Vanderbilt teams up with Duke and University of North Carolina to improve Black maternal health
by Tatum Lyles Flick
Certified nurse-midwives from three top universities have teamed up to improve pregnancy outcomes for Black women by creating a specialized training program for doulas, persons who support birthing mothers and families.
The Alliance of Black Doulas for Black Mamas is led by Vanderbilt University School of Nursing Associate Professor Stephanie DeVane-Johnson, PhD, MSN’97, FACNM; Duke University School of Nursing Assistant Clinical Professor Jacquelyn McMillian Bohler, PhD, MSN’97; and University of North Carolina School of Medicine Assistant Professor Venus Standard, MSN, FACNM. The project leaders are Black certified nurse-midwives with a combined 60-plus years of midwifery experience.
The three researchers are addressing the U.S.’s
Black maternal health crisis. The U.S. has the highest maternal mortality rate among developed countries—and the crisis is even more pronounced for Black mothers. Black women are approximately twice as likely to have a moderately low birthweight child and three times as likely to have a very low birthweight child than white or Hispanic women. Black women are also more likely than white or Hispanic women to die from pregnancy complications—almost 67 percent of which are preventable.
Doulas offer emotional and informational support for pregnant persons and their families. Unlike nurse-midwives, they are not health care professionals; however,
their help with breastfeeding, acupressure, birth plans
and postpartum and other issues can be crucial, as can their presence as advocates for the mother. Having a trained and trusted doula who can help parents-to-be make healthy decisions and choose proper prenatal care can make a difference in maternal health and birth outcomes.
DeVane-Johnson, McMillian-Bohler and Standard wrote and fine-tuned a plan to train and provide Black doulas to help Black families. In 2020 the doula project was funded by a $75,000 award from UNC, and the group trained its first 20 doulas. In late 2021 they received a $545,000 Duke Endowment grant, which will fund the program for three years.
“The goal is to help mitigate Black maternal
and infant mortality rates,” DeVane-Johnson says. “Doulas stand in the gap. Sometimes, Black women bring things up to their health care providers and are not taken seriously, or the provider does not talk at a level that the patient and family can understand. The doula is there to bridge that gap and potentially interpret information.”
Other goals include improving patient experiences, providing doulas for free to families, and helping those interested in becoming doulas build critical skills that can later be used to earn wages.
The faculty hope the training creates opportunities for Black women to find their voices and be empowered to ask questions. The program’s doulas recognize that birthing parents have the right and need to speak up for their own bodies and health, and help them build the confidence and ability to do so.
“By having a culturally concordant doula, the patient has a personal advocate, educator and support person to help guide and navigate the system as a Black person, whose needs are often dismissed or ignored,” Standard explains.
According to McMillian Bohler, the program’s doula/family partnerships offer racial concordance, which can increase trust and understanding.
The doula training is expanded to accommodate the specific needs of Black women, covering topics like reproductive justice and the “superwoman schema,” which says that many Black women care for others at their own expense, increasing stress during a pregnancy.
“I think the fact that we are able to come in and talk about some of these health resources and, I hope, remove some of the stigma, opens up a whole area of health care and wellness to people who desperately need it, who maybe didn’t feel like it was for them,” McMillian Bohler says.
DeVane-Johnson works remotely as the community engagement liaison for the program, which is housed at UNC Family Medicine in Chapel Hill. Her research focus is the history of breastfeeding, and she presents lectures to doula-trainees to help them understand the hurdles faced by Black women who want to breastfeed. Research indicates that breastfeeding decreases cancer risks in mothers and improves health outcomes for babies.
“Black women have the lowest breastfeeding rate of any race,” DeVane-Johnson says. “When variables such as socioeconomic status, education and marital status are controlled for, similarly positioned white women still tend to breastfeed at higher rates.”
Doulas help solve communication issues and offer consistent labor support for those who don’t have it, something that has been shown to decrease time in labor and the need for pain medications.
“Doulas are there to empower, uplift and elevate birthing families,” McMillian Bohler says. “If something doesn’t feel right, the doulas help them recognize that
they need to speak up and keep speaking until their voice
is heard.”
The doulas are also trained to recognize preterm,
term and postpartum warning signs that may put parent
and baby at risk.
They train over the course of seven weekends. While on-call with patients, they assist with birthing plans, help pack bags for the hospital and even attend appointments, depending on how much support the birthing parent needs. Once trained, a doula is paired with three Black families who receive assistance for free.
DeVane-Johnson says program applicants need to be Black, have a passion for birth work and have a desire to support women in labor. In the past, applicants may not have been financially able to secure training, but thanks to the grants, training is free.
Applicants are screened to make sure they have reliable transportation, have jobs flexible enough to allow them to leave to attend a birth and are vaccinated against COVID-19.
“Being a doula often is different than what many people imagine,” McMillian Bohler says. “They may have a romanticized notion of what the job is like. Babies come all the time, anytime, and doulas have to be able and willing to drop whatever they may be doing to come to a birth.”
Eventually, the team would like to see doula training expanded to serve other populations. “Our goal with this program is to create a doula training model that can be tailored for birthing people with disabilities, those in the LGBTQ+ community, making things culturally relevant to whatever specific marginalized population that is birthing, because it’s these marginalized populations that have the worst birth outcomes,” DeVane-Johnson says.
The program has one year of data, and the group looks forward to evaluating the incoming qualitative and quantitative data, something the new Duke Endowment grant will help them do over the course of the next three years.
While the program currently trains doulas to work in North Carolina’s Durham, Wake and Orange counties, the faculty hope to receive funding to expand the program elsewhere.
“We want to disseminate this program throughout the country,” Standard says. “We want to reach out to other academic hospital-affiliated institutions and integrate this program into their maternal care systems.”
“The strength of the program is the expertise of the entire team and the integration of the expertise,” she says. “Although each university could independently support the doula program with its hospital system and academic affiliation, a collaboration between the three universities positively impacts the project as a whole.”