We Cannot Doula Our Way Out of a Broken System
Doulas are not a cure-all. Black mothers do not need another responsibility. We need healthcare institutions willing to change
We cannot doula our way out of a Black maternal health crisis .
That phrase feels so incredibly simple yet, it is apparently a hidden truth. I’ve been in maternal health solutions for almost a decade and the disparity is getting… checks notes… WORSE!
HOW!
How is this happening when millions of dollars have been thrown into blood pressure monitors, doula trainings, anti-bias trainings, and many interventions. However, Black mothers are still dying from pregnancy related and associated causes. Even when we survive we are more likely to experience a severe maternal morbidity – a severe complication – that can alter our lives forever.
But Kyra aren’t you a doula?
Yes! And that is how I know we cannot doula our way out of this.
Doulas continue to be used and abused as underpaid Band-Aids on a system that has remained largely intact. Doulas are valuable, but we cannot independently overcome hospital closures, ignored symptoms, delayed treatment, insurance gaps, obstetric racism and violence, or weak accountability.
A Blood pressure cuff cannot make a provider respond, a doula cannot force a clinician to listen and antibias training cannot force providers to lead with empathy and respect nor can it force a consequence when they don’t. You can complete the module, pass the quiz, collect the certificate and get right back to racist treatment of Black women all before lunch!
We also have to stop pretending that the burden of being saved rests on Black women.
They are expected to know the warning signs, monitor the symptoms, investigate every provider and birthing place, make a birth plan, hire the doula, speak up, and then survive with in a system that doesn’t see their humanity .
When exactly do they get to relax and enjoy the beauty of being pregnant? When do they get to prepare for parenthood and not just survive the pregnancy?
We are even at the point of shaming Black women for throwing baby showers instead of hiring a doula. While I do believe doulas should be at every birth, I also want expecting families to be able to celebrate the expansion of their families. Black families deserve joy! They deserve maternity pictures, cute baby clothes they wont use, silly shower games and anything else that allows them to experience pregnancy as more than a medical threat!
Insurance companies should be shouldering the cost of doula care, not the pregnant person. Doulas are a cost savings to the system by reducing costly interventions , so let the healthcare system take on the financial responsibility. Let Black moms enjoy pregnancy.
We should not be afraid to demand that the system actually change. We should champion risk appropriate care, widely expand use of the midwifery care model, expand meaningful postpartum coverage, protect access to maternity services and for heavens sake, hold providers and institutions responsible for explicit bias and racism.
Doulas should be there to provide emotional, physical and spiritual support for expecting families. Doula care should be covered by insurance and widely and readily available to everyone.
But doulas should not be the systems change you seek.
Change the damn system!