Doulas seen as key to battling maternal, infant death among san diego’s black community

The nightmares hit Sharavyn Johnson not too long after a pink line on a pregnancy test told her she was with child. Johnson and her wife, Nasira, were elated that the reciprocal in vitro fertilization was a success, but that was quickly followed by Johnson’s terrible dreams she or their baby would die during birth.

“It was haunting,” Johnson said.

The fear is not uncommon during pregnancy, but data confirms the nightmare is more likely to become reality for Johnson. Because she’s black, federal statistics show she is three times more likely to die during childbirth than a white woman, and her child faces twice the risk that white babies do. Two San Diego groups are addressing the disparity by increasing access to a pregnancy and childbirth aide known as a doula.

Johnson said she was so worried about becoming one of the rare but worrisome 700 annual maternal deaths in the U.S., she wrote a letter to her unborn child.

“I remember saying that I loved him, and that if anything did happen, I tried my hardest to hold on,” Johnson said.

American Indian/Alaska Native29.7
Asian/ Pacific Islander13.5
SourceCDC, Sept. 5, 2019

Infant deaths per 1,000 births

American Indian/Alaska Native9.4
Native Hawiian / Pacific Islander7.4
SourceCDC, 2016

But Venice Cotton, a doula, helped put Johnson and her wife at ease. She is trained by the nonprofit For the Village to provide emotional support and information before, during and after childbirth.

“They trust us to be able to explain to them what’s going on and let them make the right decision,” Cotton said.

Limited research shows a doula, a Greek term for women’s servant, can reduce the risk of complications and low birth weights and increase the likelihood of breastfeeding, but hiring one is pricey and not typically covered by insurance. The health-focused nonprofit Project Concern International, or PCI, partnered with For The Village this year to train and compensate doulas for supporting black moms-to-be.

PCI’s long-running Healthy Start program typically serves only low-income families, but recently removed that requirement for black women in an effort to counter the high rates of maternal and infant mortality. The five-year, $5-million federal grant for the program also covers midwives to support the doulas and provides families with a health consultant for 18 months after the baby’s birth.

However, doulas aren’t without controversy. They don’t have medical licenses, so their training and experience vary. Plus, Cotton said medical professionals may feel doulas get in their way.

“We come in not with medical training but knowledge and experience and a more natural way to do what they do with medicine,” she said.

For Johnson, Cotton’s support was what she and her wife needed.

“Having a partner there was nice — a spouse or family member — but someone to guide that family member and to tell me what to do and to tell her how to help me — it was comforting,” Johnson said.

That comfort wasn’t just during labor. Johnson had prenatal check-ups, but Cotton was keeping up with her while she was at home. She made sure Johnson was resting and drinking enough water and even requested proof.

“I would have to send confirming pictures that I was laying in bed with my big jug of water,” Johnson said.

The Healthy Start program offers the same support after birth. Other doulas like Cotton visit moms at home before their first postpartum check-up, which often takes place six weeks after birth. The additional attention already helped two black moms get to the hospital for life-threatening issues they didn’t even know they were experiencing.

Johnson said Cotton’s continued presence not only assuaged her fears but also helped her achieve a positive birth experience with son, Asir. For her first child, Makayla, now 5, Johnson had labor induced and reluctantly agreed to an epidural. She wanted a drug-free delivery at a birthing center for her son, but needed help getting through the final hours of painful contractions.

Cotton, Johnson and her wife, Nasira, laughed together as they remembered what was then a tense time.

“Nas was getting frustrated. Nas was just like, ‘You know what, I’m going to sit over here.’ And Sharavyn? She was being more than stubborn,” Cotton said.

Cotton said Johnson didn’t show signs of complications, such as hemorrhaging, and the birthing center’s midwives didn’t raise concerns, so she pushed her on. For that, Johnson is grateful.

“Having him naturally and allowing my body to do what it’s made to do, is the best thing ever. Definitely,” Johnson said. “I would do it again. I would. I would risk it all again.”

She now plans to do that for other moms to be. Johnson completed doula training at For The Village earlier this month.


How to choose the right doula for you

In 2019, it’s almost certain that any pregnant person with a smartphone and an Instagram account knows what a doula is (a non-medical childbirth support person, for any latecomers). A doula can accompany pregnant women through the transformative process of pregnancy, labor and postpartum. And there is evidence that a doula can provide both physical and emotional support, as well as a variety of other benefits, some of which include a lower chance of Cesarean and a higher rate of satisfaction with the overall birth experience.

