As conversations around the importance of better maternal health care for Black people circulate, there remains a number of demographics facing barriers to equitable maternal health care that may be overlooked. Hispanic birthing people face similarly high rates of maternal and infant mortality, but while they share some barriers to care with Black birthing people, others, such as language barriers and differing cultural sensitivity biases, are unique. As is the case with other populations of birthing people, such as in rural and Black communities, doulas and community health workers (CHWs) provide highly-effective solutions to the problems Hispanic birthing people often face when seeking and receiving care. Ruth McCleery, a Spanish-speaking doula and CHW with Altruism Media, Inc., sat down for an interview to discuss the barriers to care affecting Hispanic birthing people.
McCleery has been a doula since 2019 and became a CHW in 2022. Her entry into the field came at a dark time in her life when she was looking for a safe and stable place for herself and her new baby. At a friend’s recommendation, she took the leap and started training. “I knew nothing of what a doula was or what they did but I knew I was doing what I was called to during that season in my life,” McCleery said. Now, she pursues her career as a midwife with a passion for sharing the healing that experience gave her — to empower women with the knowledge they need to retain their agency, “to know the power and strength they hold within themselves and this specific season in their life.” In her line of work, that passion targets the heart of the issue: the disenfranchisement of Hispanic birthing people.
First and foremost among the problems Hispanic birthing people may face is the language barrier, where applicable. “The language barrier impacts everything,” McCleery said. “Most of the time clinicians aren’t sensitive to the fact that they’re not English-speaking. They’ll just go in assuming they speak English. So then the client will just kind of look at me like, ‘What are they saying?’ And once I answer, they apologize and offer to get a translator.” Rarely do clinicians approach patients while leaving room for the possibility that they may not speak English. “They just wait until the patient has that dumb look on their face like ‘What are you saying?’ instead of just cordially asking, ‘Would you like English or Spanish?’ I think that would be more sensitive, especially in that time frame that everything is going on.” While the language barrier is the most egregious example of a commonly-missed cultural nuance, McCleery named a myriad of others, including the strong family and community connections that are central to many Hispanic and Latina birthing people. “No matter what country we are from, it runs in our culture to be one family/village and connect,” McCleery wrote. Many find strength in the support of trusted family and community members, such as doulas.
The combination of the language barrier and, where applicable, immigration status makes some Hispanic people more reluctant to have that same trust in other medical professionals and seek care. “It’s fear-based. Unless they know somebody in the community that has gotten the care,” McCleery said. “That’s how I get most of my clients.” Her confidence and knowledge, the product of having worked with clinicians and various medical institutions for years, helps bridge the gap for people who may otherwise face significant anxieties about health care. Not only does she translate from English to Spanish and vice versa, she also does the work of translating medical jargon into more comprehensible terms, helping her clients to fully understand their options and circumstances. By spreading the word about her and sharing that there is a way to receive care without facing all of the fears and stressors of the medical system alone, more Hispanic birthing people in McCleery’s community feel empowered to seek and participate in the care they need.
Without a doula and/or CHW at their side, McCleery says, the fear can be paralyzing. Faced with so many uncertainties and unfamiliar, serious consequences to every decision, the fear these people face and its resulting paralysis is, without compassion, often mistaken for dumbstruck lack of intelligence instead. “What I’ve noticed is because my clients are controlled by fear when they go into these places, all their beliefs and culture they had, they just are nonexistent because they are so scared,” McCleery said. “They just assume we’re ignorant.”
As an example, McCleery spoke of a time when a brand-new client called her in tears because a doctor had told her that her baby was going to have autism and she needed to have an induction. McCleery was quick to arrive and talk through the situation with her client to gain an understanding of the patient’s wants and needs without the doctor’s judgment putting pressure on her to give in and concede to the procedure. With McCleery there to help her work through it, the patient was able to refuse the induction and carry her baby to term for a natural birth. The baby was born without autism or an induction, said McCleery, and is happy and healthy with his mother today.
While that mother and child have a happy ending, Hispanic maternal mortality is sharply on the rise across the U.S. As the American Heart Association reported, the CDC noted a 44% increase in the Hispanic maternal mortality rate just last year, which experts say is the result of the coronavirus pandemic highlighting entrenched social inequities. For example, while more than half of Hispanic mothers are in the workforce, far fewer had the opportunity to work from home and stay safe when the pandemic began in earnest, and many work in more demanding, stressful, and lower-income jobs, increasing their risk of cardiovascular problems and related health complications. For many, life is stressful enough without confronting the myriad of anxieties that comes with visiting the doctor.
With a knowledgeable, culturally-sensitive guide like a doula and/or a CHW to aid them in navigating the system and reassure them that they can stay true to their preferences and voice their needs, that fear diminishes, no longer such a significant barrier. In fact, almost all of the discriminatory practices Hispanic birthing people face through the medical system can be effectively mitigated with doulas and CHWs there to stand up for patients’ wants and needs. Now, the main obstacle they face is lack of manpower. “I do help, but I can’t help everybody,” McCleery said. “Between doulas and community health care workers, I think we could really educate and knock down this fear wall and connect them to the right resources that they need. I think it would really make a difference.” With more Spanish-speaking doulas building the community which offers that crucial strength, Hispanic and Latina birthing people could not only survive, but thrive. “We need more Hispanic/Spanish-speaking faces in this field.”
If you or someone you know is in need of assistance with maternal health care, the Maternal and Infant Health (MaIH) Project can help. Visit https://altruism-media.org/the-maih-project/ to learn more.