Denetria Thompson remembers her first cesarean section all too well.
During a pregnancy checkup 10 years ago, Thompson’s doctor scheduled her for induced labor. She was 38 weeks pregnant, and her doctor told her she could deliver early if she wanted to.
A week later, Thompson anxiously walked into Missouri Baptist Hospital at 9 a.m. ready to deliver her little girl. After a few hours, her doctor told her she was not dilated enough and would need a C-section. When Thompson asked why, her doctor said she would tell her after the baby was born. Thompson did not question her doctor’s recommendation because she did not know she could.
“I was young, I was 26 at the time, and I didn't know any better,” said Thompson, 37. “I didn't understand you should have gone through the natural processes.”
Black Doulas in the St. Louis region are seeing increasing demand for their services. Many Black women are seeking out trained childbirth professionals to help support them throughout their pregnancies. They want someone to advocate on their behalf in the hospital room, where they have experienced traumatic births or have faced discrimination during labor and delivery.
Thompson agreed to a C-section with her first child because her parents told her to and because nurses pressured her into having one. After delivering her daughter, the doctor told her that her pelvic bone was too small and that she would never be able to have a vaginal birth.
Six years later, Thompson’s doctor performed another C-section to deliver her second daughter because she had a prior cesarean delivery. It was not until she became pregnant last year that she came across podcasts and social media posts from Black doulas and midwives that explained that vaginal births are possible after C-sections.
Thompson reached out to Jamaa Birthing Village, a Black midwifery and maternal health care center in Ferguson, for doula recommendations. The clinic team introduced her to Asia Jacobs, who has been a certified doula for almost three years. She chose Jacobs because she wanted someone to guide her through a vaginal birth after having two C-sections.
“I feel kind of robbed, like with my last two kids,” Thompson said. “I didn't even know that I could have a vaginal birth after the C-section, nobody told me anything.”
Missouri has one of the highest maternal mortality rates in the nation. According to the state’s health department, Black women in Missouri are three times as likely to die while pregnant or within a year of pregnancy than white women.
Black doulas and their patients often talk about the disparities in health outcomes and how hospital workers unfairly treat Black women. Jacobs hears stories of the lack of transparency from medical teams, how clients have received the wrong dosage of medicine or inadequate treatment for pain management.
Jacobs will never forget how the nurses did not listen to her while she was in labor with her only child 10 years ago and did not want drugs during delivery.
“I remember them literally like four times asking me, ‘Hey, you ready for your epidural?’ They kept trying to press that on me,” said Jacobs, 33. “By the fourth time, I kind of snapped a little, because I'm like, ‘Now, you do not see this on my birth plan and not once do you hear me screaming, yelling, cursing or any of that, so if I tell you no the first time, you shouldn't have to keep asking me’.”
This experience and other conversations about Black maternal mortality rates helped determine Jacobs' decision to become a certified full spectrum doula in St. Louis. She opened Doula Love, Light, & Life in November 2020.
She still worked a full-time job as a postal worker until summer 2021, when her clientele picked up. Since she began working as a doula, Jacobs has helped 22 mothers. She also teaches prenatal yoga classes and provides placenta encapsulation services to help level out hormones and help with milk supply. All but two of her clients were African Americans.
Her goal is to let mothers, particularly Black women, know that they have options during childbirth, which she said medical teams often do not present to them.
Keana Nwaneri chose to have a doula help her during her first pregnancy. She gave birth to a baby girl in November. The 32-year-old clinical mental health counselor in St. Louis knew about the grave statistics for Black women during childbirth, but she became determined to work with a Black doula after remembering a childhood friend’s baby was stillborn because of a mistake in labor.
“Statistically, [having a Black doula] can decrease my chance of literally dying or statistically decrease my chances of not being heard by medical providers,” Nwaneri said. “It became like, ‘Oh, I've never done this before, so I need somebody that does this all the time to help guide me through it.'”
Doulas have proven to help mothers have smoother deliveries because of their emotional and physical presence during childbirth, but Jacobs said having more Black nurses and doctors in labor and delivery units could further help Black mothers feel safe while giving birth.
The obstetrics field is struggling to find ways to overcome the damage done to Black women, said Dr. Jeannie Kelly, labor and delivery medical director at Barnes-Jewish Hospital. Hospitals could better serve Black patients by treating them fairly and hiring more Black doctors and nurses in labor and delivery units, she said.
“The vast majority of our history, the people who are physicians, and the people who work in the hospital, are not Black women,” said Kelly, also an associate professor of obstetrics and gynecology at Washington University in St. Louis. “I think part of that is not understanding and or refusing to understand that people come from different walks of life, and have different abilities to be empowered in a kind of power differential that is inherent in the medical system.”
Gov. Mike Parson said last month in his State of State address that his proposed budget would allocate $4.3 million to the state’s health department so it can tackle the state’s high maternal mortality rates.
Missouri legislators also are working to help more women, especially Black women and women in rural communities to have more health care options. State Rep. Jamie Johnson, D-Kansas City, introduced a bill last month that would require health insurance carriers in Missouri to cover doula and midwifery services through sending direct payments to providers.
Carmen Shelton, a full spectrum doula who helps mostly Black mothers through pregnancy and after they deliver their babies, would also like to see more support for Black women from lawmakers and hospital institutions.
The 22-year-old St. Louisan started Keeper of the Birth Realm in 2021. She has helped seven women throughout their pregnancies. Shelton, who primarily serves low-income women, is excited about her work because she can inspire other Black women to support friends and family emotionally or physically as they are going through childbirth.
Shelton is not a mom, but she has had her own battles to fight in the hospital while trying to help her clients. Nurses have ignored her questions and comments and discredited her qualifications as a member of her client’s birth team. She said the nurses' disregard for her during deliveries energizes her.
Shelton sees her work as transformative, but also considers doulas symbols of power for Black women and their families.
“It almost feels like I'm going into a battlefield every single time,” Shelton said. “And I feel like I have to put on my armor not just for myself, but for my clients as well."
