Tamika McPhail thought it was just the hospital. While pregnant with her second child, she noticed that the baby wasn’t moving. Soon, it was nearly too late, and her obstetrician couldn’t find a heartbeat. After an induction and emergency C-section, she said her son had to be “brought back to life.”
She’s had four children since, trying out three different hospitals and four different obstetricians, but she said each subsequent birth came with serious complications for her or her child.
“I’ve come to see that it’s not just the hospital, and it’s not just the doctor,” McPhail said. “It’s a systemic issue. Black women go in to give birth and they don’t come home.”
According to a Connecticut Health Foundation study in 2018, Black babies in Connecticut are more than four times as likely to die before their first birthday than babies born to white mothers, and are twice as likely to be categorized as having a low-birth weight compared to white babies. Nationally, the CDC finds that Black women are three times as likely to die from pregnancy-related causes compared to white women, and the majority of pregnancy-related deaths are preventable.
State Senate Bill 1, An Act Equalizing Comprehensive Access to Mental, Behavioral and Physical Health Care in Response to the Pandemic, aims to improve outcomes for Black mothers in Connecticut by creating a task force to study racial inequities in maternal mortality in the state, and create recommendations to reduce racial inequities.
But it also commissions a study to determine whether the Department of Public Health should establish a state certification process for doulas, which the bill defines as “a trained, nonmedical professional who provides continuous physical, emotional and informational support to a pregnant person during the antepartum and intrapartum periods and up to the first six weeks of the postpartum period.”
Advocates and experts across the state testified in a public hearing last week that this provision could do a lot of good for Black mothers in Connecticut, who could be meaningfully helped by increased access to doula care.
States like Oregon, Minnesota and New York require Medicaid to reimburse for certified doula services, a policy this bill would bring Connecticut one step closer to enacting. Black women are more likely than other racial subgroups to desire doula services, but not be able to access those services due to cost.
“Defining the doula profession is crucial to doulas here in Connecticut and can really advance health equity by offering a key step towards Medicaid reimbursement,” said Samantha Lew, policy analyst for Health Equity Solutions. “Title protection provides stronger identity and credibility and prevents misinterpretation of the profession.”
Zaria Smith, health policy fellow for Connecticut Mission for Women, Children, Seniors, Equity and Opportunity, testified about the phenomenon of “weathering,” a hypothesis that asserts that the stress of living through racism on a daily basis is responsible for some racial health disparities. Smith testified that racial inequalities in health outcomes cannot be fully explained purely by socioeconomic status, education, or other factors.
“Because of this chronic exposure to racism, Black women are more likely to have elevated levels of cortisol, which is a stress hormone,” Smith said. “That results in chronic inflammation that wears away at the body’s immune system, and results in premature onset of disease, especially among Black women. In the context of maternal health, that is thought to contribute to the increased incidence of low birth weight and overall poor maternal and infant health among Black women within the US.”
Smith advocates for greater access to doulas as one potential solution, testifying that because doulas can help mothers communicate their needs and provide informational and emotional support, they can help mitigate some of the causes of Black maternal mortality.
In a nationwide study from the University of Minnesota School of Public Health, women who received support from doulas were less likely to need C-sections, and were 22 percent less likely to give birth prematurely. Black women are more likely to receive C-sections than any other racial subgroup, and caesarean deliveries cause an 80 percent increased risk of severe maternal complications compared to vaginal delivery. Women who received support from doulas also have shorter labors and report greater satisfaction in the labor and delivery process.
Kay Hairston Wells, a doula in Bridgeport, testified that she became a doula as a direct result of witnessing Black mothers face challenges in labor and delivery.
“I watched as my daughter was wheeled into surgery because of the threat of cardiac arrest during labor,” Wells said. “I could have easily become one of those grandparents raising my grandchildren.”
Multiple other doulas testified in favor of the bill, as did NARAL Pro-Choice Connecticut, whose state director Liz Gustafson said that accessing “culturally appropriate care due to systemic and structural inequalities” is a key part of reproductive freedom.
Rep. Jaime Foster, D-Ellington, said in the public hearing that the combination of sexism and racism in the medical system can be debilitating for Black mothers.
“Women aren’t believed when they describe their symptoms and feelings in the healthcare sector, but if that’s exacerbated by racism, outcomes are worse,” Foster said. “A lot of us like to believe that childbirth is a natural and safe process, but there are certainly disproportionate risks by race and ethnicity in delivery of the child and in the surviving of an infant, which is tragic and upsetting to talk about.”
Cynthia Hayes has been a doula for nearly 17 years, and she started at an agency in Fairfield in New Haven that primarily served the white, wealthy mothers who could afford their services. One night, as she cared for a white mother whose baby was bruised from a traumatic birth and felt helpless as she had no family in the area to help, Hayes wondered how much worse the situation must be for Black women, and refocused her doula work back to her own community.
“I couldn’t be more proud of this work,” Hayes said. “We provide childbirth education, continuous support during labor and delivery, and lactation support to families in Connecticut to improve the negative outcomes that currently exist. The time has come for proper recognition of doulas in Connecticut as a profession.”