Choosing a doula is a big deal, though—they will be a major part of your support system during this hugely important time in your life. So how do you find and pick the right doula for you?

Finding a doula

The obvious place to start is, of course, the internet. You can do a simple Google search for doulas in your area, but also check out (a national doula database) or peruse the directories from doula training organizations like DONA InternationalSista Midwife or Doula Trainings International. 

Word-of-mouth is one of the best means to find potential doulas. You may get recommendations from friends, family, and even your local parenting Facebook groups. Sabia Wade, a full-spectrum doula, doula trainer and mentor in San Diego, says she gets the vast majority of her clients from word-of-mouth and social media.

If you take a childbirth class, you can ask the teacher about doula options in your area. Some midwife and obstetrician practices also have lists of local doulas or will suggest specific ones they work with. If you trust and feel aligned with your provider, this can be a way to get some other names to check out.

Things to consider

Every doula is different and brings their own personality, philosophy, energy and experience into the birthing room. You may want to consider whether or not the doula is certified (although certification is not required to practice as a doula in any state), their years in practice, number of births attended, specific training, further education and other skills, such as massage or aromatherapy. Some families will also want to find a doula who has a similar background, views or beliefs.

If you’re a marginalized person, says Wade, “Queer, trans, person of color, poly, disabled, be sure to hire someone who has some understanding of your experience. They don’t have to match exactly, but they should have an understanding and self-education of what your experience might be like.”

Figure out what resonates with you for your pregnancy and birth experience, and from there, what criteria will matter in the type of support you want. If you’re planning a vaginal birth after Cesarean, you may want someone who has supported a lot of VBAC births. Maybe you want a doula who also offers belly casting, or postpartum cooking, or is a lactation consultant.


Doulas can range from $200 (for a student or inexperienced doula) all the way to upwards of $3000 (for professional doulas in high-cost-of-living areas like Los Angeles or New York City). Most doula packages are somewhere in the $500-$1500 range and include several prenatal and postpartum visits, weeks of 24/7 on-call time, continuous birth support and other perks.

Expectant families are often on a budget, though, and cost can be a concern. Many doulas offer flexible payment plans, sliding scale, or even barter agreements with clients. Others work in partnerships, agencies, co-ops, or other group practices, and these types of structures often have multiple options for payment. Community doula groups may be funded with grants and charge a nominal fee.

Choosing a doula

After you’ve identified some doulas you’re interested in, start with a deep-dive on their websites and social media profiles. Get a feel for what they share, how they represent themselves and the general vibe they present to the world. From there, schedule interviews with those whose words and ideas speak to you.

You can chat over the phone or text at first, but a face-to-face meeting (make sure to include your partner or others who will be present at the birth) is vital to see if you’re a fit. Most doulas offer a no-cost interview or consultation at a neutral place like a coffee shop. If that isn’t possible, try Skype or FaceTime. You may also be able to attend a “meet the doulas” or “doula speed dating” event where you can hear from a few doulas at a time.

Show up prepared to get personal—ask about qualifications and experience, sure, but don’t shy away from delving deeper to see if there’s a true connection. Freelance writer and parent Jenna Jonaitis says this aspect was the deciding factor for her during her pregnancy.

“I chose our doula because I felt like she listened to me,” Jonaitis says. “During our initial conversation, she wanted to hear about me, my partner and our future baby. She validated my feelings. Her spirit was warm and calming—which seemed like exactly what I would want during labor.”

Wade also suggests sharing your birth goals with the doula in order to make sure you’re aligned. “Ask them, ‘What are your feelings about this? What do you teach about this?’ If you have a doula who seems uncomfortable with or is pushing a certain way of birthing, that’s not the doula for you.”

Go with your gut

Interview at least a few doulas and from there, take time to think about which person you want at your birth. This is someone you’ll probably be spending a significant amount of time with, someone who will likely see you naked and vulnerable, crying and emotional—so you should fully trust and feel comfortable with them.

Ultimately, says Wade, trust your intuition.

“The doula should make you feel safe. They should make you feel like you’re not being judged,” Wade says. “They should make you feel like they’re ready to support you in any kind of way, no matter what you want to do or what may happen during your birth.”

