Pushing for Black Maternal Health Equity: Doula Shares Essential Tips for Moms-to-Be
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Black people in America are three to four times more likely to die from pregnancy or childbirth-related issues than white women, and many advocates are fighting to improve the nation’s maternal health disparities. 

One of those experts includes Nicha Cumberbatch, a doula, physician’s assistant and childbirth educator. 

She’s also the Director of Population Health Curriculum at Spora Health, a culture-centered telehealth service. 

As some mommies-to-be prepare for their first Mother’s Day, Cumberbatch shared her essentials for how these women can advocate for themselves at the doctor’s office and ensure their concerns are heard. 

Hey, Black Mom!: What is the first step a Black pregnant woman should take when seeking out maternal care, especially first-time mothers? 

Nicha Cumberbatch: As a first step, I advise Black moms-to-be to do some research on the type of birthing journey that they want to pursue. Spend some time thinking about what’s most important to you: what type of support are you looking for during pregnancy? Are you envisioning a “traditional” hospital birth, or a medication-free birth at home? Are you looking to incorporate spiritual traditions? How you answer these questions will inform what providers you should look for, and what you need to ask in an initial consultation. If possible, put some thought behind this before you’re even pregnant, so you can hit the ground running when it’s time to see a provider.

When you’re ready, get started on building a network of supportive people who can help you achieve your birthing goals. This means looking for the right OBGYN, absolutely, but it can also mean seeking out a doula or midwife to be your guide through the physical, emotional, and spiritual aspects of pregnancy and birth – or simply talking to a trusted friend, family member or partner about your plans. It can be difficult to navigate pregnancy alone, but having a network of people who understand your needs and desires can help you advocate for yourself when it comes time to make important decisions about your pregnancy and birth.

HB: What specifically should they look for in a provider? 

NC: Whether it’s an OBGYN, midwife, doula, or other provider, compatibility is extremely important. Beyond basic questions about a provider’s degree or background, ask them what type of services they can support you with, and make sure that they are receptive to your needs before you even step foot into their office. 

For example, not every physician will support their patients in alternative birthing styles, like at-home births.

For example, not every physician will support their patients in alternative birthing styles, like at-home births. If this is something you are interested in exploring, do your research first to ensure that your provider will be able to support you through the journey that’s best for you. Be upfront about your needs and desires, and don’t be afraid to shop around for the provider who will be the best fit. 

It’s also important to consider if your provider is the right person for your budget and lifestyle. If you’re already a parent or caregiver, for example, providers who offer telehealth visits may make more sense for your busy schedule.

HB: Some Black women prefer a provider of color. How much have you seen race factor into these decisions? How much does it matter? 

NC: Many Black women understandably feel more comfortable with a provider who looks like them and shares a similar background. If this makes a difference for you, you should feel encouraged to seek out a Black provider. 

Evidence backs this up, too: research has found that when there is a patient-provider race concordance, infant mortality significantly decreases. This is not to say that sharing the same racial background as your provider guarantees that you will have a good experience. For many moms-to-be what matters most is if they feel respected and comfortable with the provider. 

HB: What are the options for Black pregnant women when there is limited access to diverse providers? What can they do to build additional support and comfort? 

NC: Unfortunately, there is a shortage of Black healthcare providers in the United States – meaning you may have a very limited selection of providers to choose from in your area. Thankfully, there are other ways to find a provider who meets your cultural needs.

Consider your provider’s qualifications: have they undergone cultural competency training to ensure they understand your unique cultural needs? This type of training can help eliminate biases, no matter what your provider’s racial/ethnic background is.

You can also explore providers who offer telehealth services. Looking beyond your immediate area may expand the number of in-network providers you have to choose from, helping you find someone who fits your background or who has undergone cultural competency training.

The biggest factor for moms-to-be is finding someone you feel capable of building trust with.

While it may seem simple, don’t forget to leverage those in your network. Ask around to other Black moms in your life who you trust: what providers have they seen in your area? Were they receptive to their needs? The biggest factor for moms-to-be is finding someone you feel capable of building trust with.

HB: What’s the most telling aspect of the fact that while Black women are three to four times more likely to die from childbirth, 60 percent of maternal deaths are preventable? 

NC: Sadly, healthcare providers of all backgrounds often don’t take Black women’s health concerns or birthing preferences seriously. When doctors don’t listen to their Black patients, they may miss tell-tale signs of pregnancy issues, or perform unnecessary procedures that can contribute to higher rates of medical complications.

Even as a doula and birthing educator myself, when I was pregnant I felt unheard by my physician – who convinced me to have a medically unnecessary C-Section despite my wishes for an at-home birth. It is stories like mine that make these statistics painfully real, and make change an imperative.

HB: What does it mean to be an advocate for yourself while pregnant? How can others rally behind you in this mission? 

NC: One way we can combat disparities in maternal health is by ensuring that Black women are heard in the doctor’s office, and that they have an active voice in how their bodies are treated throughout their pregnancy. Yes, women can speak up in the doctor’s office – but this is only one piece of the puzzle. We need to train doctors to listen to women of color and be receptive to their cultural needs – while also giving women the resources and education they need to make the right choices for themselves.

Yes, women can speak up in the doctor’s office – but this is only one piece of the puzzle.

HB: What action can a mom-to-be take if her doctor doesn’t listen? 

NC: Understand that no one knows what you’re feeling better than you do. If your doctor isn’t listening to your concerns, feel encouraged to push back on them or seek out a second opinion. You can use this second opinion to guide your conversation with your primary provider, or, if you find a better fit, make the switch to a new provider completely. 

HB: Please provide your best tips for pregnant women who need to speak up for themselves at the doctor’s office. It seems like it’s easier said than done. 

NC: Speaking up for yourself at the doctor’s office is easier said than done; and that’s why it’s important to have a network of support behind you. Use a doula, friend or partner as a sounding board to talk through the concerns you have. If you’re nervous about bringing up issues with your doctor, have a friend role play the conversation with you – you’ll feel more prepared walking in the door. 

…remember that you should never feel out of line for expressing how you are feeling and communicating your needs.

It can also be wise to do your own research ahead of time, or consult another physician for a second opinion, to help guide your conversation. Lastly, remember that you should never feel out of line for expressing how you are feeling and communicating your needs.

HB: Have you seen an increase in these types of conversations and this type of advocacy in recent years? What has that meant to this movement? 

NC: Black maternal health has been a topic of conversation that has thankfully gotten more attention in recent years, and has gained traction as a movement on a national scale. In fact, December 2021 marked the first White House Maternal Health Day of Action – a call to both the public and private sectors to help improve health outcomes for parents and infants in the United States. Further, this April, as part of Black Maternal Health Week, the President introduced a number of new programs aimed at improving perinatal health outcomes and maternal health equity. All of this traction is a result of the grassroots organizing of Black led organizations like Black Mamas Matter who have been doing this work for years. We still have a long way to go to ensuring Black women receive equitable maternal care, but such initiatives are absolutely a step in the right direction, and mean we can go further to once and for all address maternal care disparities that exist for Black birthing people.