The Mother Lode

Leslie Casimir | January 25, 2019 | Story News and Features National

Her water had broken more than 24 hours earlier, but Simone Taylor, a 39-year-old with gestational diabetes, was still in labor. Her plans had been clear from the start: She wanted a natural water birth at her Oakland home with doula Linda Jones by her side. But Taylor’s medical condition threw a wrench in the plans. A hospital delivery was on the horizon.

Jones turned to the first-time mom and laid it out: “Sometimes, the road we have to take is not the one we want. But it’s the road that we have,” the longtime leader in the Bay Area doula community said.

Several hours after Jones and Taylor arrived to Alta Bates Summit Medical Center in Berkeley, the mom’s blood pressure spiked to a dangerous 200 over 130, a result of preeclampsia. Common among African-American women, the disorder can lead to a stroke, seizures and even death. Through an IV, nurses and doctors administered labetalol and hydralazine to lower her blood pressure, magnesium sulfate to prevent seizures, nsulin and sugar water to manage her blood glucose levels, and Pitocin to encourage the uterus to contract. The baby’s heartbeat then began to fluctuate, and, ultimately, a cesarean section was performed to deliver a 7-pound girl Sept. 15. Taylor named her daughter Rebel, who was quickly whisked off to the neonatal intensive care unit because she had swallowed amniotic fluid during the delivery. Taylor considers herself lucky.

“Our birth outcome could have been traumatic,” says Taylor. “We don’t even want to imagine what it would have been like without Linda there. She kept us safe.”

While only 5 percent of babies in San Francisco are delivered by African-American moms, African-Americans make up 23 percent of all infant deaths in the city. The numbers are similar across the bridge in Alameda County, where they represent 9 percent of the births and 22 percent of all infant deaths, according to public health departments. Add to that a rising number of preterm births—the leading cause of infant mortality—and it’s clear there’s a crisis. Here, in a region that prides itself on progressive policies and health care, it’s difficult for African-American babies to survive.

Part of the solution, it seems, starts long before labor. Research suggests pregnant women who receive continuous care and support from doulas have fewer complications—and better birth outcomes. Few insurances cover the service, which can run from $1,500 to $2,000, and is out of reach for many. But here’s some welcome good news: This month, San Francisco officials have launched a new citywide program that offers pro bono doula services to low-income African-American moms-to-be.

“No community has been decimated like San Francisco’s black community,” says Dr. Zea Malawa, a health department pediatrician. “The challenges that exist here are very specific to us, and it’s important that we have people who understand those challenges.”

According to Jones, the doula with 30 years of experience who helped Taylor deliver, one of those challenges is racial profiling in hospitals. “When they see a black woman walk into labor and delivery, all the preconceived notions about who we are come into play,” says Jones. “They think we’re uneducated; we’re on drugs; we’re difficult; we don’t want to have this baby.”

As part of her work, Jones founded Roots of Labor Birth Collective, an organization that recruits doulas of color to provide affordable services to East Bay women and to inmates at Santa Rita Jail. She’s also the co-founder of Black Women Birthing Justice, which, two years ago, published Battling Over Birth: Black Women & the Maternal Health Care Crisis in California, a book based on more than 100 interviews with black mothers about their labor experiences. A majority described being dismissed by hospital staff or coerced into accepting directives by nurses or doctors. One woman said she was threatened by a physician who would not deliver her baby until she lay down on her back. Another mom said she was slapped by a nurse after she refused to stop pushing before a doctor could arrive. “Providers are not listening to these women about their bodies and what they know,” says Jones. “You can be a lawyer—it doesn’t matter. As long as you’re black, you’re going to get treated the same way.”

Having a doula present can serve as a buffer between an already-vulnerable mom and medical staff, deflecting some of the clashes. “A doula is an advocate when you’re at the hospital and on that birthing floor,” says Malia Cohen, the San Francisco Board of Supervisors president, who secured funding for community group SisterWeb to run the program that will also train local black women to become doulas themselves. “She is educated; she’s able to understand the medical terminology. She can connect on a sister level to help an expecting mother’s anxiety.”

The program is a vital step in the right direction, says Jones, whose next focus is on encouraging black women to enter the profession and help pregnant women before, during and after childbirth. “It’s a different kind of care,” says Juju Angeles, a member of Jones’ Roots of Labor Birth Collective. “It’s more culturally based. My clients don’t want to hear about meditating. They need a ride to the grocery store, or they may need me to go to the child birthing class with them because they don’t have a partner.” It’s been hard to recruit since the work can be unpredictable.

“I know what it’s like to not know anything about birthing and being scared,” says Jones, who has helped women—from a 13-year-old sexual assault victim to a 57-year-old college professor—deliver more than 1,000 babies. “There’s nothing better than watching life come into the world. It’s the most magical moment. But too many of us are getting robbed of this precious experience.”

Originally published in the January issue of San Francisco

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