During an ultrasound at 16 weeks into her pregnancy, doctors at a hospital in Aurora found a mass growing on Halle Payne’s right ovary and said they believed she had a fibroid tumor.
“I told them that did not seem right,” Payne said Dec. 13. “The symptoms weren’t the same as what fibroid symptoms would be like.”
Doctors said they weren’t concerned about the mass and sent Payne home without any treatment.
A month later, in November 2022, Payne was vomiting and having acute abdominal pain and was rushed to the same hospital, where doctors said they misdiagnosed her and that she actually had a dermoid cyst that was so huge, it wrapped around her right ovary twice and needed to be removed immediately.
“It was cutting off blood flow to me and my baby, and if they had listened to me before, we could have looked into it way earlier on and got it removed before it almost killed me and my unborn child,” she said.
After her surgery, Payne reached out to Mama Bird Doula Services in Aurora and asked if they could provide support for the remainder of her pregnancy. Doulas are trained to provide nonmedical physical, emotional and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.
In a partnership with Colorado Access, the state’s largest nonprofit health plan, Mama Bird is helping 24 doulas earn higher wages and get free training and mentorship in hopes of improving pregnancy and birth care for Black women such as Payne.
It is one of a few programs in Colorado trying to reverse troubling trends in maternal and infant deaths. Black women across the U.S. are three times more likely to die from a pregnancy-related complication than white mothers, and racial disparities in infant mortality have likewise persisted, despite the overall decline in the infant mortality rate across the United States.
Through the partnership, 40 Black families covered by Medicaid, who typically can’t afford doula services, receive two prenatal visits, 12 hours of birth support, unlimited access to yoga, at-home postpartum visits after the baby is born and prenatal massages, among other services, some of the same supports Payne received.
The doulas offer prenatal appointments at Mama Bird’s offices or in the mother’s home where they address concerns, answer questions and help alleviate any physical pain or discomfort. Doulas will also accompany pregnant people at a prenatal appointment at a hospital or doctor’s office.
If Colorado Access had not covered these services for the families with Medicaid, they would have to pay $4,200 out of pocket for the Mama Bird program.
The partnership comes at a time when birth workers have rising concerns about maternal and infant mortality rates across the state. In 2021, Colorado had the sixth highest infant mortality rate compared with all other U.S. states with 314 babies dying that year before their first birthday.
Black mothers also suffer more mistreatment when compared with other pregnant women of color, according to the Centers for Disease Control and Prevention.
Breastfeeding rates have increased but racial and ethnic disparities similarly also persist, a serious concern because breastfeeding has many benefits such as possibly reducing the risk of respiratory infections and death among infants and decreasing the risk of breast cancer and cardiovascular disease for the breastfeeding person, according to BMC Public Health, a public health journal.
Mothers are less likely to have a cesarean section and are not as likely to need pain relief medications when a doula is present, according to the American Pregnancy Association.
Similarities in race and culture between a mother and a doula can create a trusting relationship during pregnancy, according to PubMed Central, a biomedical and life sciences journal.
Doulas can help prevent racism in the medical setting such as by ensuring that mothers are asked for their consent ahead of procedures and that they are respected by medical staff, according to the journal.
Doulas are different from midwives, who are trained to provide uncomplicated obstetric and gynecological services.
Training to address a decadeslong problem
Through the training, some participants become certified doulas, while others become certified lactation counselors and instructors. Others get certified to become postpartum or bereavement doulas.
Colorado Access funded the startup of the program by giving Mama Bird $640,000 for two years to pay staff and doulas and help support the education component of the program, among other things.
Payne was the first mother with Medicaid to be selected to participate in the partnership and when her son was born in April, he was the first infant born in the program. In all, she received about six months of doula care from Mama Bird.
“What I got most out of it is that my feelings and experience as a Black woman are valid and that I deserve to be heard and seen and that I am powerful,” she said. “They also taught me how important it is to lean on your community, which is another reason why I ended up going into the doula field.”
In December, she was certified as a doula through the partnership, receiving her training through Allo Doula Academy in Westminster on a scholarship from Mama Bird.
Other Colorado organizations are also working to improve health care for families of color statewide.
Children’s Hospital Colorado is working to address the longstanding issue of inequitable infant and maternal care in a slightly different way. It is providing simulation training about bias in the medical system for all providers on staff, said Jeannie Dixon, health equity program manager at the Children’s Hospital Colorado Child Health Advocacy Institute.
