Birth workers are helping Black parents navigate overlapping crises.
COVID-19 has killed more than 1 million people in the United States, set back students’ academic progress, and destabilized our collective mental health. It’s also worsened the U.S. maternal mortality crisis. The rate of people who died during pregnancy or within the first six weeks after delivery increased by 40% in 2021, according to a Centers for Disease Control and Prevention report released in March.
While that increase impacts people across lines of race and ethnicity, maternal mortality increased the most among Latinas. Black people continue to suffer disproportionately, dying at more than twice the rate that white people do. About a quarter of deaths in 2020 and 2021 were directly related to the birthing person having COVID. Pregnant people and those who have recently given birth are more likely to have a severe response to COVID, and risks for certain pregnancy complications, such as preeclampsia, increase when someone who is expecting has the virus.
Latona Giwa, co-founder of Birthmark Doula Collective and the New Orleans Breastfeeding Center, offers a fuller picture of the maternal mortality and morbidity spike in Louisiana, the state where she lives and works. “We had the height of the pandemic, and then we had Hurricane Ida on top of that in 2021 that was really devastating for pregnant and birthing families,” Giwa says. “Then we had the formula crisis and an economic crisis. I think the last couple of years have really laid bare that we are in a state of constant and overlapping crises, and that birthing families are bearing a lot of the brunt of that.”
Even before the pandemic, many pregnant and postpartum people in the United States were suffering. Deaths occurring during pregnancy or in the weeks and months following birth have been steadily climbing in the U.S. since 2000, making the country an outlier in maternal mortality compared with its high-income peer countries. Pregnant and postpartum people in the U.S. die at more than three times the rate of people in countries such as France, Canada, and Australia. Families in those countries can rely on universal health care, generous maternity leave policies, and the wide availability of midwives, who offer more personalized care and fewer interventions than the obstetricians commonly relied upon in the U.S.
Efforts to reform health care in the U.S. are underway, as are efforts to train clinicians away from white supremacist impulses and toward cultural competency. But as pregnant people prepare to give birth in a broken system, doulas can offer the support families need to stay safe. Doulas assist with nonmedical needs throughout pregnancy, birth, and the postpartum period. They can bridge communication gaps between the birthing person and clinician, help monitor for complications, and offer counsel for postpartum depression. They also provide an extra set of hands, tending to the many tasks new parents face.
While doula care was once seen as a luxury available only to the wealthy, it’s now widely accepted as an intervention that can keep a pregnancy on track. “We see ourselves as frontline workers. We see ourselves as emergency responders,” Giwa says. “Families are coming to us with so many layers of trauma, and we’re taking that on.” This has meant building new infrastructure into the doula practice, including the creation of a perinatal emergency preparedness program.
“We can’t just keep conceptualizing emergencies as this far-off thing you plan for,” Giwa says. Instead, an ethic of preparedness is now embedded into all doula interactions with families, some of whom live in maternal health care deserts where they must travel more than an hour to receive basic support. “We talk to them knowing that homelessness could be a reality for someone. Natural disaster could be a reality. A traumatic birth experience could be a reality.”
This critical work requires resources. Over the years, Birthmark has funded its work through a combination of sliding fees, donations, contracts, and grants. Reimbursement from insurance—including Medicaid, which covers more than 40% of pregnant people in the U.S.—is another potential revenue stream. Minnesota and Oregon were the first states to pass legislation that expands access to doulas through Medicaid coverage.
Advocates and elected officials are trying to bring such solutions to scale at the federal level. The Black Maternal Health Momnibus Act, a package of bills that addresses pregnancy-related deaths and dramatically expands maternity care, has been introduced in Congress three times since March 2020. Taken as a whole, it has not been successful, though a bill supporting veterans’ maternal health passed in late 2021. The Biden administration has voiced its support for meaningful change and last year called on states to expand Medicaid coverage to one year for postpartum parents. Funding for some programs that provide home visits to birthing families received additional funding through a spending bill Congress passed in late 2022.
State and federal funds to address the maternal health crisis are just one piece of the puzzle. “It’s hugely important,” Giwa says. “But at the same time, we have to build our own reality of the future we want to see in our communities and on the local level.” Giwa is a nurse and a community organizer, so she understands the broader landscape of how change is made. “If you look at Black women organizing on any issue, that’s what we do,” she says. “We’re working all the possibilities.”