Anyone who pays even scant attention to news about pregnancy and Black people knows the sobering reality: The United States has the highest maternal mortality rate of high-income nations (and it is increasing) and in that alarming number, Black pregnant people are the most likely to die from pregnancy-related complications, three to four times the rate of non-Latinx White mothers.

While the real solution to reversing these statistics is an end to structural racism in medicine, Black pregnant people are now relying on another way to make their birthing experience safer. According to ABC News, there is an increase in Black women using doulas. Studies show that having a doula present while giving birth has led to a decrease in preterm birth or low birth rate,  better communication between lower-income earning pregnant people of color and their health care providers, and a reduction in the rate of C-sections, which are higher among Black women.

Doula, Maiysha Campbell Kramer, CD (DONA), CLC has been helping to bring babies into the world for decades. The mother of two and former home birth assistant had been unofficially doula-ing her pregnant friends for years before she became certified in 2010. Although Kramer adamantly believes that “every birth is a new birth and every birth is a first,” she admits that assisting with births during the COVID-19 pandemic has been a first like no other. Here, the New York-based doula explores how racial privilege helped change pandemic hospital restrictions, why her profession is invaluable and the reason it is often dismissed by the medical and insurance communities.

What services do you provide as a doula?

The official description is informational, physical, emotional support during pregnancy, birth and the postpartum time. And so, I am answering questions, reassuring, also establishing personal connection and understanding of [women’s] hopes, wants, and goals for the birth. I also help them understand what’s the realistic goal within the parameters of what’s happening in their birth if there are complications. 

How does the definition of what you do change if you are working with Black pregnant people?

Well, everyone’s their own person, but I will say that most, if not all, of my Black clients are aware of the stats. They come to me a little more afraid. Besides all the other things on their list of what they want in their birth, they also want to stay alive.

How does having a doula as part of your birth team help you to stay alive or even just have a better birth?

One study found when they stuck a female in the corner [of the delivery room], not even a trained doula, but just a female-bodied person in the corner, the health stats improved. Just the physical being and energy that a female body can provide the other body is huge.

But then there’s the other side. I know a lot about the clinical part of birth, like this drug does this and that drug does that. For example, last year, one of my clients had an alert band on her wrist because she was allergic to something. I asked her what and it was shellfish. During delivery, they were going to give her a urinary catheter. To do that, they sterilize the outer area of the vulva with Betadine that comes in a kit. The nurse tears open the kit and I scream, ‘Shellfish!’ because if you’re allergic to shellfish, that could cross indicate that you’re allergic to Betadine. And the last thing we needed at the birth was her vagina and throat to swell shut.

So, I carry a lot of positive vibes and am conscious of my energy, but that wouldn’t have done anything if they had swabbed her body with Betadine.

How has your work changed since the COVID-19 pandemic began?

I chose to stop doing births at first. I was actually in the hospital March 15th [2020] when we were told to go. It was an hour after a birth, and the nurse was like, ‘Everyone get out.’

I had clients go through it alone- which is terrible. It was just a few days that they made anyone give birth alone. And that’s because it was white women who got pissed off, so it only took about a week to change the law. 

What is it like to support women through pregnancy now?

For everyone, being pregnant is the most intense time. And while a pandemic is obviously different, every parent always has a terror period as part of being a parent. The world has been terrifying. When you’re having a baby, all the things intensify like terrorism, racism, the environment and ‘will I stay pregnant, will this baby survive to term, will it survive the birth?’ ‘Will I survive the birth?’ Moms have been fearing death forever, for themselves and their child. So while this time is more intense, I feel like it has opened up an allowable space to say, “I’m afraid of dying.”

It can cost up to $3,000 for a doula, meaning many women may recognize the benefits but can’t afford one. Some of your work is with lower-income earning clients, how do they find you?

I work with the Healthy Start Brooklyn program [providing free or low-cost doula care to qualifying women in the borough through the Department of Health]. I was a poor, single mom so I want to pay it back.
 
Is your work with low-income clients different ?

Yes, in a ton of ways. A lot of them usually get referred in by their healthcare clinic, as opposed to finding me on their own. And there is a lot of poverty. I’ve worked with moms in shelters. And sometimes they don’t have a phone. That’s a whole other world when the doorbell in the apartment building hooks up to the phone and you can’t get in their building because the phone’s off. 

Other than being back in hospitals, what are you doing now?

I’ve started giving trainings because I really want doulas to be prepared out here. So many of us learn on our own and don’t know the meat and potatoes. Like what is a bad heart rate? What are the drugs and what do they do? What does an induction look like?

You need to know the clinical- and then not practice the clinical. Do not give medical advice. For example, if you’re induced, there’s a 60% chance of having a Cesarean. But don’t tell your client ‘don’t induce’ and they go back for a prenatal and there’s no heart rate. Then what? So, know this information so you can be helpful, but don’t give advice unless they’re about to do something that’s going to kill your client.   

Since doulas can save lives, why doesn’t the United States or its healthcare system recognize their importance more?

Because women, women, women, women, women. There are people who don’t identify as that who give birth and perform this role, but it’s a mostly women teaching profession. And mostly women means mostly treated like shit, right?

Do you believe every pregnant person can benefit from having a doula?

Just about. My friend was having her fourth home birth, and I said, “Do you want me to come?” She told me, ‘I’m alright’ and I thought, ‘You’re probably right. I think you’re good.’

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To find a doula, begin by asking your medical care provider for recommendations, as well as people in your community with children. Beyond that, the National Black Doulas Association has a directory of doulas across the country. Some insurance companies will partially reimburse for doula services, so check with yours. Also, contact your city’s health department to learn about programs, like Healthy Start Brooklyn, that provide free or sliding scale doula services. Finally, when you find a doula you like, be upfront with them about what you can afford and see if they can work with you for sliding scale or staggered payments.


Ayana Byrd is a journalist, author and screenwriter. She is the co-author of Hair Story: Untangling the Roots of Black Hair in America and an expert in the intersection of race, privilege and beauty culture. She also covers reproductive health and other women’s health topics. A new mom, Byrd lives in Philadelphia and is finishing her first novel.