Today’s guest columnist is Jennifer L. Greer
Last year, when I got the news that my great nephew had been born in Birmingham, AL, at the height of the pandemic, that he was healthy, and that his mom was healthy, I cried. And not just happy tears.
I cried tears of relief.
Yes, I was stressed about COVID-19. But I was also concerned about the increasingly risky question of having a baby in Alabama, in this era of closing hospitals, OB/GYN doctor shortages, and rising rates of poor public health across multiple measures, from diabetes and high blood pressure to obesity and mental illness.
A recent federal report cited Alabama for the third highest death rate of mothers in the nation for 2018. At 36.4 mothers lost per 100,000 live births, maternal mortality remains statistically uncommon; yet Alabama’s ratio was more than twice the national level (and the U.S. ranks behind Russia and last among developed countries.) What’s more, in 2020, a state report said 70% of maternal deaths studied were preventable.
I was not the only one worried. Last year, the Medical Association of Alabama launched a state-wide Save Alabama Moms campaign to sound the alarm about our maternal health crisis.
How can this be, you ask, in a “family-values” state? What must we do to turn the situation around? Answers are both small and large.
Mom’s best friend: a birth doula
Among the many things that went right for my family was the fact that my niece was able to afford to hire a birth doula, albeit a virtual one (via phone and Zoom) because of the pandemic.
A doula is “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible,” according to DONA International, a leading educational, training and certification organization.
Research shows that doula services improve both maternal and infant health outcomes. In fact, doulas offer critical education on everything from birthing techniques and laboring at home to breastfeeding, bonding, and self-care after birthing, when as many as two thirds of maternal deaths occur in Alabama.
The trouble is that not every expectant mother in central Alabama can afford to hire one. That’s where BirthWell Partners Community Doula Project, (BWP), a small not-for-profit organization based in Birmingham, comes in.
Unique in the state, BirthWell offers free and reduced-cost birth doula services – such as childbirth education, breastfeeding assistance, and non-medical labor and post-partum support — for under-resourced moms, many of whom are at higher risk for infant and maternal mortality. The services are all provided by BWP’s specially trained doulas like ShaTaura Lewis, 36, a Birmingham mother of four sons, who is a contract doula for BWP.
Empowering those who give birth
In 2020, Lewis attended 10 BWP births and worked in person and virtually before and after the births, depending upon what clients needed. A typical day found her on a Zoom call, coaching a very pregnant client before heading to the hospital.
“We were doing a series of techniques at home, while she is dilating, to help her stay relaxed and decide when it is time to go. With COVID-19 cases on the rise, she wanted to shorten her time in the hospital.”
Another day found her on the phone again: “You’ve tested positive for COVID?” she confirmed with one client, who has a new baby at home. “What do you need? Groceries? No problem. I’ll leave them on the porch.”
On yet another call, an in-home visit, Ms. Lewis is comforting a client who has just lost her infant. ”I’m here to help the mother, comfort her in that moment. We have a relationship, and not everyone knows how to talk to someone who has just lost a child.”
In every case, Lewis’ goal is helping her clients “advocate for themselves.” BWP clients like Jonnita Turnes say once you have had a baby with a doula, you will be convinced. “Nurses can do only so much; a doula is more hands-on,” says Turnes.
“ShaTaura respected everything in my birth plan, supported me, and worked with me on stretches and exercises to help me prepare for labor. She was there when I had my baby at Princeton Baptist Medical Center. She also helped my husband get ready, which is important. A lot of guys are lost [about birthing].”
Better outcomes, diversity, entrepreneurship
What kind of difference do doulas like Lewis make? “Look at the data,” says BWP co-founder Dalia Abrams, of Birmingham, who holds an M.A. and M.P.H. and is the organization’s Executive Director of Program Operations. BirthWell Partners doula clients are:
- Less likely to give birth by cesarean section (26% vs. Alabama rate of 34%);
- Less likely to get an epidural during labor (54% vs. Jefferson County rate of 89%);
- More likely to initiate breastfeeding (94% vs. Jefferson County rate of 76%).
“And as amazing as those numbers are, our real priority is the total wellbeing of our clients,” say Abrams, who is also a mother of four.
”We have a vision, and I quote, to ‘treat childbirth not as a transient episode in the lives of some people, but as the foundational episode in the lives of all people,’” she explains, citing Harvard professor and OB/GYN Neel Shah, MD, author of “Growing a Family with Dignity.”
In 2011, Abrams, who is a Certified Doula CD(DONA), a Birth Doula Trainer BDT(DONA), Lamaze Certified Childbirth Educator (LCCE), and a Certified Lactation Counselor, co-founded BirthWell Partners with Susan Petrus, a local mother of two, whom she met while lobbying for reforms to Alabama’s midwifery laws.
After first establishing a for-profit doula service, Abrams teamed up with Petrus to create the non-profit BWP. They wanted to reach “the people who need the support most and can benefit the most from it,” says Petrus, who has an M.A., is the Executive Director of Business Operations, and is also a certified childbirth educator and labor doula. “Also, there was no diversity locally in doulas. We wanted to change that.”
This year, as BWP celebrates its 10th anniversary, the organization can claim gains as an educational innovator and an incubator of trained doulas. Indeed, through a series of doula workshops, Abrams and Petrus have taught more than 300 trainees, 1/3 of whom were people of color, and provided some form of pregnancy support and/or childbirth education to more than 700 people.
For example, Lewis, a single mother, had been forced to leave nursing school to care for a family member; in 2016, she took BWP’s doula training, became a DONA certified birth doula, and now runs her own business, Doula & Beyond, LLC.
Says Petrus: “Today, we coordinate 40 to 50 doulas who work with us on and off at any one time. We serve over 100 pregnant individuals and their families each year. We have worked in almost every Birmingham area hospital.”
And they do it all with a staff of two.
Alabama: Best state to have a family?
I know what you are thinking. While this small Birmingham non-profit helps lead the way to healthier Alabama moms and babies, it’s doing so one birth at a time.
What could the state of Alabama do to reduce maternal deaths by at least a half?
First, expand Medicaid to cover new moms in the post-partum period (when most Alabama deaths occurred), as recommended by the state’s new Maternal Mortality Review Committee (MMRC) in its 2020 state report. Second, cover doulas on Medicaid plans for better maternal and infant outcomes, as other states are doing.
Nearly seven in 10 Alabamians now favor Medicaid expansion, according to polling by a statewide coalition called Cover Alabama. And this spring, new federal funds for Medicaid expansion could generously support start-up costs, among other critical budget items like mental health and substance abuse, for the next two years.
Instead of being rated the worst state in the country to have a baby, experts say that, with Medicaid expansion, Alabama has the potential to become the best state in the South to have a family.
Watching my niece and nephew play with their bright, beautiful pandemic baby, I realize that this young couple, Turnes and her husband, and all of those giving birth here assume a great deal of risk and responsibility in growing Alabama’s future.
Surely, we can do our part in return.
Jennifer L. Greer is a freelance journalist and a retired university instructor who lives in the Birmingham, AL. area. She serves as a volunteer for BirthWell Partners Community Doula Project .
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