By Dianne Anderson

Black women are tough, they have a high pain threshold. They can take it — or so the perception goes.

It could also be one of any number of reasons why Black mothers are dying over three times that of white mothers during, or shortly after childbirth.

That’s the rate of death, but they are also are hitting the highest morbidity, defined as “near misses,” or an otherwise close brush with death during the birthing process.

Deidre Coutsoumpos, local perinatal health educator, said various research suggests various explanations for the disparities, including access to prenatal care, or how mothers manage their health before they get pregnant. Some have pointed to educational or insurance status, or how old the mom was when she got pregnant.

But all things considered, and all things being equal, there is still a huge racial gap.

Coutsoumpos said none of it explains why a white woman with a high school education has a higher chance of not dying than a Black woman that is married with a Ph.D. in their mid-30’s, and has the right insurance coverage is more likely to die.

“When it comes down to the Black maternal health crisis, the only factor between white women and Black women is that the women are Black,” she said.

Other factors stand out as a viable cause.  One is that doctors are not listening to Black women, she said.

Serena Williams described her hematoma crisis, about how the nurse and doctor hadn’t taken her seriously when she told them what she needed to address clotting that had set up in her lungs after childbirth.

Other recent research put forth by Arline Geronimus, a professor at the University of Michigan School of Public Health, describes a “weathering” process, the idea that Black people live with the daily stress that releases a steady stream of high cortisol into the system.  It is placing women at higher risk in pregnancy and delivery.

“We are triggered more frequently,” Coutsoumpos said. “Are we being followed in the store?  I think a lot of our stressors are in our bodies, and when we have babies, those stressors have been building up over time.”

Midwives, known as doulas, are the next best thing to an ancient approach that has played a historic vital role to support Black mothers through the birthing process.

Little has changed in the method, except these days she said that moms can choose to have a doula at the hospital, which is where she attends most of her cases.

In her work at Loma Linda University Children’s Hospital, she is a perinatal health specialist teaching pre-natal preparation classes, including breastfeeding, and newborn and childbirth preparation. She also teaches a postpartum discharge class, and leads a breastfeeding support group on Sunday.

Moms come to her classes and are engaged in the birthing process, but ultimately, she said most patients will have their baby in the hospital setting.  There, doulas act as a coach and as advocates, listening and supporting mothers, creating a dialogue with their providers during the pregnancy, labor, and there for the mom during birthing.

But access is the next big step. While some states lately recognize the need for public insurance coverage for doula care, she said there is still more work to do in California. Many Black women are dealing with low-income status. One challenge is that doulas are usually not covered by insurance. Right now, the average doula charges $400-$1,200 for services.

“What we’re trying to do is inform people about how they can alternatively get funding, setting up a Gofundme, or asking for that as a baby shower gift,” she said.

Not long ago, she and a group of other professional talked about the Black infant death rate, and how research shows it was lower than today, mostly because Black people as slaves were viewed as a commodity to white people.

“It has been going on for a long time, and I believe it is solvable,” she said.

In a report late last year, the National Health Law Program cited many widely recognized benefits of doula care, including improved health outcomes, shorter labors, lower cesarean rates, and that mothers with doula help were less likely to have low birth weight.

“Researchers now theorize that these disparities can be traced to the chronic stress caused by a lifetime exposure to interpersonal and structural racism. Structural racism, such as histories of redlining, discriminatory caracal practices, and income inequity have sustained these deep health inequities,” the report states.

The “Routes to Success for Medicaid Coverage of Doula Care”  calls for successful Medicaid coverage for doula care, and greater education for medical professionals on how patient-centered care can lessen the impact of racism on pregnant women of color.

“Equally troubling, the dismal maternal mortality rate in the United States masks significant race-based health disparities. In general, women of color are less likely to have access to adequate maternal health care services and more likely to die in pregnancy and childbirth than white women. The rates of maternal morbidity and mortality for black women and indigenous women are particularly high, and alarmingly so,” the report states.

For more information on local doula resources, contact Deidre at deidre.doula@gmail.com