Altruism Media, Inc.’s inaugural mission, The Maternal and Infant Health (MaIH) Project, boasts a variety of methods to equitably support birthing people for the best health outcomes — but underpinning each method is one foundational concept: empowering parents with information to achieve the best health outcomes. One of The MaIH Project’s information campaigns centers around the benefits of doulas, who are especially effective partners for Black parents as they navigate a health care domain which can range from unfriendly to deadly indifference. 

Besides offering parents traditional forms of support during pregnancy and birth, doulas also have a familiarity with the medical system that allows them to advocate confidently for the birthing parent’s wants and needs. According to a study in the Journal of Perinatal Education, doula-assisted mothers were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. 

One organization delving into the role doulas and other practices play in racial health equity is the Black Mamas Matter Alliance (BMMA), whose mission often brings experts together to share data on best practices and other developments. Dr. Karen A. Scott, MD, outlined best practices for medical care and obstetric health systems to center racial equity, describing a CNM & OB Integrated Hospitalist Program. 

Honoring the culture and first language of birthing parents and families is a key component of health equity, and it often begins with having a staff that reflects the local demographics and access to 24/7 translation services. Beyond those meetings, however, after any positive or negative event, staff have the right to call for a confidential debriefing run by nurses. “We start with praise, we move to critique, and then we move to, ‘How do we grow and do better?’” said Dr. Scott. Nurse-centered leadership also allows for CNMs and RNs to more effectively call out abuse and advocate for the Black birthing family. 

The program is patient-centered, which ensures that the birthing parent retains control of their birth and that the role of involved medical professionals is to offer guidance and facilitate the birthing parent’s wishes, rather than to dictate the process. When a Black birthing person makes informed decisions about their birth process, it is important to acknowledge informed refusal as a choice, rather than framing it as noncompliance. Listening to the patient and their family to learn before evaluating is a valuable practice. “We treat Black mamas as equitable partners and decision makers in their birth experience,” said Dr. Scott.

Dr. Scott shared the experience of a Black midwife, the founder and CEO of a midwifery service in Atlanta. In response to a question concerning what OB physicians can do to show respect, empathy, and dignity for Black birthing people, Dr. Scott’s friend said, “Trust midwives. Trust Black women. Midwives care about the women that they are serving. It’s so disheartening to be supporting a mother who is more than capable of achieving a goal, and the physician takes away that vision of their desires due to impatience or discomfort of a natural process.”

A multitude of established medical best practices all play a part in creating a positive experience for Black birthing parents and families. Sex positivity, motivational interviewing, patient-centered models, and trauma-informed care models each contribute valuable guidance for culture and protocol alike. Dr. Scott described a model derived from these practices called SACRED birth. “SACRED birth is a radical attitude toward human births, specifically Black births, that regards all birth activities as fundamentally normal, healthy, sacred, transformative, erotic, communal, and empowering.” 

The SACRED birth movement advocates for birth education and safer, dignified births. SACRED is an acronym, representing the following: safety and sustainability while providing high-quality sexual and reproductive health access and care; acknowledging the historical legacy of degradation and oppression without re-traumatization, and affirming agency and autonomy; cultural safety and humility in communication and coordination of care; reflective listening; valuing Black mama-centered empathy, equity, and empowerment over efficiency, and ensuring autonomy; and dignity-driven decision making. 

Dr. Scott followed up with SACRED birth guidelines for medical workers. These guidelines included checking biases and assumptions, embracing Black birthing people as experts in their own experiences, centering Black birthing people’s voices and priorities in communication and decision-making, collaborating with Black birthing families, doulas, midwives, and nurses in birth work, and seeking ongoing training and development. Doulas, whose relationship with the birthing family is often more personal and involved than medical personnel, are especially well-equipped to embody and advance the principles of SACRED birth. 

Shafia Monroe, a veteran midwife and creator of a Black doula training program in 2002, also shared her expertise. Drawing on motifs in African art and tradition, Monroe described a model of care wherein Black births are venerated and celebrated, and Black doulas are more to a mother and family than simply someone to ‘catch the baby.’ They honor and care for the mother, helping her to feel beautiful and loved, taking responsibilities off her shoulders and ensuring she can rest comfortably, including after birth. “When you feel good, your oxytocin hormones rise and maintain a healthy pregnancy,” Monroe said, suggesting that helping mothers to feel loved and cared for can help mitigate postpartum depression. 

Postpartum care is an especially important component of doula work. “We’re hearing so many mothers die, unfortunately, after the baby is born, during the postpartum period,” Monroe said. Many postpartum risks to the mother are increased for Black birthing people, as economic and social factors may place more stress on them and strain their bodies. In some Black doula traditions, the 40 days after birth were treated with special care and caution, considered the bridge from life, or birthing, to passing through death. These traditions may treat this time as sacred, and so the duty of the doulas to shepherd the mother safely across that bridge held celebrated cultural importance. 

Doulas are not only supports for the birthing person, but also for their family and friends, who may wish to help but may not have the knowledge to do so. Enabling the family of the birthing person to provide effective care and support increases the quality of care they receive, especially because it empowers the family, the people at the center of the birth, to better care for themselves and direct their own care. 

The MaIH Project knows the importance of doulas, postpartum care, and equitable best practices. Information is one of the most valuable tools to arm expecting parents with, especially Black parents, and the MaIH Project is dedicated to giving parents the best chance at positive health outcomes, from educating parents about the benefits of doulas to much more.

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