Using Doulas to Address Infant Mortality

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One of many health disparities in Northeast Ohio centers on infant mortality.  In Cleveland, black babies die at more than twice the rate of white babies before their first birthday.  The number one cause of infant mortality among African American infants is premature birth. As part of our continuing Be Well series on Healthy People, Healthy Places – Healthy Beginnings, ideastream’s Kay Colby explores some factors associated with premature births among African American women and a new local program designed to address them.

One of many health disparities in Northeast Ohio centers on infant mortality.  In Cleveland, black babies die at more than twice the rate of white babies before their first birthday.  The number one cause of infant mortality among African-American infants is premature birth. 

“This is the box they gave me from the hospital. This is what he wore."

Kisha Nicole Foster gently holds up a blue and yellow cap and matching knit blanket.

“I still smell him. He still smells in here …”

Foster’s box contains other treasured memories of her son, Elijah Henry Foster-Hammond, who passed away in 2010 … shortly after birth.

“And they asked me if I wanted to take pictures and I said no I will always have that memory in my head. And then literally, in my hands, he just stopped breathing.”

Foster’s baby was one of many black infants born too early -- too under-developed and fragile to survive.

While it’s often hard to pinpoint exactly what goes wrong in any given pregnancy, doctors do know that preterm labor is associated with certain medical conditions, as well as social issues like poverty and stress that disproportionately affect African-American women.

“I feel her right there – yeah. The sunlight … she moves towards the light.”

Nakia Smith is feeling the belly of a client who’s seven months pregnant. Smith is part of “Birthing Beautiful Communities” … a local program designed to help pregnant black women navigate stress and other barriers to healthy pregnancies.

Smith’s client is married with three young children ... works two part-time jobs ... and just lost her food stamps.

“You know, you look at food stamps. That is what you use to buy all your groceries. And when it’s suddenly taken away from you, then you have to rework your whole budget. And we go over things like that with them. Because this is real.  This is what happens every day. This is what affects the baby at the end of the day.”

Smith is a trained “doula” … a non-medical worker who provides emotional and social support to women during child birth.

Smith and the other four doulas in the program do everything from making sure clients get to prenatal appointments to following up with home visits through the baby’s first year and beyond.

“What we do is above and beyond the normal scope of a doula.”

That’s Christin Farmer who founded the organization.

“We really call ourselves ‘birth workers’ and more specifically ‘perinatal birth workers.’ We are present during the pregnancy, at the labor and delivery … and postpartum.”

Another thing that makes her program unique is that all the doulas are women of color who live in the same neighborhoods they serve.

“We are not a doula or a birth worker from a suburban area coming down to the inner city to save women and black babies. We live and breathe this every day.  This is in our backyard.”

Farmer’s program relies on volunteer doulas. Over the past year, they’ve served 18 women. All but two delivered full-term babies.

Nationally, studies have demonstrated success using doulas to lower the rate of preterm births.

Doctor Tirun Gopal heads obstetrics at Saint Luke’s California Pacific Medical Center. He often works with doulas and says there are many benefits. But problems can arise when they try to get involved in the patient’s medical care.

“Some doulas have a tendency to do that. Although I must admit, it’s far and few between. But when they do it becomes rather difficult. And we have to put them in their place.”

Back in Cleveland, Christin Farmer says her program follows a training curriculum that ensures doulas understand their role is purely supportive.

With grant funding, Farmer has now launched a project in Hough to train and pay six more local women to become birth workers and serve as least 25 women.

“It’s two-fold. It gives support to the pregnant mom and it gives the birth worker an opportunity to make money.”

The biggest challenge is sustainability. Farmer’s grant only runs for a year.  Her hope is to get Ohio’s Medicaid program to reimburse for doula services.

This story is part of our ongoing series Healthy People, Healthy Places… exploring the intersection of people, place, and health. To access all these reports visit bewell.ideastream.org

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