INDIANAPOLIS — With nearly 17 deaths for every 100,000 births, the United States has one of the highest maternal mortality rates among the world's richest nations.
The numbers are even grimmer for Black and Native American women. Black women are more than three times more likely to die from a pregnancy-related cause than white women, and Indigenous women are more than two times as likely, according to the Centers for Disease Control and Prevention (CDC).
The Commonwealth Fund reports that racial disparities in maternal health care have been happening in America for more than 100 years. Even higher education does not prevent this disparity, according to the report.
Perhaps more alarming, the CDC has found that two in three women who die from pregnancy-related causes were preventable deaths.
"Being pregnant and giving birth should not carry such great risks," Vice President Kamala Harris said during the country's very first Maternal Health Day of Action on Dec. 7. "But the truth is women in our nation — and this is a hard truth — women in our nation are dying. Before, during, and after childbirth, women in our nation are dying at a higher rate than any other developed nation in our world."
Harris announced Tuesday her plan to help reduce the high maternal mortality rates in the United States.
As part of the Build Back Better Act, Harris proposed $3 billion go toward grants to study maternal mortality and health in minority communities. The money would set aside funding to grow the country's maternal mental health workforce, designate "birthing-friendly" hospitals, and lay out guidance to state governments on postpartum coverage under Medicaid.
One of the most crucial parts of the plan perhaps is providing funding for more doulas.
Becoming a certified doula was personal for community-based birth workers Shanea Angrick and Joslyn Cunningham.
"I just wanted to do more," Angrick said.
Andrick, a TLTP board member and yoga instructor, shared with WRTV that one of the drivers that made her want to become a doula was watching her daughter lose a baby at 26 weeks pregnant. At the height of the COVID-19 pandemic, she was presented with the opportunity to become a trained doula, and she took it. To this day, she is still helping her daughter through postpartum.
For Cunningham, the BIPOC Doula Scholarship Fund co-chair, getting into birth work stemmed from her experience of giving birth to twins prematurely by C-section.
"I really kind of wish I was just a little bit more educated on the situation or the other options I could have possibly had versus having a C-section, or just being educated about the process," Cunningham told WRTV. "Having a single birth and then turning around and having a multiple birth, they're very, very different, and there were a lot of things that I just didn't feel like I knew."
Doulas do a lot.
Cunningham says she often tells clients she's a "birth companion" because she feels it encapsulates the work of a doula more easily for those that aren't familiar.
"Support can look different depending on who the birthing person is, what the situation is, but really it is our opportunity and job to essentially support them throughout the full course of labor and postpartum," Cunningham explained.
Doulas support their clients with birthing education, breastfeeding education, postpartum care, prenatal labor support, and advocacy.
"We're there for more of the emotional support during delivery, before delivery, and after. So we're there to take care of mom and create space for her to advocate for herself ... during the delivery, before the birth, and after the birth," Angrick said.
The two Indianapolis-based doulas shared that they often find midwives mixed up with doulas.
A midwife comes into a birthing room and actually delivers the baby, similar to an OB/GYN; however, their practices tend to be more holistic and are commonly outside of the hospital setting. A doula is not clinical and is solely there to advocate for the birthing person and provide emotional support.
Another common misconception Angrick and Cunningham say they come across frequently is the idea that mothers should only get a doula if they're predicted to have a high-risk birth — which is not true. Doulas, or birth companions, are for everyone.
"Regardless of what your birthing plan looks like, regardless of your past experiences, if you feel like you want that support, need that support, you feel like your partner may need that support — you hire a doula," Cunningham said. "Some people have preferences because of high risk or because something happened last time. There are people who have not had complications; they just would like extra support. And we're here for all those situations."
Connecting Hoosier families to improve birth outcomes
At this time, the Biden Administration's Build Back Better Act is still under debate in the Senate. But while legislators work through the proposal, nonprofits and grassroots organizations are doing the work with feet on the ground recruiting, educating, and caring for pregnant people.
The Little Timmy Project (TLTP) here in Indianapolis is one of those organizations working to address Indiana's maternal and infant mortality rates.
