Southwest Georgia doula collective bridges health care gaps amid black maternal mortality crisis

ALBANY – Sharri Anderson said she believes each family has an unofficial doula – a mom, an aunt, a sister -- who steps up as a guide and advocate for the mother of a newborn baby.

During Anderson’s third pregnancy, that advocate was her own mother. As Anderson worked to push out her 10-pound daughter who had a heart murmur, she said she was under immense stress.

She tried to tell a nurse she was having a hard time breathing.

“The lady told me, ‘If you’re talking, you’re breathing,’” Anderson said. “And I just remember looking at my mother who said, ‘I’m sorry? She said she’s having a hard time breathing.’”

That’s when the nurse took notice and started giving Anderson oxygen.

“Being an African American woman, sometimes we are known to be stronger or that pain shouldn’t affect us,” Anderson said. “So we are heard a little less.”

After four pregnancies, Anderson became her family and friends’ unofficial doula. The people in her life gravitated toward her for nurturing throughout their pregnancies.

When Anderson saw the opportunity to get her official certification as a post-partum doula through the Morehouse School of Medicine’s Center for Maternal Health Equity, she jumped at it.

In April, Anderson graduated with a dozen other black women from southwest Georgia as the second cohort of Morehouse’s Perinatal Patient Navigator Training Program – the first cohort to come out of this region of the state. The program’s goal is to train people as perinatal patient navigators who assist black women in making informed health care decisions before, during and after birth.

Doulas provide emotional support to pregnant patients. They meet with clients to create birthing plans and educate pregnant people on the process. During birth, they may serve as an advocate for patients as well as physical support, helping them to breathe or change positions.

Studies show that doula support leads to better birth outcomes and decreased need for medical intervention like Cesarean section.

Community-based doulas increase communication between mothers and their health team – a factor identified by black women’s health organizations as essential to the birthing experience, a 2023 study from the Drexel University College of Medicine reported.

The hope is that the Morehouse program could improve health outcomes for black mothers, who are disproportionately dying pregnancy-related deaths, in a state with one of the worst maternal mortality rates in the country.

Georgia’s rate is about 34 deaths per 100,000 live births. In southwest Georgia, the rate is about 40 deaths per 100,000 live births

For black women, the problem is worse. There were about 49 pregnancy-related deaths per 100,000 live births in Georgia from 2018 to 2020 according to the state Department of Public Health.

Elizabeth Mosley, a researcher with Emory University’s Center for Reproductive Health Research in the Southeast, said many of these deaths occur post-partum. Leading causes include hemorrhage, cardiovascular system issues as well as pre-eclampsia, a complication during which pregnant people experience high blood pressure, which can lead to life-threatening eclampsia or seizures during pregnancy.

Mosley said these are pregnancy stress-caused physiological changes.

“Black women are experiencing racism their entire lives; so, when it comes to pregnancy, their cardiovascular system has already been weathered,” she said.

Mental health in the post-partum is also a leading cause of death. That is an area in which Anderson’s work as a post-partum doula can help.

Since beginning the Perinatal Patient Navigator program, Anderson’s worked with two clients as a certified post-partum doula under IV You Doula Services.

One is Fredericka Williams. Williams had her first baby in 2022 at Phoebe Putney Memorial Hospital without doula care. She said as a young mom, she didn’t know much about the birthing process. She began having complications and experienced severe pain.

After a poor epidural experience, Williams said she had other health issues that she believes were related, in her lower back and right foot a few months after her child was born. At the time of her first pregnancy, she said the pain made it hard for her to communicate with the medical team.

For her second pregnancy, Williams took on Anderson as her doula who was with her step-by-step throughout her journey.

Anderson educated Williams on what foods to eat to maintain her health. She helped Williams come up with questions to ask doctors and educated her on birthing and breastfeeding methods.

Williams said she didn’t want to return to Phoebe to have her second baby after her epidural experience, so, she traveled to Tifton. With Anderson’s lessons, Williams said her journey was much easier and she felt more confident. Her second baby was delivered in just 10 minutes.

