more than doubled in the past 30 years. In traditional healthcare settings, one in six women have reported experiencing one or more types of mistreatment, such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Community-based maternity healthcare models are a solution to these alarming rates of maternal mortality and mistreatment as they offer enhanced care and support. These models include Doula and Midwifery services during labor, perinatal, and postpartum periods. Doulas and Midwives address social factors negatively affecting maternal and infant health, provide psychosocial support to bridge cultural gaps between providers and clients, and provide care coordination grounded in reproductive justice.

Doula-assisted mothers were four times less likely to have low birth weights (LBW), two times less likely to experience birth complications, and significantly more likely to initiate breastfeeding – improving the overall health of both mother and child. Though official research on Doula care efficacy is limited, with the research that has been done, studies have reflected the continuous benefits of having a Doula such as a decreased incidence of cesarean deliveries and negative childbirth experiences. These impacts are that much more valuable to Black women who systematically experience higher rates of poor birth outcomes such as higher rates of Cesarean deliveries, preterm births, low birth weights, and infant deaths.

There have been tremendous hurdles and uncertainties for pregnant and birthing persons in the past year. In order to prevent the spread of COVID-19, clinical settings/providers have understandably prohibited partners/birth supports during pregnancy processes such as attending labor and delivery. While well-intentioned, some previously mentioned policy changes have had negative impacts on birth outcomes such as increased cesarean deliveries, heightened separation anxieties of mothers and newborns, and over medicalization, especially with Black mothers. It is important to note that policies that uphold the human rights of birthing people and policies that decrease the risk of COVID-19 transmission are NOT mutually exclusive.

In order to continue providing perinatal services and support, many providers have increasingly switched to remote and virtual care options in order to reach their clients due to the impacts of COVID-19. The current pandemic has brought about “remarkable ingenuity” with telehealth and telemedicine technologies providing expecting families health care services through online video appointments and virtual chat windows allowing for quick and convenient access to providers. Many believe this will help close the gaps in racial and maternal health disparities as currently, the vast majority (98%) of maternal-fetal medicine specialists in the are located in cities, and pregnant patients living in rural areas, most often Black women, are left without access to care.

Though telemedicine and virtual models of health care include a variety of benefits, opponents of such models argue that virtual settings might do more harm than good. In order to receive virtual heath care, one must have access to the internet and associated software to be able to communicate with their providers. Even in the 21st century, an era of major technological innovation, not everyone has access to broadband, nevertheless access to reliable broadband. To combat this point, it should be noted that women, the majority Black, currently living in maternity care deserts would greatly benefit from any available maternal healthcare services– be it virtual or in-person.

This past year’s pandemic has only exemplified the need for community-based maternal telehealth support services for black birthing persons as the work Doulas and Midwives do to provide empathy and greater mental and emotional assistance to women are unsurmountable. The compassion and established community support system that they provide is associated with overall greater maternal satisfaction during labor, birth, and postpartum which can be emulated through a virtual setting during these unprecedented times. The implementation of this model will ultimately work to eliminate preventable maternal deaths in the USA and save Black mothers’ lives. Maternal health is the health of our humanity, making the eradication of such disparities that much more important.

The authors of this blog post are members of the Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R.) Lab working to research maternal health disparities and advocate for policy changes.

Originally published on motherlab.org (opens in a new tab).

Vaccination is by far the most essential thing we can do to protect ourselves from disease, and it is especially crucial when it comes to the human papillomavirus (HPV). HPV is widespread, and according to the Centers for Disease Control and Prevention, “more than 42 million Americans are infected with disease-causing HPV strains, and around 13 million Americans, including teenagers, are infected each year”.1 HPV infections are present in a variety of forms including cervical cancer and precancers, oropharyngeal cancer, and other anogenital cancers, but HPV is best recognized for causing cervical cancer. HPV is the most prevalent sexually transmitted disease in the United States, and current vaccinations are advised to be administered beginning at the age of 11, or before sexual activity begins. Despite the fact that HPV-related cancer rates are expected to decline in the United States, inequalities in vaccination rates across race and ethnicity are predicted to persist.

