Tamika Tali, a mother of five and grandmother of eight, had unpleasant experiences with the health care system during her pregnancies and after she gave birth.
She didn’t want other women, especially her daughters, to have the same difficulties, so she decided to become a doula.
Last month, Tali was inducted as a community-based doula into the Birth in Color Danville program.
A doula is a woman, usually without formal obstetric education, who provides guidance and support to other women during pregnancy, birth and postpartum. She can serve as a liaison between her client and a medical professional.
Birth in Color is a Richmond-based nonprofit founded in 2018 that trains doulas to serve Black, brown and Indigenous mothers to ensure safe deliveries. It has served more than 500 women in Virginia so far.
These community-based doulas come from the same background and culture as the people they’re helping, the organization’s website says, and can help “navigate structural racism in healthcare.”
“When people think of doulas, especially as it becomes more popular and trendy to have one, they usually think of somebody who just comes to a birth and then leaves,” said Sequoi Phipps-Hawkins, director of communications and marketing for Birth in Color.
But community-based doulas remain with their clients from pregnancy to postpartum, she said.
“People are seeing that same face through the whole journey, which is really significant especially for people of color, because they have someone who looks like them, who is educated and a professional in this space, who they’re building a relationship, and who they trust in the labor room,” Phipps-Hawkins said. “And then they also have them around checking in during postpartum.”
One of the primary goals of Birth in Color is to see a decrease in the maternal mortality rate.
According to the Centers for Disease Control and Prevention, maternal mortality is “the death of a woman while pregnant or within 42 days of termination of pregnancy,” regardless of the duration of the pregnancy, “from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
The maternal mortality rate for Black women is 2.6 times higher than it is for white women, according to a 2021 CDC study.
During the 20th century, maternal mortality rates dropped rapidly globally as living conditions and medical practices improved.
But Black mothers have still been more likely to die than white mothers for more than 100 years, according to data from the National Center for Health Statistics, cited in a report by the Commonwealth Fund.
“Black-white disparities in maternal mortality have existed since the beginning of the collection of such data,” the report says.
White maternal mortality rates declined more rapidly than those for Black mothers after World War II, the report says, and the disparity between the two groups increased until the maternal mortality ratio for Black mothers was four times that of white mothers.
Since the early 1970s, Black mothers have been three to four times more likely to die than white mothers. The disparity in 2018 was the same as what was seen in the 1940s, the report says.
According to the report, the racial disparity in maternal mortality rates is a result of disparities in factors such as income, housing, safety and education, which can lead to poorer health and increased rates of chronic disease — and therefore to greater risk for Black women during pregnancy.
It also says that the intersection of sexism and racism could lead to Black women being less respected or listened to by care providers, and it references tennis star Serena Williams, who has talked openly about a life-threatening experience after giving birth to her daughter.
This is why the Birth in Color project is targeted specifically for mothers of color.
“There is a critical need for safe, respectful, anti-racist care,” according to the Birth in Color website. “One of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”
But death isn’t the only concern for mothers of color during their pregnancies, births and postpartum periods.
“A lot of Black women, we’re expected to have a high pain tolerance,” Tali said. “A lot of times you could tell the doctor, ‘Hey, something’s hurting,’ and they shrug it off and say, ‘You’ll get over it.’”
Tali, who has lived in Danville her entire life, said that after she gave birth to her daughter, she got an infection in one of her breasts from breastfeeding.
“I went to the doctor, and he made a mockery of the whole situation,” she said. “I’m in pain, severe pain, and he just basically shrugged me off. He didn’t give me antibiotics or anything.”
Mastitis, an infection caused by breastfeeding, usually requires a simple antibiotic to clear it up. But if left untreated, it can cause the development of an abscess that needs to be removed through surgical drainage.
It became too painful to even hold her baby to her chest, Tali said, so she went to another doctor who was able to perform surgery right away. But he couldn’t use any local anesthesia because the infection had gotten so bad, she said.
“The surgeon literally cried in the room with me while he was doing surgery,” Tali said. “He told me several times to sue the other doctor, but at that time, I was going through so much postpartum depression and I never went through with it.”
Tali said she made sure to always have an advocate with her during her subsequent pregnancies, and she always went to the doctor with her children when they were pregnant.
Having someone else there “helps the situation,” she said. “It helps them with the right questions to ask, and it also helps them advocate for themselves and stick up for themselves.”
This is the overarching idea behind doulas.
“Positive birth outcomes are increased with the presence of a doula,” Phipps-Hawkins said. “That’s for a number of reasons.”
According to a study published in the Journal of Perinatal Education, mothers who received doula care were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.
Doulas have also been associated with shorter labor, fewer cesarean section births and a “decrease in health disparities and a lesser effect of stressors (from racial discrimination, food insecurity, poverty, etc.) on the birth process,” according to the Birth in Color website.
“Truly, just the presence of having a doula in the space of a client and a care provider is a really, really helpful bridge even for things like breaking down some of the medical jargon that we hear when we go to a doctor’s appointment or while you’re in labor,” Phipps-Hawkins said. “Having somebody there to help prompt you with the questions that you should ask to get the clarity that you need to make an informed decision is also really valuable.”
To spread this service across Virginia, Birth in Color has expanded from Richmond to five other locations: Hampton Roads, Lynchburg, Northern Neck, Roanoke and, since late 2022, Danville and Martinsville.
The program in Danville and Martinsville is completely funded by donors, according to a March news release from Birth in Color. This alleviates the financial burden of receiving doula care, which the organization’s website calls the greatest barrier for women seeking these services.
“Over 95% of our clients don’t have to pay for the services that they receive,” Phipps-Hawkins said. “They have free or occasionally low-cost services.”
Doula care can be expensive, usually costing over $1,000, she said.
“If someone knows they want a doula, or truly needs a doula, but they can’t afford it, we can fill that gap,” Phipps-Hawkins said.
The Danville branch inducted its first cohort of doulas of color at a ceremony on March 18. Tali was inducted alongside six other women, who were trained by Kenda Sutton-EL, founder and executive director of Birth in Color.
“The training was real fun,” Tali said. It took place over three days and was very hands-on, she said, and all the inductees had a chance to ask questions.
The training can be offered at a discounted rate for aspiring doulas, and financial support can also be offered to those pursuing relevant training, according to the Birth in Color website.
After their training, doulas are expected to complete 10 hours a week of self-guided study, client communication and skill work.
The doulas each provide care to eight to 10 pregnant clients, including two prenatal visits, two postpartum visits, continuous labor support, record-keeping and phone support.
Community-based doulas can work full time if they want, meaning they assist with about five due dates per month, Phipps-Hawkins said.
“Birth in Color allows our doulas to be flexible and communicate their capacity,” she said. “Many have full-time jobs elsewhere and are part-time doulas. … It just depends on what they can handle.”
There are a handful of full-time doulas in the organization, but most are part-time, she said.
On April 15, Birth in Color Danville is hosting a community baby shower where clients of color can receive free newborn and postpartum supplies, and also apply to receive doula care. This event is already at capacity, but the organization plans to hold another community baby shower in August.
“They don’t have to spend money and we’re not asking them to buy anything, but we truly just want them to have access to this resource,” Phipps-Hawkins said.
Tali said she would like to see this program lead to a drop in maternal mortality rates. Because of her personal experiences, she felt called to become a doula, she said.
“This is a training that most women need,” Tali said. “It’s not something that you just feel like you want to do. It’s something that I think you’re chosen to do.”