And Jonaitis says it’s important to remember that this person will be there on one of the most challenging and momentous days of your life.

“Choose someone you feel connected with, someone you’ll want in your memories of your birth story,” Jonaitis says. “I treasure the experience we had with Sarah. She was by our sides through it all. We will never ever forget her.”


Nonprofit addresses racial, economic disparities in pregnancy-related deaths with free doula services

Black women among the most vulnerable population to benefit from doula-assisted births


Ten little toes wiggled on Jeanetra Deshotel’s lap while she sat in the living room of her Point Loma home.

“Can we get a smile to show your dimples?” Deshotel said to her newborn son, Ze’Kerion.

Eight days after Deshotel gave birth to a 6-pound, 11-ounce baby boy, Venice Cotton, a doula with the nonprofit For the Village, stopped by for the mother’s first postpartum visit.

Sitting in the living room, Cotton asked Deshotel questions as she held Ze’Kerion.

“Have you been eating?…Do you have a plan for when your family is gone?…Are you having trouble breastfeeding?…Are you resting?” Cotton asked.

A postpartum visit within the first few weeks of childbirth is routine, Cotton said, adding “mom gets lost because she’s so concerned with taking care of everything else that she forgets to take care of herself.”

Cotton is a full-spectrum doula with For the Village. Doulas are non-medically trained individuals who support, advocate and provide information before, during and after birth.

When the nonprofit started in April 2018, it had six doulas, including founder and Executive Director Sabia Wade. Today, the organization has 43 doulas who have collectively assisted more than 60 clients since July 2018.

The organization’s growth, Wade said, is a direct result of the nonprofit addressing a “resource that was needed” among black and low-income families in San Diego County. Wade said most clients hear of the nonprofit by word of mouth.

Doulas with the nonprofit are known as “full-spectrum doulas” because they also support women during miscarriages, abortions, still births and more.

The nonprofit provides free doula services to populations at higher risk of pregnancy-related deaths and minority populations lacking access to adequate medical care.

Federal statistics show that black women are two to three times more likely to die from pregnancy-related cases then white women.

In San Diego County, African American mortality rates were 26.2 per 100,000 live births compared to a rate of 6.6 per 100,000 live births for white mothers from 2000 to 2018, according to data from the county Health and Human Services Agency.

A study conducted by the Centers for Disease Control and Prevention in September found that the disparities are likely related to access to quality care and implicit racial bias in the health care system. It also said racial and ethnic disparities have been persistent over the last decade.

However, a growing amount of research suggests that the use of doulas can improve both birth and breastfeeding outcomes, especially among minorities.

“Our work is focused specifically on giving access and free care to black people, black immigrants, to be able to change the disparity,” Wade said.

In San Diego County, there were 4.5 infant deaths per 1,000 live births in 2018, compared to 3.7 in 2017, according to county data. Records show the mortality rate for African American infants was 8.1 per 1,000 live births in the county compared to a rate of 3.7 per 1,000 live births for white infants.

When Alana Pearson, who is African American, discovered she was pregnant with her third child, she worried about the growing infant mortality rates for black babies, she said.

She was also hesitant to give birth in a hospital because she felt that nurses dismissed her concerns during her last pregnancy.

“In the hospital, it just felt like you are going through an assembly line,” Pearson said.

Doulas say that feeling is common, especially among black and immigrant moms.

Doula Meisha Johnson said navigating conversations with doctors is sometimes what helps moms the most, being able to ask questions about procedures that doctors want to do or why they are suggesting feeding the baby formula over breastfeeding.

Johnson said being a doula is about “being able to educate, support and show (moms) different options.”

Wade trains and certifies the doulas who work with the nonprofit but they are not medically licensed. She said doula work can be controversial but some doctors and even hospitals have embraced it.

Forty percent of the mothers served by For the Village doulas are Haitian immigrants living in San Diego. Fifteen percent of the mothers are active members of the military. Most of the women are African American.

Wade said there is a disparity in the way that both African American moms and black immigrants are treated in the medical world but there are differences in the needs of both groups. The Haitian immigrant mothers lack basic needs, but the African American mothers face the racial disparity.

“We have doulas from every background and they are all aware of what people of color are facing,” Wade said, adding that in total the doulas speak 12 different languages.

For the Village partners with Project Concern International and Birth Roots Maternity Center in Chula Vista. Doulas are paid by the nonprofit and earn about $400 per client.