One of the important ethical questions surrounding the HPV vaccination is why immunization rates vary based on race and socioeconomic status. Healthcare providers seek to attain a high HPV vaccine rate in patients in their early teenage years because it provides the best protection against HPV prior to exposure through any sexual activities. The current HPV vaccination is given in three doses and is recommended for both males and females starting at the age of 11 to 12. Because “young, Black women have a higher prevalence of HPV,”3 it’s important to address this correlation between immunization rates and race. An infection with HPV has the potential to impact future pregnancies in these women, as cancer treatments not only impact fertility, but pregnancy after a trachelectomy (surgical removal of the cervix) leads to a higher risk of obstetrical complications including preterm birth, premature rupture of membranes, and abnormal bleeding.4

HPV infections are more common in Black women than those in other racial and ethnic groups, emphasizing the significance of early HPV immunization for Black children.4 To enhance the health of Black women, we need to intensify HPV prevention and education initiatives. Specifically, providers should receive education on these stark differences in vaccination rates, and subsequently make efforts to educate parents of all races and encourage HPV vaccinations amongst all children. Further, even with the overwhelming benefits of the HPV vaccination, immunization rates continue to fall along socioeconomic lines.2 “Progressively higher SES was positively associated with higher rates of vaccination initiation and completion. In this observed difference, completion of the HPV vaccine varied more than initiation”.2 The barriers to health care are always shockingly present, but primarily exist with multiple-dose vaccines. For completion of the HPV vaccine series, healthcare providers should remind patients and parents at each subsequent visit and establish policies that encourage medical staff to follow up with parents, reminding them of their child’s next dose date. Considering the barriers to transportation and the inability to take time off work, those in a lower socioeconomic bracket are at a disproportionate disadvantage.2 By communicating with patients and guardians, providers can determine how to best meet the needs of these patients and connect with other allied providers such as social workers to arrange solutions to address transportation barriers.

Furthermore, it’s important to understand that Black women have a higher incidence of HPV-related cancers.3 Despite the fact that the incidence of cervical cancer in Black women has decreased in recent years, higher rates continue to persist and “young Black women were found to have significantly longer persistence of high-risk HPV types when compared to young white women.”3 In the United States, Black women account for 25% of cervical cancer cases. In contrast, Caucasian women account for only 18%.3 These inequalities illustrate how racial and ethnic disparities in healthcare persist to this day.

When considering women who have been diagnosed with cervical cancer while pregnant, there is data to support that many of them were in their early stages of the illness.5 If an individual is more than three months pregnant, their physician will likely encourage them to continue with the pregnancy, but the baby is at a higher risk for preterm delivery via cesarean section, further increasing risk for mortality in both the mother and baby.5 Additionally, because of the HPV presence, it’s possible that following delivery, the mother will undergo a hysterectomy along with subsequent chemotherapy and radiation to address the underlying cervical cancer.5 Thus, not only do these women face higher mortality rates, but they also face higher odds of requiring hysterectomies, which prevent them from becoming pregnant in the future.

To increase HPV vaccination rates amongst women of color and prevent these pregnancy-related complications, we as a healthcare community must commit to providing education on how the HPV vaccine works and introduce the vaccine as a social norm. The first step is to encourage Black parents to get their children vaccinated, and one of the most effective methods to do so is to highlight the importance of vaccination and its role against cervical cancer. One of the most successful strategies to raise the percentage of the target population that receives the HPV vaccination is to connect with parents and family members regularly to remind them to get the vaccine and encourage communication around any reservations against the vaccine.

References

1. https://www.cdc.gov/hpv/parents/about-hpv.html
2. https://www.sciencedirect.com/science/article/pii/S0264410X20309427
3. https://www.sciencedirect.com/science/article/pii/S0090825821003437
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363146/
5. https://www.cancerresearchuk.org/about-cancer/cervical-cancer/treatment/pregnancy

Originally published on motherlab.org (opens in a new tab).