Ob-gyns like Sharee Livingston, DO, experience the happiest moments of many families’ lives.
But on rare occasions, they also see the most devastating.
“I have the wonderful privilege of helping to bring life into the world, but there are moments, and I have experienced it personally and firsthand, where a woman has died shortly after childbirth,” says Dr. Livingston, chair, obstetrics and gynecology, UPMC Lititz.
“And that really shook me. It shook me to my core, and I wanted to do something to ensure that would never happen again.”
Dr. Livingston also knew that women of color face a higher risk of maternal mortality. Black women are three times more likely to die from a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention (CDC).
Those concerns led Dr. Livingston to join Patients R Waiting. The physician-led, Lancaster-based nonprofit seeks to eliminate health disparities by increasing diversity in medicine.
She also co-founded Patients R Waiting’s Diversifying Doulas Initiative (DDI). The DDI seeks to train Black and Brown women to become doulas and provide free access to pregnant women of color to try to reduce maternal mortality.
“I understand that I don’t have all of the control to avoid life and death, but I want to control the things that I can control,” Dr. Livingston says.
‘I Do Not Want to See Another Black Woman Die’
Each year, about 700 women die during pregnancy or in the year after childbirth in the U.S. Tens of thousands of women experience complications during pregnancy that can have serious long-term effects.
More than 60% of maternal deaths are preventable, Dr. Livingston says. And women of color face a higher risk of complications because of health disparities.
Health disparities are inequalities in health care that occur among people of a population. They can affect access to health care as well as health care outcomes.
Many different factors can cause health disparities. They include systemic and structural racism, less access to quality health care, socioeconomic issues, and underlying health conditions.
Health disparities affect Black mothers.
“When I stared maternal death in the face, I said, ‘I do not want to see another Black woman die,’ Dr. Livingston says. “I don’t want to see any pregnant woman die, but especially women of color who have three to four times the increased risk.”
Physical, Informational, and Emotional Support
Doulas are nonmedical birth assistants who support pregnant mothers through the different stages of pregnancy.
Data show that doulas have a significant impact in improving pregnancy and childbirth outcomes. Doulas can help increase the number of vaginal births and decrease the number of C-sections. They also can decrease preterm labor and postpartum depression.
“Doulas work in many capacities because they are advocates and provide physical, informational, and emotional support,” Dr. Livingston says. “They’re not only helping the patient, but they’re helping the newborn. They’re helping the support person and the families.”
However, a doula’s services typically cost somewhere between $1,000 and $1,500. And that makes them difficult for women in underserved communities to afford.
That led Dr. Livingston and Patients R Waiting to the idea for the Diversifying Doulas Initiative.
“The objectives of the Diversifying Doulas Initiative are to decrease maternal morbidity and mortality,” Dr. Livingston says. “We want to increase the number of Black and Brown doulas. We want every woman, specifically pregnant women of color, to have access to doulas.”
‘What I’m Most Proud of’
The Diversifying Doulas Initiative launched in June 2020, in the middle of the COVID-19 pandemic.
The initiative seeks people of color to become doulas. They go through 16 weeks of online training and participate in hands-on training and three co-managed births. After completing training, they become certified doulas.
“Those women can now go out into the community and provide doula care to women in need,” Dr. Livingston says. “Specifically, Black and Brown pregnant women.”
Before the DDI, Lancaster only had one doula of color. In the first year of the program, they trained 26 Black and Brown doulas. And 72 women of color in Lancaster received free doula care through the initiative.
“I am extremely proud of DDI,” Dr. Livingston says. “But what I’m most proud of are the 26 Black and Brown doulas who recognize a need, who have trained really hard.”
‘Every Woman Deserves the Support of a Doula’
As proud as Dr. Livingston feels about DDI, she hopes to accomplish even more. To make the program sustainable, she is working with local organizations and attempting to secure funding through grants.
UPMC Pinnacle Foundation provided the program’s first grant back in 2020, and UPMC is one of the program’s current sponsors.
“We’ve done a lot of work, and now we’re looking forward and creating a pathway,” Dr. Livingston says. “And what we want to do is create sustainable systems in Lancaster so that women here can continue to receive free doula care.”
The fight to end racial health disparities in pregnancy outcomes is happening nationwide. Efforts like the Black Maternal Health Momnibus Act, the Kira Johnson Act, and the Perinatal Workforce Act all aim to improve outcomes for pregnant women of color.
“If my dreams came true, every pregnant woman would have a doula,” Dr. Livingston says. “Every woman deserves the support of a doula, specifically pregnant women of color because of the marginalized situations that prevail.
“And so I would love to see, looking into the future, a very formalized system with Diversifying Doulas Initiative, where we’re sustained through grants and funding, and we have trained many more doulas to provide services and improve health outcomes.”
Centers for Disease Control and Prevention, Working Together to Reduce Black Maternal Mortality. Link