Bay Area doula works to improve maternal health care for Black and underserved women
Black women in the United States are disproportionately at risk for maternal mortality — but experts say change is coming.
"Especially with Black maternal health care, it's definitely in crisis," Bay Area doula Marna Armstead told CBS News Bay Area. "The reality is in order to do the work, it is deep, meaningful work before it's a wide amount of work."
For Armstead, the crisis of maternal mortality among Black women is something she's not only experienced personally, but a challenge she's chosen to take on head first.
When she was pregnant with her daughter, she says her very first experience with maternal health care was rooted in racism.
"I walked into the doctor's office, and they quickly were like, shoving me to this other place. I didn't know what was happening," she described of an early appointment. "They were like, 'Where's your case manager?' and all this stuff I had no idea about. And then they were getting kind of short with me. I give them my insurance card and they check it and I guess they see now that I have private insurance and the treatment changed immediately."
That experience, she says, is a common one. It led her to want to not only see a change, but to be the change.
"Racism, especially, you know, overt, systemic, whatever the racism, it comes through many ways that disempower Black people," Armstead explained. "Whether it's lack of education, lack of community resources coming up, lack of proper health, education and access -- you know, all of these things -- can tear down someone. Ao by the time they've gotten to the childbearing age, and they're having children, they're in a weakened state, mentally, emotionally, physically."
Today, Armstead serves her community as a doula through SisterWeb, working as an advocate for and partner to underserved pregnant women by helping educate and mitigate health outcomes that often start with implicit bias.
"America, in and of itself, has a problem with health care. So even White people aren't doing as great as they could be doing," Armstead explained. "So if White people aren't doing as great, you go back down the line to the least served folks and they're they're just suffering. We are suffering."
The maternal mortality rate in the U.S. is higher than any other developed nation. According to the CDC, the maternal mortality rate among Black women is nearly 3 times higher than it is for white women.
While California is seen as a nationwide model to set a standard of maternal healthcare, according to the state's health department, Black women make up 5% of pregnant people in California, but 21% of all pregnancy-related deaths.
"Unfortunately, maternal mortality...it's not something that we can 100% eliminate," Dr. Angelyn Thomas explained. "But there are a lot of causes of maternal mortality that are preventable."
Dr. Thomas is an obstetrician at Sutter Hospital in Berkeley. She works every day to prevent maternal mortality and change some of the deep-rooted causes that can lead to fatal outcomes.
At Sutter's Alta Bates campus, she proudly says they haven't had a maternal mortality in four years, in part due to implicit bias training she helped establish that has since been mandated at hospitals across the state since 2020.
"Implicit bias training is the minimum but that is not enough," said Dr. Thomas.
While racism is rarely the direct cause of a maternal fatality, Dr. Thomas says the numbers speak for themselves and just one decision can have a lasting impact on a patient that can change their health outcome.
"In some of the more tragic outcomes, or even outcomes where the patient didn't die but had a poor experience, that often in the story, they said, 'You know, I was telling people something was wrong, but my healthcare team or someone was not really taking what I was saying seriously,'" she explained. "And I think a combination of understanding that really making an effort to get the voice of the patient is important."
Prevention can include changing a diet, reading up on the birthing process, and treating pre-existing conditions. Dr. Thomas notes that the leading causes of maternal mortality are cardiovascular disease, sepsis, hemorrhage and hypertension.
Both say one solution can be working with a doula to get ahead of existing health issues to educate an expecting mother on labor and birthing.
"This doesn't have to be your experience," Armstead said. "And even if this is starting to become your experience, there's help and support for you along the way the whole time."