It's been proven that doulas can improve birth outcomes, and this year TLTP started its Black, Indigenous, People of Color (BIPOC) Doula Scholarship Program. The program supports the training and recruitment of Black and Brown Hoosier birth workers.
According to TLTP, the organization has helped over 1,000 Hoosier families yearly with a wide variety of services for birthing persons and infants since it was founded in 2019.
With its BIPOC Doula Program, TLTP hopes to increase that help in a targeted way by helping to prevent the racial disparity in maternal health care in Indiana.
"Just being able to educate Black birthing persons, mothers, who are going into their delivery on what to expect, to be there, to have them advocate for themselves, to ask questions when they don't understand something that the doctor or the nurses are saying," Angrick explained.
For example, Angrick says she always advises her clients to ask five whys. It ensures mothers receive all of the information they need.
'Anyone can have a doula'
It is proven that doulas improve birthing, perinatal and postpartum outcomes for mothers.
According to The Commonwealth Fund, mothers who have a doula are two times less likely to experience a birthing complication and are more likely to be satisfied with their care.
"For Indiana, the importance for a doula is number one," Angrick started.
"Anyone can have a doula. If you think you need additional emotional support or education and you want your person that you can go to, hire a doula," Angrick said.
And the need for Black and Brown doulas in Indiana is urgent.
Angrick shares this is why TLTP believed the BIPOC Doula Program was one of the best ways to start tackling Indiana's high maternal mortality rate.
"We want to target our doula scholarship to future BIPOC workers so that we can start to make a change with the health care crisis that's going on with birthing parents, especially Black birthing parents, and getting into those communities and making an impact and spreading education," Angrick said.
TLTP's Doula Scholarship Program
This is the first year for the TLTP Doula Scholarship. Applications closed in August, and four candidates were chosen to receive scholarship money to enroll into a doula program of their choosing, based on the inclusive programs pre-selected by TLTP.
"It's very exciting. I mean, I think we got great candidates, it was really hard to choose. We actually originally were only supposed to choose three; we ended up choosing a fourth person because, I mean, our list of candidates was really good," Cunningham said of the application process. Out of 20 applicants, only four could make it through with their available funds.
Although it's not set in stone yet, they're hoping to make it an annual offering.
"There are a lot of people who are dedicated to wanting to learn how to do the work; are dedicated to continuing doing the work," Cunningham said. "And that's something that we will really love to see and hope for years to come. We can continue to fund this really educational journey and just for anyone who wants to kind of pursue it."
The CareSource Foundation, a multi-state health nonprofit, granted the TLTP $15,000 in November. In a release to WRTV, CareSource's Market Chief Medical Officer and VP of the Indian Office, Dr. Cameual Wright, stated:
“Doulas nurture and support the birthing person throughout labor and birth, yet doula care is often an underused resource in improving maternal health equity. CareSource knows mother-doula cultural concordance can strengthen patients’ health care satisfaction as well as outcomes. We are proud to support The Little Timmy Project in their goal of achieving reproductive justice in maternity care.”
TLTP support for its training doulas does not stop at monetary needs.
Cunningham says the program also follows the soon-to-be-doulas through the process of gaining their certificate.
"That is just a start for them," Cunningham said. "We're gonna try to support even if it's just, you know, words of encouragement or building relationships and networking with them to kind of get them into looking at other opportunities outside of just this one training and how you continue to educate through that."
Certified doulas can be booked through an agency or found via social media channels and independent websites. Doulas can also be booked for a wide variety of prices, according to Angrick and Cunningham.
"Doulas are not for just rich people. Doulas are not just for financially stable people. There are a few — me personally, and I'm sure Shanea as well — offer sliding scale services, volunteer services because we know that there is a need there," Cunningham said. "There's not a doubt in my mind that there are other doulas who think the same. I mean, there are some who literally all they do is volunteer services. And that is always an option."
Those interested in learning more about TLTP and its BIPOC Doula Program, or donating, can visit www.littletimmy.org.
WRTV Digital Reporter Shakkira Harris can be reached at email@example.com. You can follow her on Twitter, @shakkirasays.