Black maternal deaths: These doulas want to reverse rising rates


“Sixteen years ago, I almost died giving birth,” said Ebonie Karma Tudor, recalling her son’s birth. “It was just a really traumatic experience.”

It was 2007. Tudor, a black woman, was 24 years old. During the birth, she needed two blood transfusions and was unable to see her son immediately after giving birth, she said.

Experiences like Tudor’s are not uncommon, research suggests.

But while labor and delivery are considered the most dangerous times of pregnancy, studies show that it is after mother and child come home when most deaths occur, according to US Centers for Disease Control and Prevention.

Of the pregnancy-related deaths, 53% occurred within one week of birth to one year postpartum. The same study lists heart and coronary disease as the leading cause of pregnancy-related deaths among non-Hispanic blacks.

Also, wealth doesn’t make much of a difference for black families. The wealthier a mother is, the more likely she is to survive the first year after giving birth — unless she’s a black woman, a January study published by the National Bureau of Economic Research found.

The study included infants born to primiparous mothers in California between 2007 and 2016.

Tudor’s experience inspired her to become a doula – a skilled birth attendant who provides physical, educational and emotional support to their clients before, during and after birth. For some black mothers, this kind of advocacy could mean life or death.

The recent death of Olympian Frentorish “Tori” Bowie once again raised questions about black maternal health care in the United States.

The track and field athlete died of “complications of childbirth” in early May, according to an autopsy report. The 32-year-old, three-time Olympic medalist, who was found dead in bed, was estimated to be 8 months pregnant. There was evidence that he was “subject to labor,” an autopsy report released of Orange County, Florida, the Medical Examiner’s Office says.

Her manner of death was ruled natural and the report found there were “possible complications” including “respiratory distress and eclampsia”.

Eclampsia is a particularly serious complication of pregnancy and can occur when it is the mother’s blood pressure becomes too high.

The overall rate of pregnant women dying from causes related to hospital birth appears to have dropped significantly—by more than 50 percent—in the United States in recent years, suggests a new study.

That decline, seen among more than 11 million hospital patients, occurred over a 13-year period from 2008 to 2021, according to the national study, published Thursday in the medical journal. Open JAMA Network. But the decline represents only hospital maternal deaths, not the nation’s overall maternal mortality rate, which has been rising.

The new study “seems to contradict national data where maternal mortality is increasing because most women do not die in hospital during childbirth; die after they leave the hospital after birth,” said Dr. Jean Guglielminotti, an assistant professor at Columbia University Medical Center, who was not involved in the new study but has conducted research on severe maternal morbidity.

And black maternal death rates have been rising steadily in the United States for decades. Black mothers are nearly three times more likely to die from pregnancy-related complications than white women, with 69.9 deaths per 100,000 live births in 2021, According to the CDC. Rate among white women it was 26.6 per 100,000. Many factors contribute to the racial disparities seen in the data, including underlying chronic conditions, structural racism and implicit bias, the CDC found.

Black babies are more likely to die than any other racial or ethnic group, the agency found. They are also much more likely to be born prematurely, causing health problems that may follow them through life.

Ebonie Karma Tudor became a doula after a traumatic birth.

“The important thing for me is advocacy. That was what was missing from my birth story,” Tudor said. “I didn’t know I could say no.” I didn’t know I could switch providers. I didn’t know I had all these different options.”

Tudor recalled a comment from a doctor when she was pregnant who told her: “You’re a strong girl, you know this is nothing to you, you can handle it.”

After her traumatic birth experience, Tudor became a certified doula in New York City, she said.

Studies have shown that pain treatment for black patients has been influenced by racial bias. A 2019 study of American Journal of Emergency Medicine showed that black patients were 40% less likely to be prescribed acute pain medications. A separate one study in 2016 showed racial bias in medical trainees’ assessment of pain and beliefs that black and white patients have biological differences, such as the misconception that black patients had thicker skin than their white counterparts.

When you’re working with black birth doulas, Tudor said, such comments aren’t as common.

“I find that once a doula comes into the room, it’s less likely to happen.”

Tudor was trained by a group called Mama Glow. Based in Brooklyn, Mama Glow is a global health and motherhood education platform. She has trained more than 2,500 doulas worldwide, it says. The two-day Doula Expo is a gathering of birth workers and families who prioritize education, connection and community.

Mama Glow founder Latham Thomas likes to call the expo “Coachella for birth workers.”

This year’s exhibition was held in New York at Hudson Yards. The space was transformed into a festival-like event with keynote talks, live entertainment, a children’s play area and a children’s feeding lounge. Amid the fun, the exhibit tackles serious health care issues.

“Black women tell us they don’t feel seen, they don’t feel heard; that they feel rejected, ignored and undervalued by our health care system,” Thomas said. “We have people who are afraid to give birth, that something will happen to them.”

Mama Glow aims to raise awareness of the high death rate of black mothers and find ways to reduce it.

“It’s really scary, I think, for people to sit with the statistical information, we know what it is. We know it’s alarming, we know it’s unsettling, and yet there’s still room for improvement. We still need to build towards a future where childbirth is safe,” said Thomas.

One such effort is an initiative called “Love Delivered.”

Mama Glow and beauty company Carol’s Daughter have teamed up to combat high black maternal mortality rates with the initiative, which provides doula training and expands access to doula services through grants to black families.

Cost is one of the major obstacles to hiring doulas. Kiyoko Ray was pregnant with her seventh child when she decided to hire doula Zania Mathis. Cost was a major factor in her decision.

“I felt like I couldn’t afford (a doula), but I wanted it so badly,” Ray said.

Mathis has worked with Ray since the beginning of the pregnancy. Based just outside Atlanta, Mathis says most of her clients live in Georgia — a state with one of the highest maternal mortality rates in the United States, according to the CDC. Georgia ranks sixth in the country.

Mathis’ assignments were not without complications.

She is 6 months pregnant with her fourth child, a girl. She is the mother of twin 7-year-old boys and a 5-year-old daughter. Both previous tasks were difficult. Mathis’ younger twin was in the Neonatal Intensive Care Unit (NICU) for 2 days after birth; he also suffered pelvic floor injuries.

Kiyoko Ray, right, was pregnant with her seventh child when she decided to hire doula Zania Mathis.

“In the black community, we’re told we don’t need a doula. It is viewed as something in terms of luxury. Look at the numbers, look at the data. We need doulas more than any other race,” Mathis said.

Research suggests that having a doula can be beneficial during labor and the postpartum period for both mother and baby. A study published in 2013 by Journal of Perinatal Educationfound that mothers-to-be who had a doula were four times less likely to have a low-birth-weight baby, twice as likely to experience a birth complication, and more likely to initiate breastfeeding, compared to those without doula support.

Mathis said she’s also seen plenty of close calls in her four years as a doula.

“I saw a mother code. I saw the mother’s contractions stop completely,” Mathis said. “I saw a mother completely neglected in active labor, having to wait in the (hospital) waiting room.

Mathis knows that cost can be a barrier to access when it comes to hiring a doula. She says she will sometimes make exceptions for clients who need her care by offering payment plans or changing services because she believes the care she provides is essential — especially for mothers of color.

Ray, a hairdresser, partially paid for Mathis’ services by styling his hair. “She’s more than a doula,” Ray said. “She became my therapist. She became a friend.”

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