by Katherine Cain –
Amidst a still rising maternal mortality rate that has more than doubled from 1991 to 2014, there is a growing need to tackle the issue and keep mothers healthy and safe during childbirth and the months that follow. Various initiatives have begun on both the local and federal levels with the goal of ultimately decreasing the rate of new mothers dying in the United States.
Among the reasons the maternal mortality rate in this country is so high and still growing – the U.S. is the only developed nation where the rate continues to increase – is that it is simply not easy for pregnant women and new mothers to get the care they need, especially if they do not have good health insurance. Other reasons include the high rate of caesarean sections, which many obstetricians push mothers to undergo with any minor heartbeat irregularity, as obstetrics is the most litigious form of medicine. A c-section is major abdominal surgery, which can then lead to more serious complications. Also, many women are having children older than they used to, often bringing pre-existing health issues into the pregnancy.
The rise of doulas – women who undergo a certification process and are employed to provide guidance and support to women during pregnancy, labor and often recovery – is a step in the right direction in terms of empowering women to make the choices that are important to them, particularly during labor and delivery. Around in an unofficial capacity since the beginning of time to emotionally support women, doulas became official in the 1960’s, emerging as part of the grassroots natural birth movement as women sought less intervention and less medication during childbirth.
There is also extreme racial disparity when it comes to maternal mortality, with women of color three times more likely to die during childbirth or from pregnancy and childbirth complications than white women. Indira Dunbar-Cano and her business partner and cousin Jennell Thompson are working to put a stop to that. Together they co-founded The Passion Birthing Project (PBP), a company that provides support to women before, during and after childbirth. Their vision for PBP is to empower women and ultimately provide them with access to a dignified and respectful birth. They understand that cost has a lot to do with it, and provide many of their services on a pro bono or discounted rate. “We should not let a dollar amount dictate whether or not someone has the proper support that they need,” Dunbar-Cano said.
Both Dunbar-Cano and Thompson have worked in healthcare for decades, and although they only recently became certified doulas about a year ago, it has been a long time coming. After almost a decade of trying for a baby, Dunbar-Cano became pregnant at 39. Due to complications, her water broke about halfway through her pregnancy. With Thompson by her side (“She spoke up for me,” Dunbar-Cano said. “She was my doula.”), they headed to the hospital, where the only option given was to induce labor and deliver her baby, a daughter named Olivia, who was too young to survive.
“It was very difficult, and it lighted my fire,” Dunbar-Cano said. She has since had two healthy daughters, after finding a healthcare provider who was able to help her find what she needed to carry her babies to term.
The women are currently working to launch “The Olivia Fund” which will be created to support families that have faced a similar traumatic past birthing experience. “The ideal candidate will be a woman of color that has suffered a past loss through childbirth or similar trauma,” Dunbar-Cano said. “Our intention is to collaborate with other birth professionals to offer full comprehensive birthing services.” The women plan to fundraise to offset the cost of services so there will be no cost to the family. “It is our intention to honor Olivia as she is truly the passion behind our work and to help change the mortality rates, one birth at a time,” Dunbar-Cano said.
Jeni Howe, a certified birth and postpartum doula, has worked with 44 women to date. Thirty-three of the women gave birth in a hospital, which can be a tricky setting for a doula to navigate, as it’s essential for doulas to perform their duties in a way that keeps the mother feeling safe and empowered, while also respecting the hospital setting around them. With the increased use of doulas, there is a risk that tensions can arise in the labor and delivery room between the obstetrician, who is tasked with delivering a healthy baby, and the doula, who is tasked with ensuring the mother feels supported. “Technically a doula should never be in the role of advocate,” said Howe. “Advocacy is a huge part of the doula’s work, but how that is manifested is very delicate. We are empowering women to advocate for themselves.”
As of 2012, around six percent of women used a doula during childbirth, which equates to 240,000 of the nearly four million women that give birth in the U.S. every year. Of those women who did not have a doula but understood what they were, 27 percent — or over one million — would have liked to have one.
On a federal level, various initiatives are in place to improve the safety of women in childbirth, some of which have been around for decades. The Centers for Disease Control and Prevention (CDC) started a Pregnancy Mortality Surveillance System in 1986 to gather more clinical information which is analyzed by CDC scientists, and the American College of Obstetricians and Gynecologists (ACOG) has initiated a four tiered approach which includes providing holistic care after childbirth and improving access to care.
According to an ACOG Committee Opinion that was published in 2017, evidence suggests that continuous one on one emotional support, such as a doula, alongside standard nursing care is associated with improved outcomes for women in labor.
“We have to make doulas a non-luxury item,” Howe said. “None of this is cherry on the top stuff. We can do this for women, can’t we?”