ST. LOUIS, Mo. — Tara Ervin will never forget the week her sister Kelly died.
It was July 1996 and Kelly, 34 weeks pregnant, was in the emergency room with swollen feet and what the doctors said was likely a bladder infection. She was sent home with antibiotics but returned less than 48 hours later in worse shape, vomiting profusely. A blood test confirmed the worst as Kelly’s doctors rushed to deliver her son by emergency cesarean. They told her family they were sorry, they had done everything they could to save her.
An otherwise healthy 28-year-old had died from toxemia poisoning caused by pre-eclampsia, a serious complication of pregnancy that went untreated. Friends showed up at Kelly’s baby shower the next day, only to learn she was gone. Kelly’s family put photos of her newborn in her coffin.
“I thought that was something that only happened in the movies,” Ms. Ervin said in a recent interview, vowing that her sister’s death would not be in vain. “I don’t want any other family to endure the trauma we endured.”
Today Ms. Ervin is a certified doula at a St. Louis-based childhood development nonprofit that is part of a movement fighting a growing maternal mortality health crisis among Black women, who suffer and die at a higher rate — as a result of substandard maternal care and racial biases — than their white counterparts.
The nonprofit, Parents as Teachers, is in a network of more than one dozen “home visiting” programs that won a large funding increase in the $1.7 trillion spending bill that Congress passed late last year.
By providing the doulas, who offer nonmedical support to mothers before, during and after delivery, the program is extending a benefit largely associated with white and affluent women to predominantly Black, low-income mothers in St. Louis who would not otherwise know about it or be able to afford it. Unlike certified nurse midwives who deliver babies, doulas offer guidance on pain or complications ahead of delivery and help clients navigate hospitals and doctors — exactly the problems that Kelly experienced. Continuous guidance from a doula has been cited as one of the most effective interventions in easing pregnancy.
The goal of the doulas is to go beyond the standard mission of supporting America’s most vulnerable children from “cradle to career.” Instead they start in mothers’ wombs.
“Doula support for a Black mother is like giving them a cape,” said Constance Gully, the president and chief executive officer of the Parents as Teachers National Center. The program, she said, teaches mothers to “advocate for their babies beyond the hospital.”
The doula program began in St. Louis about four years ago when a group of Black women working at Parents as Teachers noticed a familiar refrain from clients fearful of the health care system.
“I don’t want to die,” Aminah Williams, one of the first of the group to be certified as a doula, recalled more than one Black expectant mother telling her.
“That shouldn’t be the thing that comes to Black women’s minds,” Ms. Williams said. “And it breaks my heart that it is.”
The concerns are not hyperbole. Nationally, Black women are nearly three times more likely to die from a maternal cause than white women: The National Center for Health Statistics reports that in 2020, the maternal mortality rate for Black women was 55.3 deaths per 100,000 live births. The 2020 rate for white women was 19.1 deaths per 100,000 live births.
Black women are also more likely to have C-sections, have their pain minimized or ignored, report mistreatment, and have stillbirths than white women.
Over the years, mounting research and high-profile cases of fatal or near-fatal experiences — from that of the tennis superstar Serena Williams to an epidemiologist at the Centers for Disease Control and Prevention — have shown that the grim statistics are often a result of a health care system that leaves Black mothers to fend for themselves.
“Racial and ethnic inequities in obstetrics and gynecology cannot be reversed without addressing all aspects of racism and racial bias, including sociopolitical forces that perpetuate racism,” the American College of Obstetricians and Gynecologists said in a statement last year. “We have an obligation to work to overhaul currently unjust systems that perpetuate unacceptable racial inequities in health outcomes.’’
Women who look like us
The five certified doulas at the organization in St. Louis are a rarity — roughly 10 percent of the nation’s doulas are Black women — and see themselves as crucial to their Black patients, including newborns, who some research has shown fare better when treated by Black health care professionals.
“I’m Black and I matter to those moms because of it,” said Robin Lloyd, one of the doulas, who almost bled to death after giving birth nearly 20 years ago when she said her concerns were disregarded. “We always matter a little more to those who look like us, who go through what we go through.”
“We’re here to make sure they have a good experience when no one else is interested in that,” said Donna Givens, the manager of community partnerships and groups for Parents as Teachers, who was the first certified doula in the St. Louis program.
On a recent day, Ms. Givens was at a St. Louis maternal homeless shelter, Our Lady’s Inn, leading a support group session with a half-dozen new and expectant mothers.
“I wasn’t thinking of myself pregnant in a maternal shelter,” said Kaneisha, 22, who began to cry, and who asked to be identified only by her first name. “But I shouldn’t be judged for having somewhere to lay my head.”
One of the other mothers, Diamond, who also asked that only her first name be used, said Kaneisha would not have to worry about that with a doula. Diamond, 21, said she had recently had a vaginal birth after an earlier cesarean, even though her doctors had pressured her against it.
