Culturally based doulas are key to improving care

The Black maternal health crisis is real.

Black women are three to four times more likely to die from pregnancy-related complications — most of which are preventable — than white women. Factors at play include underlying but unknown health conditions, inequitable access to care, and structural racism and implicit bias within the health care system.

While health care systems and community partners are looking for ways to take action, one Spokane organization leads the way in showing how culturally based doulas play a key role in ending this crisis.

“Our organization takes a focus on how we bring the culture back into maternal health,” says Stephaine Courtney, executive director of The Shades of Motherhood and The Learning Project Network.

What is a culturally based doula?

Doulas are trained professionals dedicated to supporting the birthing person mentally, physically and spiritually, Courtney explains. They can help during childbirth, with prenatal and postpartum care, and as a source of support in child loss, adoption, fostering and for single fathers.

The Shades of Motherhood brought together 17 independent doulas of color into one agency to provide comprehensive care, peer support groups and community workshops. The agency also provides doulas a space for training and support from their colleagues. These doulas provided services to 44 Black mothers and mothers of infants of color in 2023.

Through culturally based care, the patient is seen as an individual, and not through the stereotypes of their culture, Courtney says. They consider their family makeup, cultural roots and possible psychological triggers.

“There’s so many things that make each person different,” she continues. “It’s important for us to learn that being vulnerable during pregnancy unlocks something in the brain … and sometimes you need a guide to walk through that.”

The Black community continues to hold strong stigmas around mental health, Courtney explains. Doulas can help break down that mindset and build connections with their clients in ways others may not be able to.

Despite hosting her podcast “Girl Get a Doula” and her work at The Shades of Motherhood, Courtney found herself ignoring her own doula’s postpartum calls.

“I was tapping into the strong Black woman syndrome,” she says. “When I finally answered and she asked about my head, I said I had a headache.”

Courtney’s doula instructed her to go to the hospital immediately, where doctors discovered she had an infection that could have killed her.

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“I realized I didn’t really know my own body. I thought I was strong and healing, but I wasn’t,” she says. “Doulas are there to help sort out what’s going on with your body, mind, experience and space.”

Doulas do not replace the birthing parent’s partner or family, or their doctor or nurses, but act as an extra set of eyes. They know you well enough to spot small changes that could cause trauma or complications if ignored. It’s been proven that access to doulas lowers the risk of birth complications.

Doulas make a difference

Doulas are an evidence-based intervention that improves outcomes, in part by providing psychological safety, explains Kristen Carter, MSN-Ed, RN, C-EFM, family birth center clinical assistant nurse manager at MultiCare Deaconess Hospital. Carter also worked as a doula for seven years prior to becoming a nurse.

“Contractions are a result of oxytocin surging in your body. When you go into a new environment, like a hospital room, and you feel fear based on real or perceived threats, your body stops producing that oxytocin,” Carter says. “A doula creates psychological safety and, as a result, supports the body’s birthing process.”

When the birthing parent and those around them can relax into the process, it lowers the risk of complications such as the need for a cesarean section (C-section).

“It’s all about continuous support,” Carter says. “I don’t know a single nurse who doesn’t want to provide that, but we work in shifts, we’re monitoring the mother, baby and medications, and may have other patients in emergent situations … a doula is another layer in being able to create a safe place.”

A doula more fully understands the nuances of your fears and experiences, which highlights the importance of culturally based care, Carter adds. Birthing mothers of color may have heightened fear because they’re aware of the Black maternal health crisis, which will keep that cycle going.

“Representation matters, especially in birth,” Carter says. “Having a doula who does the magic they do but also provides culturally relevant advocacy is a path forward in improving this crisis.”

Solutions require the whole community

When Courtney founded The Shades of Motherhood, only two Black doulas worked in the Inland Northwest region. During the group’s first Black Maternal Health Week conference, they had no local hospital representation. This year, numerous hospitals across the region have taken on Black maternal health initiatives.

“The first step we need to take is to partner with the community,” she says. “Culturally based care is about helping everyone understand what it means and what it looks like as a friend, family, provider, and not just the medical community.”

In Spokane there’s been a big movement to have these conversations in open and transparent spaces, but organizations must look past the data and focus on the lived experiences of Black women, Courtney says.

“If we don’t have that conversation … if we don’t acknowledge the harm that has been done, we will never understand how to provide better care for Black women,” she adds. “They don’t want to be seen as the complainer or needy. They’ve silenced themselves. We need people to speak up and share what they’re going through.”