Six months later, Anderson is still a part of Williams' life. She visits Williams multiple times a week, giving her time to rest, helping her prepare meals and breastfeed and checking in on the rest of her family as well.

“She’s made it so much easier. I feel love and support,” Williams said. “It’s just like sisterhood.”

Anderson said her work has a holistic approach for mothers – taking care of the whole body and mind. She said this work can decrease the chances of post-partum depression.

“I come in to help alleviate stress … and to help mom be a mom,” Anderson said.

Anderson said southwest Georgia is lacking in access to support for pregnant women, whether it’s doula care or birthing centers to provide education. Much of the region is made up of rural areas, which face declining access to basic health services, much less obstetric care.

Rural areas face health care deserts – exacerbated by a lack of OB/GYNs and hospital closures – meaning many have to travel to receive pregnancy care.

Mosley said this becomes a major issue in emergency situations.

“If someone is hemorrhaging, and they are not at a hospital, we can imagine the dire situation they're in where minutes make a difference in terms of whether that mother survives or not,” she said.

Rural areas also face a barrier with poor insurance coverage. While doula care is increasingly gaining Medicaid coverage in many states, Georgia is falling behind on this trend. Mosley works with groups like Healthy Mothers, Healthy Babies, a nonprofit that advocates for mothers, that are pushing for legislation that would get Medicaid to cover doula care. So far, they’ve been unsuccessful.

“Expanding access to people who can't afford out-of-pocket doula care is imperative,” Mosley said. “We know that people of lower socioeconomic statuses are more likely to experience complications during pregnancy or even death. We're trying really hard to understand how to get doula care to the people that need it most.”

These barriers are why Morehouse’s program is placing a special focus on mothers in rural areas. It’s also why Victoria Snowden co-founded the SOWEGA Birth Workers Collective.

Snowden said there was a scarcity of birth workers in southwest Georgia, so the collective’s mission is to educate and support mothers, train birth workers and provide this region with an array of birth worker services.

Snowden said they quickly gained members from the Perinatal Patient Navigators cohort. There are now about 20 members total with an array of birth worker skills: full spectrum doulas, death doulas, post-partum doulas and those who specialize in working with the LGBTQ community.

The collective is based in Albany but serves the entire region. Snowden said some doulas are traveling an hour to two hours to reach smaller, rural areas and follow clients to medical centers

“We have a lot of maternity deserts where there's no kind of help,” she said. “Not only can we provide the educational piece that a lot of times they might not be getting at these different medical facilities, but also we have that holistic, continuity of care piece.”

The collective also plans to host monthly support groups and campaign weeks to promote pregnancy education. In August, it’s hosting a local black breastfeeding awareness week that educates and encourages people to break the stigma.

The group is also trying to grow its presence in Albany. Snowden said a training partnership with Albany Technical College is in the works. Snowden said the collective wants to work with Phoebe to have doulas receive staff credentials.

Doula access differs from hospital to hospital. Some hospitals will recognize doulas as part of the birthing staff. Others, like Phoebe, require doulas to have visitor badges. They can be selected by patients as one of the three support persons present during labor and delivery. However, this can create a barrier when patients are having to choose between family and doulas.

Snowden said she hopes the collective can get funding that would allow the birth workers to provide their services for free or low cost as well as cover the costs to train new workers.

Anderson said the collective will help to build community for black mothers.

“The need for African American mothers is just to be heard and understood,” she said. “It’s going to create a sisterhood – a stronger community of women who see that it’s OK to say ‘I need help.’”

Mosley said doulas are getting more attention now than ever as the “silver bullet that could fix maternal mortality.” However, she said that’s an unrealistic and unfair expectation to put on them.

“Doulas are a very promising way to improve maternal well-being and reduce disparities,” Mosley said. “But we need systemic-level changes, including Medicaid expansion and investment in work force development that recruits OB/GYNs … and doulas to rural areas.”