When Shelby Irvin gave birth to her first child in a Colorado Springs hospital in 2014, she said her experience was terrible.
From the doctors to the nurses, Irvin found no comfort in the cold hospital system -- not even an ear to listen. Her negative experiences continued postpartum.
As she was struggling to breastfeed her week-old son, she recalled the moment she knew she'd never return to a hospital to give birth.
"At my last lactation appointment, my lactation nurse turned to me and said, 'People like you are lazy,'" Irvin said. "I asked, 'What do you mean' and she said, 'Black people like you are lazy and they don't want to breastfeed their babies.' I was so distraught."
Naked from the waist up with a screaming newborn in her arms, Irvin said she was discouraged, and the experience made her feel ashamed and alone.
Until she realized she wasn't alone.
Black people have a history of experiencing racial inequities and implicit bias in the healthcare system. A 2021 survey from the Colorado Health Foundation on health and living issues in the state showed that about 48% of pollers believe Black Coloradans are more likely to receive poor quality or inadequate health care compared with white Coloradans.
"As I shared more of my story, I realized that it wasn't just my experience as a Black woman inside of these hospitals -- this is how Black folks get treated in general at these hospitals," Irvin said. "I wasn't an outlier. I was the norm."
For Irvin and other Black mothers across the country, the racial biases seep into birthing rooms. According to the Centers for Disease Control and Prevention, about 700 women die annually from pregnancy-associated deaths, meaning from complications during pregnancy, delivery or postpartum. Black and Indigenous women are three times more likely to die from pregnancy-related causes than white women.
In 2018, the maternal mortality rate was 17.4 per 100,000 live births in the country. Black women experienced a mortality rate of 37.3 deaths while white women experienced 14.9 deaths per 100,000 live births.
Irvin decided to jump into the system to make space for Black women and other groups who've been marginalized and mistreated by the healthcare system. She became a certified lactation counselor, a childbirth educator and a doula at Soulful Momma in Colorado Springs.
Doulas are trained non-clinical professionals who provide physical, emotional and educational support to mothers before, during and after childbirth. That support can extend to partners, family members and friends and go beyond birth to miscarriages, abortions or stillbirths. There are also death doulas, who provide end-of-life care.
Doulas, unlike physicians or midwives, can't administer medical treatment, but they provide a holistic aspect to the process.
More and more, Black and minority women are turning to doulas for support to navigate the systemic racism in the childbirth system. According to the Institute for Healthcare Improvement, doulas could "play a critical role in combating the discrimination, racism, and loss of autonomy that Black people who give birth frequently report experiencing."
Celeste Rios agrees. Rios is a doula working out of Aurora at Mama Bird Maternity Wellness Spa. She's also a certified reiki master, yoni steam practitioner and yoga teacher.
Rios said doulas, specifically Black doulas, are being sought out by Black mothers for allyship.
"We don't see a lot of people that look like us in the hospital room," Rios said. "Black women are dying at an extremely high rate in the hospital system because of educational racism. So Black doulas are here to make sure that these voices are heard."
However, Rios notes that not all doulas have marginalized birthing bodies in mind.
Similar to the hospital system, Rios said some doula certification schools could do a better job at teaching newcomers more about the differences Black and brown mothers face as opposed to their white counterparts. Rios said doula programs should include more focus on marginalized bodies because white allyship can be essential to advocacy.
"Institutional racism is not something that Black people can stop, because we're not the ones who created it," Rios said. "It's white people who are being complacent to these institutions that uphold white supremacy. There are big certification programs for doulas who mostly have white audiences and they have the power to teach people who are in these spaces...how to best support Black mothers, even if that's not the demographic that they're coming from."
Rios said white doulas could also advocate for better funding for minority doulas. Most health insurance plans, including Colorado Medicaid, do not cover doulas, which could cost anywhere between $600 to $3,000.
Rios said there's also a pay gap. White women seeking doulas can pay the high costs, and they tend to go with white doulas.
"Black doulas have so many other jobs because we don't make as much as white doulas," Rios said. "White doulas have this privilege of being able to be a doula for the money because their people can pay $1,200 and upwards for their services. There's a lot of Black folk who cannot afford that, so when Black doulas come in we're unfortunately underpaid. White doulas and white institutions can step up and do their part in making sure that Black doulas are being paid by speaking up. For example, advocating for changes in Medicaid."
Last year, several states moved to include doula care under Medicaid, which finances a large portion of births in the country.
The move is financially beneficial. A 2016 study suggested that offering doula support under Medicaid or private insurance could save states nearly $1,000 per birth by reducing cesarean and preterm births.
Rios and Irvin both believe that the more accessible doulas become, the more Black mothers and other minorities could feel safe in the hospital systems. Irvin said as more research emerges, insurers may make the proper moves to include doula coverage in plans. She also hopes that as government officials acknowledge maternal mortality disparities, they could provide funding for more minorities to step into doula roles.
"I'm hopeful for us," Irvin said. "We're striving to create a space where people do not have to explain their mere essence. Hospitals and doctors make you feel like you're constantly explaining your natural design. How do you explain that you're Black? So we're creating spaces outside of the system. We're creating a table instead of just asking for a seat at the table. Now the system needs to have a seat at our table and listen to what we need."
