All Cassandre Dunbar wanted was an uneventful pregnancy. Dunbar, who hosts the podcast Be Well Sis and is a mom of two, chose to deliver her second child at a birthing center and opted to work with a doula. However, her pregnancy and delivery went from uneventful to traumatic in a short period of time. 

Despite receiving promising reports during prenatal visits, Dunbar grew concerned when she neared 40 weeks of pregnancy and she still wasn't dilated. Then her son started moving less in the womb than usual. 

"I had suspicions — he just wasn't doing the things that he normally did," Dunbar says. "He was really quiet for the last few days, and that scared me." She went to a clinic for stress tests, where doctors assured her that her son was "fine — just resting." 

However, that night she experienced unusual cramping. She called her doula, who recognized the situation warranted further action and a change to the original birth plan.

Dunbar's doula empowered her husband to call the ambulance to take her to the hospital for delivery. When she got to the hospital, Dunbar learned that her placenta had detached and she would need to give birth. Her newborn son had several serious complications, and doctors quickly placed him in a medically induced coma to prevent brain damage. 

Four years later, both Dunbar and her son are alive and well, and she credits their happy ending to the support of her doula and husband. 

"My doula was instrumental in walking me through everything," Dunbar says. "Because she's been a doula for so long, everybody knew her in the hospital." Having someone by her side who knew the facility put her at ease — and helped her get the care she needed. 

How can doulas help Black moms during labor?

Healthy labor and delivery outcomes aren’t as common in Black women as they are in white women — it’s just a fact. Black women are more likely to experience pregnancy complications like preeclampsia, postpartum hemorrhaging and preterm labor. The maternal mortality rate amongst Black women is also disproportionately high.

However, studies show that the inclusion of a doula in pregnancy and delivery can improve outcomes during birth.[1] This is especially true for disadvantaged groups, including Black women and other people of color. 

In general, pay inequalities and inadequate access to culturally competent, expedient care can complicate the pregnancy and birthing process for Black moms. For example, one study found that Black patients are less likely to receive treatment for pain because of false beliefs about biological differences and pain tolerance.[2]

All of these can contribute to traumatic circumstances for Black moms. Because of systemic racism and implicit bias, many women feel as though they can’t speak up for themselves because of assumed judgements of their character, says Quantrilla Ard, PhD, a behavioral scientist and professor of public health at the Morehouse School of Medicine. 

"Black women specifically find themselves in this position where they're trying to strike a balance between not being seen as belligerent versus advocating for themselves and needing answers so that they're comfortable," Dr. Ard says.

A doula can help alleviate tension by creating an environment in which the mother can feel safe, she adds. "When you're in a position where you don't feel safe, or you don't feel heard, it can be very traumatic." 

That sense of safety provided by doulas can help reduce some of the stress often felt by Black moms. (Chronic stress is also linked to health disparities associated with unfavorable birth outcomes.)[3]

During pregnancy and delivery, doulas can provide reassurance, validate experiences, reinforce calming practices and utilize various pain relief techniques outside of prescribing medication. In moments of distress or high anxiety situations, doulas can offer massage, reflexology, calming breathwork and other methods that may offer comfort to moms. 

Because Black women often feel powerless dealing with medical providers, doulas can remind them of the power they hold by arming them with health care literacy, Dr. Ard says. 

"There's a lot of medical jargon," she says. "Doulas can be a very powerful liaison between the birthing person and the medical team, especially when you are in a crisis."

For example, if an emergency C-section is suggested, the patient might feel overwhelmed with all of the paperwork. A doula can step in and ask the doctor to slow down so the patient can absorb and process the information necessary to provide informed consent. 

Studies show that doula care is also associated with a lowered chance of experiencing postpartum anxiety, postpartum depression and cesarean sections.[4]

Benefits of doulas for Black moms

Though doulas can’t solve all issues facing pregnant Black moms when it comes to their health care, they do play an important role in making sure they receive effective care. Doulas can:

  • Help hold medical staff accountable
  • Support partners by helping them feel included and empowered
  • Offer breastfeeding assistance if needed
  • Help manage anxiety
  • Help with the creation and follow-through of the birthing plan
  • Monitor mental health
  • Help combat feelings of loneliness
  • Watch for complications or changes in physical health following delivery
  • Help recognize the signs of postpartum depression

Resources to help Black moms-to-be connect with doulas

As the conversation around maternal health grows, so does awareness of a doula’s role. In recent years, more states have decided to cover doula services through Medicaid, including Oregon, Minnesota, Florida, New Jersey and Maryland. However, access to a doula still has its challenges, especially for Black moms. 

These organizations can help you find doulas in your area:

If cost or affordability deters you from hiring a doula, consider contacting an organization that can offer financial assistance or free or reduced-cost services, such as:

Receiving culturally competent care is important for Black moms because it improves communication, builds trust and supports better health outcomes.[5] These organizations have directories and/or assistance for Black moms searching for Black doulas. 

When you're getting ready to work with a doula, it’s important to ask questions about what you can expect. It can also be helpful in determining which person you’d like to work with if you are considering more than one. Here are some questions you can ask a prospective doula: 

  • How does the doula process work?
  • What is your role if I have an epidural? What about a cesarean?
  • Do you have education and experience providing culturally competent care to Black moms?
  • Have you worked with other moms who have delivered at the same hospital?
  • What are your core values and beliefs when delivering doula services?

The uncertainty of pregnancy and delivery can be especially anxiety-inducing for Black moms. However, the presence of a doula can help provide a sense of control and reassurance that a positive birth experience is within reach. 

After the birth of her son, Dunbar started an award-winning podcast — Be Well, Sis — to help Black women be healthy in mind, body and spirit. "I quickly realized that we are often underrepresented or alienated in wellness spaces, although we often also suffer the worst medical outcomes compared to our peers," she says. "I've become dedicated to providing relevant resources that resonate with those of us who feel forgotten. This is my love letter."