How Black Doulas Are Fighting Black Maternal Mortality Rates

Supermajority Education Fund

May 8, 2020

Doula and breastfeeding advocate Kristin Mejia-Greene had an enjoyable hospital experience and a caring OB/GYN when she gave birth to her firstborn in 2014. Soon after, she joined two Facebook breastfeeding support groups: one dedicated to black mothers, and another with predominantly white mothers. She noticed that members of the former group reported less enjoyable birth experiences compared to the white mothers in the latter group. 

Mejia-Greene says her initial advocacy centered around breastfeeding. Through her work with the Nashville Breastfeeding Coalition, Mejia-Greene met Davidson County Health Department representatives, who informed her of startling black maternal mortality and morbidity rates that backed up the stories she was reading on-line. Black women are three to four more times likely to die from childbirth than white mothers, according to the Centers for Disease Control and Prevention. Advocates say medical racism is the cause.

As Mejia-Greene learned more about this issue, she was drawn to traditional birth practices. She was most drawn to doulaing after learning the wellness benefits it provides expecting parents, and trained as a doula in 2016. Mejia-Greene trained under white doulas and was unsatisfied with the barriers to doula education for black communities in Nashville, so she created the Homeland Heart Birth & Wellness Collective, a community-funded initiative, to center positive black maternal outcomes in 2019. In January 2020, 24 women completed Homeland’s two-day training to be birth doulas, postpartum doulas, and breastfeeding peer counselors, and the cohort has committed to working with mothers under Mejia-Greene’s guidance for 12 to 18 months. 

In honor of Mother’s Day, Meija-Green spoke to Supermajority News about working through the COVID-19 pandemic and what it will take to create positive maternal outcomes for black mothers in America.

Supermajority News: Can you tell me more about Homeland Heart Birth & Wellness Collective’s mission? 

Kristin Mejia-Greene: It’s called Homeland Heart because I’m trying to build villages around pregnant families. We are still in a society so fond of the phrase, “It takes a village,” but where are the villages? And how do I know what I’m looking for, especially if I’m a first-time mom, or even if I’m a second-time mom, and so I have to deal with the toddler, and I got to deal with the baby. Maybe I got to go back to work a lot sooner than I thought I did. I want to breastfeed, but that’s hard. 

And I say: here’s the village that you’re going to need to raise the baby. Here’s a birth doula. This is somebody that’s going to help you get through the process prenatally and while you’re delivering. 

Here’s your postpartum doula. This person is going to [help you through] a transition at home and [teach you] how to care for yourself and how to integrate a small, tiny, needy human into your life. How to make this all work with everybody. 

Then here’s your breastfeeding peer counselor. When you have trouble, reach out to this person — she has experience. And the goal is to get them to six months of breastfeeding, which is the World Health Organization recommendation. 

So this is my hypothesis with the program: If we take better care of women on the front end, we would see better results with the babies on the back end. Because when we have healthier moms, then we have healthy babies. But I guess it’s not worthy of being funded.

Homeland Heart Birth Wellness Collective trainees

What’s it like acquiring funding for your work?

The State of Tennessee has an office called the Office of Minority Health Disparities Elimination. I applied for grant funding from the state and got denied because they said that our program, or our social media, seemingly seeks to alienate other communities [because it centers black women]. I was like, well, yeah, it does. And we wouldn’t be in this situation if we had not been alienated. 

[Without the funding], I looked up the Health Connect One community-based doula model and pretty much drafted my program off of that. 

Before starting your collective, what was your experience being a black doula in Nashville?

Before the doulas that I trained, I only knew of four black doulas, including myself [in Nashville]. That’s not acceptable.

So we think about the barriers that exist. One is cost. Maybe I [am] low-income, but you’re going to charge me $650 so that I can learn something that my great, great, great, great, great grandma was doing? The cost of the Homeland Heart Birth & Wellness Collective two-day training was $75. 

Then we hosted the two-day training on the weekend, and I made sure that we had enough money to also cover childcare. The trainees are able to bring their children to the training site, and we have two certified nannies on-site that take care of the children while their mothers learn. We partnered with the government, Davidson County Health Department, and they paid for the trainees’ books and supplies. 

There’s no cost for mothers located in our service areas. We serve seven zip codes with our Davidson County partner, Nashville Strong Babies. It’s a program through the Metro Health Department that helped fund our training when the state refused.

What did the classes entail?

We started out the training with introductions. What brought you to birth work? And [we] go around the room and listen to 24 black women tell the stories of why they are interested in birth work and what brought him there. [The stories are usually] terrible birth experiences — two miscarriages, two horrible termination experiences.

People bond through these experiences. Like, yeah, I had that doctor, and I had that same experience with him. We had one girl that didn’t realize that she hadn’t mourned the loss of her breastfeeding experience until we started talking about how to walk your client through breastfeeding her newborn. There is a lot of healing that happens in this space. We cried a lot because you never realize the power of being surrounded by people that look like you until you are.

How long is the training?

The major requirement of program [participants] is [they must] dedicate at least 12 to 18 months of their lives to make sure that these babies see their first birthday. If you’re coming to Homeland Heart, you’re staying here until we make sure that [clients] survive. 

Trainees rotate jobs so that they can figure out what they really like. Is your heart in the prenatal journey? Or do you really want to be here to support [a mother] during breastfeeding?

You were trained as a doula in a white space. How is the training space at Homeland different for black women?

We didn’t talk about what happens if your mom dies [in a white space]. What happens if you’re supporting a birth, and the baby you are waiting on dies? How do you support the family? How do you support yourself? That is not a conversation anybody had with me. I have chosen to work solely within a demographic that is seeing death more frequently than the demographic that taught me. So [white teachers didn’t] have any reason to teach me about this because the chances of them seeing it are way lower than the chances of me seeing it. 

About a year ago, I experienced my first infant death, and it rocked my entire world. You don’t ever unsee that  —  the whole experience of having to go through this with the woman, the fact that she had two other children at home that she has to care for after this. You got books that are going to teach you about how birth works. Read them. That’s important. But I’m here to teach you about all the things that you’re not going to learn in a white-led training because we’re trying to change numbers in the community.

How has the work of Homeland Heart Birth & Wellness Collective changed since COVID-19?

Right now, we’re taking donations to make sure that our doulas have personal protective equipment because we’ve been given permission to assist births in two local hospitals here.

Unfortunately, it has impacted our training. I’m a real big on hands-on. Our plan was to roll out another training during Black Maternal Health Week in April. We weren’t able to do that because of COVID-19. So I am reassessing [the program] because there have been so many inquiries since the last class that we had in January. It’s time for another class, but I’m trying to be mindful of regulations and recommendations. So that might mean smaller classes. And we are not able to meet with our clients face to face as much in the prenatal period.

I would ideally like to have Latina doulas. So the plan is to roll out training for them, but I have to do more work on the statistics and barriers they specifically face. Those are some of the plans that we had that COVID twisted up a little bit.