“When I said I had a doula, they flipped the script,’’ Diamond said. “They looked at me like, ‘How do you know about that?’ I felt famous.”
That same day, Ms. Lloyd hauled a backpack with a doll, a prosthetic breast and a bag of diapers up to an apartment to check on another mother, Alaila Jordan, who had delivered the day before Thanksgiving. Ms. Jordan told Ms. Lloyd that her baby girl was finally gaining weight, but she was still on edge. She worried about where to store her milk supply and had been researching some storage strategies on TikTok.
“Please don’t stress yourself out,” Ms. Lloyd said. “And please, please stay off TikTok.”
Ms. Lloyd pulled out a postpartum depression screening and handed it to Ms. Jordan. The 22-year-old filled it out and handed it back, prompting Ms. Lloyd to lean over to her and ask softly, “So tell me, what can we do to make you feel better?”
Ms. Jordan admitted that she was frustrated with her partner and felt unsupported. “I try to hide it and say it’s the breastfeeding, but it’s really that,” she said.
Ms. Lloyd promised she would be back to work with the young couple, and that she’d also bring a thermometer after noticing the apartment was too warm for safe sleeping.
Ms. Jordan said there was a marked difference between talking to Ms. Lloyd and her obstetrician. “It’s nice to have somebody asking about me,” she said.
A birth plan, delivered
Imoni Cooper was in the early stages of labor at Barnes-Jewish Hospital in St. Louis last October and frustrated. The nurses, she recalled, kept asking her to sign paperwork she did not understand, and would not look at her birth plan, which included directions on everything from her epidural to the music she wanted during labor and delivery, that she and Ms. Ervin, her doula, had drawn up.
“We all know that as African Americans, they paint us in a different picture — drug addicts, father not there — and treat us accordingly,” Ms. Cooper, 27, said. “So I wasn’t signing nothing, doing nothing.”
From the hospital Ms. Cooper was in phone contact with Ms. Ervin, who was not planning to get there until Ms. Cooper was further along in her labor, as was standard practice. But there was something in Ms. Cooper’s voice that made her uneasy.
“I’m not doing anything until Ms. Tara gets here,” Ms. Ervin could hear Ms. Cooper tell her medical team.
Ms. Ervin, who had conferenced in this reporter on the phone as she raced to Ms. Cooper, said she heard the kind of strain in those words that she knew all too well could lead to fatal outcomes.
“Not today,” Ms. Ervin said, part declaration and part prayer, as she started to race toward Barnes-Jewish. “By the time I leave the hospital, I’m going to have a beautiful baby. And a living mama.”
Minutes later, Ms. Ervin was at the hospital with Ms. Cooper, where she said the attentiveness of the medical team changed as the nurses took the birthing plan in hand. In a statement, a representative for the health care center said it has collaborated with doulas in the community and has sought to “thoughtfully focus on how to close gaps in maternal health outcomes.”
Ms. Ervin dimmed the lights, walked Ms. Cooper around the hospital three times, then had her bouncing on a birthing ball and inhaling peppermint essential oil fragrances from a towel.
When Ms. Cooper was five centimeters dilated, her mother prayed for the baby via FaceTime, as requested. Ms. Cooper held on as long as she could before shouting the code word she and Ms. Ervin had come up with, “cookies,” to ask for an epidural.
Then it came time to push. Ms. Ervin was rubbing the back of Dushawn Blakely, Ms. Cooper’s partner and the father of her children, while holding Ms. Cooper’s leg. A baby girl, Denim, was born on Oct. 10 at 9:49 p.m., weighing 7 pounds, to the soundtrack of Ms. Cooper’s favorite gospel song, Kirk Franklin’s “Melodies From Heaven,” just as planned.
A close call with pre-eclampsia
Since the doula program started in St. Louis, the women have helped expectant mothers through more than 50 births. The program so far reports that 88 percent of the births have been without complications, 56 percent of mothers participated in two prenatal doula visits, and 88 percent of them began breastfeeding. All reported reduced stress.
At least one credits the doula program with saving her life.
Kodi Washington, 30, experienced intense swelling in her feet after the birth of her second child last March. The doctors told her that it was normal and should subside in 10 days, and that she should drink water, elevate her feet, and avoid fried food. When it hurt for her to stand up, she sent a picture to her doula, Ms. Givens, who was alarmed and urged her to go to the hospital.
Ms. Givens’s fears were confirmed. Ms. Washington was admitted with postpartum pre-eclampsia and dangerously high blood pressure and spent three days in treatment.
“If it wasn’t for you, I wouldn’t have ever even gone to the hospital,” she told Ms. Givens in tears on a recent day. “I would have just spent 10 days — dying.”
“Wasn’t going to happen,” Ms. Givens replied. “Not on my watch.”
