Native, Black doulas say culturally specific birth care could help reduce high maternal death rates

After Jazmin Williams gave birth in 2009, she suffered from uterine prolapse — when the uterus slips out of place.

But when she tried to tell the nurse, she said, “I’m trying to point to her [that] my uterus is outside me, and she hits me. She hits my hand, tells me, ‘Don’t touch.’ And I go and tell the doctor but she tells the doctor that I’m exaggerating. And that was it.”

They didn’t evaluate or treat her condition.

She went home, where she developed a second complication and had to be rushed back to the hospital, where she was seen by an ER doctor.

“He just told me to lay back so he could see what was going on and then immediately just started operating,” Williams said.

Williams said he didn’t tell her what he was about to do, obtain her consent, or offer anesthesia.

In Washington state and nationwide, Black and Native American mothers and their babies are more likely to die during or after pregnancy than white moms and their babies. And the rates are getting worse.

The state health department reported in February that discrimination like what Williams says she experienced contributed to 41% of preventable pregnancy-related deaths. Now, some birth workers in the Seattle area are trying to turn things around with help from some new government funding.

“The only thing that Black skin does is overexpose you to racism,” said Monica McLemore, a professor of nursing and director of the University of Washington’s Center for Anti-Racism in Nursing. “To me, it’s how patients are treated or mistreated. It’s how they are listened to or not.”

Black women in Washington state are three times as likely as white women to die due to pregnancy or childbirth.

The health department’s report says that the vast majority — 80% — of maternal deaths in the state are preventable.

That’s why, in 2019, the agency launched a project to fund community-based organizations that are working to improve birth outcomes.

McLemore, the nursing professor, said that maternal and infant deaths are devastating, but also rare, fortunately. She said stories like Williams’ are much more common.

“The other thing we don’t talk about is the near misses — the Beyonces and the Serena Williamses of the world,” she said. “You didn’t die from your pregnancy, but you almost did — where there's some intervention that we have to do in order to save your life and the life of your baby.”

Leading causes of maternal deaths include hemorrhage, infection, and behavioral health, such as overdoses and suicides.

When women die of blood loss or an infection, that usually happens 10 to 11 days after delivery — before their first postpartum follow-up appointment.

“How many people have we lost because no one was checking in on them?” said Camie Goldhammer.

Goldhammer is the founder of Hummingbird Family Services, which works with Native women throughout King County. Their doulas do prenatal visits, attend births, and follow up afterwards.

“I believe doulas are an answer, because we are in their homes,” Goldhammer said.

In Washington, Native women are the most likely to die as a result of pregnancy or childbirth — more than six times as likely as white women.

“It is not our fault that we’re dying, and it is not our responsibility to not die,” Goldhammer said. “That is a failing of a system and those that are supposed to be taking care of us, because a newly postpartum person is responsible for taking care of one person, and that’s their baby.”

Having a doula at your birth can cost thousands of dollars, but the families in the Hummingbird program pay nothing, thanks to county funding.

Goldhammer said most Native families — most families in general — choose to give birth in hospitals, so that’s where the Hummingbird doulas also primarily work.

“Our goal as doulas is to preserve the space for that parent so that they leave their birth feeling safe, secure, and loved, and really experiencing that sacred space,” Goldhammer said. “And the beauty of it is that we have great birth outcomes.”

Someday, she’d love to have a birth center exclusively for the Native community.

That’s something Jazmin Williams is working on: a culturally specific birth center for her community. Following her own traumatic childbirth, she became a doula, to help other Black women have more positive birth experiences.

Now, Williams is trying to open Washington’s first Black birth center to provide an alternative to hospitals — for women giving birth, and also for Black traditional midwives who don’t have the certifications they need to work in hospitals.

“We have to find a way to divert from hospital care,” Williams said. “We need our own place that’s not a shared space either so we can be here and be ourselves without white gaze, without the worry of, ‘I'm no longer holding up to the strong Black woman stereotype and wanting to be vulnerable,’ wanting to feel weak in the moment and receive the support that they need. We need to be allowed to do that.”

She’s eyeing South King County for a location — somewhere in the heart of the area’s Black community.