the true cost of underpaid black doulas in reversing the black maternal mortality rate

in the summer of 2017, tanya spent considerable time planning to have an unmedicated hospital birth. after settling on a hospital with birthing suites, i was summoned to serve as her doula. i was unable to accept the assignment after previously committing to attend a film festival. when i flew back and got to catch up with tanya, i asked her about her birth story. i was disheartened to hear that her plan had deviated from what she desired. she and baby were healthy and her road to physical & emotional recovery were long ahead. she shared some bright spots about her birth and overall desire to accept it as “the best that could be done”. i asked her,

“what was one of the most difficult part of your birth story?”

she replied,

“probably that when it was over my mama said to me “i knew you weren’t ‘gon be able to do it”, it being successfully having a vaginal birth without pain medication.”

much of my work as a doula involves listening to stories of laboring and birthing. these stories identify the desires mothers have for their own birthing experience. i focus my attention on helping mothers get as close as possible to the fulfillment of their birthing vision — safely. the comprehensive care black doulas provide is magic. it is an ancestral kind of care that nurtures the wellness of mother, child, and family as they sit on the cusp of life and rebirth. unfortunately, though deserving, not all families receive the care of a doula. subsequently, black women continue to parish under the effects of systemic racism perpetuated by medical providers. this #blackmaternalhealthweek it is important to explore the effects of underpaid and overworked black doulas and how it undermines better birth outcomes for people of color.

the cost of a traditional vaginal birth in america ranges from $5000-$11000. an average of 20% of black americas endure this cost with no health care coverage. the cost of a doula can range anywhere from $800-$2000. it is uncommon for insurance companies to cover doula services. if they do, reimbursement can feel like a conundrum to pocketing cash.

black doulas are severely undervalued.

some doulas may offer sliding scale and payment plans in order to alleviate the financial strain on families, but it takes a toll on the doula’s livelihood. many black doulas find that serving the families who statistically need doulas the most and earning a comfortable living are not financially sustainable. this is caused by several factors including but not limited to: patriarchy, colorism, capitalism, the pay gap, racism, assumed (in)competence, and probably most devastating, the decision decades ago to label midwifery as “dirty” in order to expand obstetrics & gynecology. present day, midwifery and doula care are marketed as essential. they are: but only attainable for those who meet certain income requirements. the doulas most likely on the receiving end of upward out-of-pocket costs rendered for doula services are not doulas of color.

there exists a longstanding expectation for women to work as nurturers and bear the brunt of emotional care for little in return. this is evident in the wages of professions that hinge on emotional intelligence as a metric for success. for example, teachers are still striking for equity pay. early childhood care workers average a yearly salary of $25, 692. food/hospitality industry workers barely make minimum wage in some states. the world of birth work is no exception. though these services are worth every penny, there is still uneven fiscal distribution. that which falls through the gaps in the face of unequal pay, is often caught by doulas of color.

black folks, even when tired and spread thin, still donate themselves and volunteer one another. we feel moral obligation to try to be there for each other rather than trust the systems created to take care of us in totality. it is the reality that peppers the effects of traumatic vicarious racism. this means that a black doula might serve a family and only charge them a few hundred dollars or complete the service for free in spite of the practical costs it costs them. in many cases the delivery of a healthy baby aligned with the family’s desires is justifiable reason, until it’s time for the doula to pay their living expenses and/or reinvest in their business.

due to the weight of capitalism or any other viable factor, culturally and historically minorities have had to rely on the support of their families to move through life’s milestones. white americans tend to get to tackle life’s experiences with more independence, autonomy, and the financial ability to foster the two. in families of color it is typically expected for family members to pool together resources to fund life events. the end result is a shared feeling of accomplishment rooted in the energy of “we”.

“we” birthed this baby.

“we” needed items for the baby, so “we” threw the baby shower.

and this is generally after a series of events held down by our “we”.

“we” just graduated from college

“we” are getting married

“we” have had to thrive and survive together long before “we” birthed this baby.

thus

“we” are entitled to the experience

what does it mean when “we” have supported you because you couldn’t afford your doula? the help from the “we” (mothers, grandmothers, siblings, aunts, and cousins) can induce shame and guilt for the laboring person trying to establish boundaries. you don’t want to disappoint the people you feel you owe. the same way tanya’s mother unknowingly brought disappointment by critiquing her daughter’s ability to endure a vaginal birth sans medication, our “we” is not always prepared to provide the care of a professional. doulas assist new mothers by allowing them to advocate for the time and space needed to heal confidently and privately. doulas are a neutral knowledgable support with little emotional attachment to and investment in family’s personal choices.

the last thing a family needs to worry about repairing during the postpartum period are riffed relationships amongst family members who want to help but don’t understand how. this is especially true if the laboring person is attempting to introduce a type of child rearing inconsistent with preexisting family patterns. birth affirmations feel and sound foreign. birth tubs look unsafe. people bombard you with stories of how their plans went haywire. the winced faces of family members meeting the sounds and smell of birth in it’s pure form. misinformation. archaic unsolicited advice. even with good intent, family members’ presence can be overbearing. the surveillance brings frustration to decision-making and adds friction to what is already a variably unpredictable experience. the care of a doula serves as a buffer between mother and extended family by helping to communicate expectations. a laboring person who is not stressed is more likely to have favorable birth outcomes and less likely to need interventions (induced labor, pitocin, etc.)

cultural competence is an invaluable benefit that accompanies black doulas serving black families. it’s the freedom and space to exist organically without compromising the quality of support deserved. when black doulas are paid their worth, they develop the endurance necessary to holistically take care of themselves, their families, and the families they support. this enables their clients’ access to a birth story more on par with their desires. it also provides mothers the ability to recover within families from a place of celebration and restoration.

black folks are not giving up our “we” spirit any time soon. it has afforded us much love and survival. seeing black doulas reap the benefits of higher wages as they support black families reinforces the strength in our “we” and increases the vitality of black caregivers across the diaspora.

written & edited by

sol+glo

#blackmaternalhealthweek2021