About three times as many Black women die while giving birth than white women, regardless of education level or socioeconomic status, according to the Center for Disease Control.
Non-racial factors cannot explain away this discrepancy, said Venus Standard, an assistant professor at the UNC School of Medicine's department of family medicine and a certified nurse midwife.
“A doctoral degree Black woman has more of a chance of dying (while giving birth) than an eighth-grade educated white woman,” she said.
That's why Standard teamed up with Vanderbilt University's Stephanie DeVane-Johnson and Duke University's Jacquelyn McMillian-Bohler to create the Lived Experience Accessible Doula program. The three women work as co-principal investigators.
The eight-week program trains Black doulas, or non-medical birth experts, on how to support Black mothers emotionally, physically and informationally during the birthing process, Standard said.
DeVane-Johnson, an associate professor in the School of Nursing at Vanderbilt, cited allostatic load (the burden that results from accumulation of stress) and weathering (repeated exposure to adversity and discrimination) as reasons why Black women’s bodies age faster. Because of this aging, Black women are more prone to high blood pressure and health complications, she said.
“It's amazing what you get like-minded people who potentially have the same lived experiences together to serve the greater good and how impactful that is,” she said.
The LEAD program also focuses on how to support mothers outside the birthing process, through things like grief training, Black culture and mindfulness. McMillian-Bohler, the director of the Institute for Educational Excellence at Duke University School of Nursing, said she instructs the mindfulness aspect of the program.
“Our goal is to help improve not just the birth process, but the relationship building,” McMillian-Bohler said. “It's a gateway into the Black maternal community to provide information associated with empowerment and self-care and wellness.”
Doulas are also taught sustainable business practices and marketing so they can start making money and helping families independently, DeVane-Johnson said.
Shaunda Fennell graduated from the first cohort of the program. She said that she has begun to practice on her own and that the program really opened her eyes to the importance of birth work.
“Honestly, it was better than my college experience,” she said. “It was just each week loving to go to class and learning so much. Some weeks it was hard to leave because you just wanted to learn, learn, learn.”
Amber Bell, who graduated from the program's fourth cohort, echoed Fennell’s sense of gratitude.
“We got a real chance to dig into systematic oppression and just the foundation of how things have affected (Black women) from the beginnings of times,” she said. “So I appreciated the historical references and the fact that it was for us, by us.”
So far, the program has graduated about 50 doulas over four cohorts, Standard said. However, it took some time to get LEAD up and running, as the program initially struggled to find funding.
In early 2021, however, Standard, DeVane-Johnson and McMillian-Bohler received the C. Felix Harvey Award to Advance Institutional Priorities for a one-year pilot program through UNC. In 2022, they received another grant through the Duke Endowment to continue the program for another three years and expand to nearby counties.
The first cohort began training in May 2021 and started working in the UNC Hospital Labor and Delivery Unit in July.
“There are a lot of Black birth workers who want to do this work, but because of financial barriers of the training, they are not able to,” DeVane-Johnson said. “And there are lots of Black families who think that having a doula is something that rich people have, but everybody should have a doula.”
Standard, DeVane-Johnson and McMillian-Bohler said they eventually hope to expand to other area hospitals and create doula trainings catered to other underepresented populations.
McMillian-Bohler mentioned wanting to expand the LEAD program to the Latinx, LGBTQ+ and Asian communities, but the program cannot expand to these communities without more funding.
“Doula training and certain trainings cannot be one size fits all,” DeVane-Johnson said. “It needs to be culturally sensitive and tailored to fit that population. That's what our program does.”
The doulas who have graduated from the LEAD program maintain close bonds and frequently congratulate each other on successful births, DeVane-Johnson said.
“These doulas have a sisterhood. These cohorts are like sisters and family,” she said.
The three doctors seek to continue educating and graduating cohorts, and they believe the doulas will make a difference in maternal mortality, based on literature and evidence from their program.
“As a midwife of more than 20 years, I’ve been on births, been on labor and delivery units, done all of that,” McMillian-Bohler said. “And I really have a strong feeling about how powerful those moments are, and anything we can do to lessen potential trauma or poor outcomes or empower moms and babies then we need to do that.”
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