The Black Wellness and Prosperity Center in Fresno is running a program to train doulas to assist Black women in birthing process. The program’s aim is to address inequities in the health outcomes of Black mothers. Photo by Tembinkosi Sikupela.

Black women often report discrimination in a hospital setting, particularly during labor and delivery of their babies. Doctors’ treatment points to a false belief that Black women have a higher pain tolerance than white women.

Access to quality, respectful health care remains a challenge for Black mothers and their newborns.

“This is not something new; it’s generational,” said Shantay Davies-Balch, president and CEO of Black Wellness and Prosperity Center in Fresno.

These observations prompted her to begin her work at the Center, which serves to educate and train a broader population of Black doulas to advocate for Black mothers.

Doulas are trained professionals who provide support for mothers before, during and after childbirth.

The goal is to train up 30 doulas in the Fresno area. Right now there are three.

Doulas’ role is to advocate for and empower women in the labor and delivery process, so the team at Black Wellness and Prosperity Center believes that the solution is more doulas and therefore more advocacy.

The California Health Care Foundation issued a survey for more than 2,500 women who gave birth in 2016. The study reflects that doulas can be a solution for providing Black women with emotional, physical and informational support. Doulas also reduce the likelihood of using pain medicine and Cesarean birth and increased likelihood of a satisfying childbirth, according to the report.

Davies-Balch said her interest for Black maternal health piqued in high school when she realized there was a disparity. It started when her mother was diagnosed with breast cancer — one year after she begged for referrals from her primary care doctor.

“She died of breast cancer and it was preventable,” Davies-Balch said.

After a year of asking to be referred to a specialist, her mother was consistently dismissed by doctors who told her it was probably an infection or rash.

“By the time she got a referral, her cancer was pretty advanced,” she said. “It had really taken a toll on her mental health too by this time.”

Her mother died a year and a half later.

Part of the problem falls on environmental and social issues too. The 93706 zip code is notorious for heavy pollution near highway traffic routes and minimal green space.

“The bottom line is we’re not talking about 1890 or 1910. But we’re talking about you know, five years ago. And these physicians believed that Black people had thicker skin than white people. These are people that have graduated from medical school,” she said.

One of the leading causes of maternal death is hemorrhage

“If we know that we have a culture of not listening to Black women or not believing they’re in pain because we believe that their pain tolerance is different, for example, then guess what? That’s one of the indicators of why our maternal mortality rates among Black women are so high,” Davies-Balch said.

According to the Centers for Disease Control and Prevention, Black women are three times more likely to die from a pregnancy-related cause than white women. The agency says that this is due to variation in quality health care, underlying chronic conditions, structural racism and implicit bias. And according to a Stanford University School of Medicine study published in 2017, it concluded that infants’ race influences the quality of care California hospitals give.

The study included 18,000 babies and 134 California hospitals. The results found that black and Hispanic infants were more likely than white infants to receive care in poor-quality NICUs.

Amya Brooks, an employee of Black Wellness and Prosperity Center and new mother, recently delivered her baby in June after a series of medical hurdles and misjudgments.

“The whole experience was just a nightmare and I wish people would know that it’s okay to speak up,” Brooks said.

After increasing headaches, feeling faint, and a fluctuating heart rate, she decided to go to the doctor to be checked, only to be sent home. Her doctor told her she was fine. Eventually she started having premature contractions.

“They were treating me pretty much like my life didn’t matter, the baby’s life didn’t matter,” Brooks said.

“One of the nurses just gave me some ice water and some crackers and told me to lay there. She didn’t tell me what was going on with my body — she didn’t say anything,” Brooks said.

After being sent home again, she researched how much amniotic fluid should be around the baby and it did not align with her medical records on MyTurn, the state’s digital medical records portal. After returning to the hospital to confront health care staff about the problem, she received proper fluids to continue her pregnancy.

She eventually went into the hospital at 35 weeks and delivered her baby prematurely, but not without being placed in a delivery room with no air conditioning after requesting she move to the next empty room. That room, she found out, was given to a white woman after Brooks made the request.

Brooks received mixed messages from nursing staff and was not warned when the epidural was placed in her, and was not instructed when to push, though her lower body was numb.

“The way the hospitals treat you, it’s just not okay,” she said.

Brooks’ daughter was delivered unresponsive with a lack of oxygen momentarily, and Brooks suffered intense bleeding.

Brooks said the solution is to bring awareness to what happens in the health care sector to Black women. She said it would help to bring more African American women into the field as well.

She advocates for women of color to pay attention and speak up for themselves.

“This is not just a health care issue; it’s a societal issue,” said Davies-Balch.

San Francisco-based Dr. Pooja Mittal oversees health equity strategy and execution for HealthNet’s Medi-Cal population.

“The biggest disparity that we see in maternal and newborn care is focused around African Americans in terms of maternity morbidity and mortality,” Mittal said.

This population has a higher rate of complications, and so do their newborns, she said.

“The origin of that is racism and systemic racism,” Mittal said.

HealthNet invests in several community-based organizations to bridge the gap in disparities. A lot of their focus is on early childhood support and maternal support. They’ve invested in a program to train and educate doulas for Black mothers.

“The reason why we supported community-based doulas is because the evidence shows that they improve outcomes — that their support and work during pregnancy and then the immediate postpartum period improved outcomes for Black mothers and babies,” Mittal said.

Though HealthNet is still working through the final data, Mittal said they are able to see a significant drop in Cesarean section rates through the work of the project. The project, which spanned 2019 to 2020 in Los Angeles County, included education on the effects of racism during maternal and newborn care. It worked with health care staff that cared for about 90 pregnant women.

The presence of doulas, Davies-Balch said, creates an environment where Black women are less likely to report discrimination. They serve as a communication bridge for the patient and doctors and nurses.

Davies-Balch said she believes hospitals all want to do the right thing to see better outcomes.

“It’s a matter of identifying solutions that, quite frankly, are both patient centered within their confines of how a hospital functions,” she said.

But part of the problem is that doulas are considered visitors — and Covid-19 has complicated all of this.

“That means if you’re birthing at the beginning of the pandemic, you can have one support person,” she said.

Black mothers have to choose between a doula to advocate for them, their partner, mother or another loved one. In the past couple weeks since the delta variant tightened hospital visitors, many mothers are back in the same position.

“Part of implementing this doula network is helping to normalize doulas as part of the care team so that a doula is not considered a visitor,” Davies-Balch said.

And comparatively, the number of nurses is not limited, so the Black Wellness and Prosperity Center argues that doulas should be considered part of the care team, and thus, shouldn’t be limited either.

Davies-Balch personally shared her story about preterm birth with StoryCorps, initiated by the National Library of Medicine. The video is now archived in the Smithsonian National Museum of African American History and Culture, and it’s an engagement tool she can use with physicians to educate them and work together to create solutions.

“I think that telling stories is a powerful, non-threatening way to help engage people and help raise awareness,” she said.