Part of the goal is to improve pediatric care for Black families, who also face higher rates of premature births because of implicit bias within health care systems, Dixon said.
Marcela Mendenhall, an emergency department doctor who took the training, said the teachings were so powerful, she believes she saved a Black mother’s life based on what she learned.
Children’s Hospital Colorado is trying to make things better and the Black Health Initiative, which is run from the Center for Advancing Professional Excellence on the medical school campus, aims to train all providers and clinical staff at Children’s Hospital Colorado and has been funded by a federal grant from the Health Resources and Services Administration.
A new recognized profession
Some doulas who were accepted into the Mama Bird-Colorado Access program were already working in the profession and others are new. Most live and work in the Denver area and all who were selected expressed an interest in working full time as a doula, said Birdie Johnson, executive director at Mama Bird.
The families with Medicaid who were selected also mostly live in the Denver area. But there’s growing demand to expand the program to families in rural Colorado, she said.
“We start with very basic education — education of rights, education of birth and education in postpartum, so there’s an understanding of this journey that you’re going through,” she said. “You’re present, but you’re not present when you’re in labor, and if a doctor comes in and says they want to do ‘this,’ being able to educate that client on what their options are and getting them to understand their choices is what doulas do.”
The new partnership aims to prove that doulas are a necessity and not a luxury, said Gaubriella Miller, a college student who has been a doula for six years and will soon complete four training courses through the initiative.
The youngest person receiving doula services through the program is 17, has no family to help her, and lives at a center for young people with mental health challenges.
The young woman had three doulas on call who were available to answer any questions she had around the time of her expected due date. The doulas gave her physical, emotional and mental support during labor and delivery, and once she gave birth, they offered eight weeks of postpartum care to help her heal and learn how to care for her baby, Johnson said.
Doulas in the program are paid just under $30 per hour. Conversely, doulas who are not involved in the program typically earn just above minimum wage, Johnson said.
Lactation education, for example, costs $875 per training, a price most self-employed doulas typically cannot afford, Johnson said.
“Our hope is that other states will start to adopt this,” she added. “It’s possible to pay doulas a livable wage and cover people through Medicaid so that families of color who need the support can get that full coverage and don’t have to worry about a financial barrier.”
Saving a mom and her baby’s life
Children’s Hospital Colorado held dinner talks in 2020 and 2021 where Black women shared concerns about inequities in perinatal, delivery and postpartum care, Dixon said.
Leaders there had been seeing rising rates of maternal deaths, babies born prematurely and infants dying before their second birthday in Black communities across Colorado.
Since the first training launched in early 2021, almost 100 Children’s Hospital staff have completed the course.
Mendenhall, the Children’s Hospital Colorado ER doctor, noticed a nurse carrying a newborn baby into a trauma room last year at Children’s Hospital Colorado’s emergency department in Aurora at the Anschutz Campus.
The mother and baby had been discharged the day before from a different hospital where the baby was delivered safely and everything had gone as planned.
But soon after, the baby became lethargic, Mendenhall said.
Doctors, including Mendenhall, who took the simulation training, began providing resuscitative care. But soon after, the baby’s mother became ill.
“I’m assuming, as we typically assume, that it’s because her baby is getting IV pokes and bag mask ventilations and that it’s just a typical parental emotional response,” Mendenhall said. “But something in the back of my mind was telling me, ‘this is different.’”
Through the training, Children’s Hospital staff learn about preeclampsia, a serious blood pressure condition.
In the past, Mendenhall was taught race was a risk factor for preeclampsia. But through the training, she learned racism puts Black women with preeclampsia at higher risk because they’re often dismissed when they report feeling ill from those symptoms. Doctors are not educated well enough about bias and how it impacts care, she said.
Mendenhall also learned in the training that mothers can have preeclampsia for up to six weeks after they deliver their baby. “It’s not just while they’re pregnant,” she said.
Doctors admitted the mother to the hospital, she received medications to help lower her blood pressure and in a few days, she and her baby were sent home, Mendenhall said.
“I don’t have a crystal ball, but in my experience, I worry that the mother would have progressed from preeclampsia to eclampsia, and at that point, she could have had severe morbidity or even mortality because her condition may have gone unrecognized,” Mendenhall said.
“I could have missed this and her three children could have been without a mother,” she said. “It was a really important experience for me and one of the few life-defining, career-defining moments that I am very thankful to have.”
CORRECTION: This story was updated at 10:22 .m. on Jan 3, 2024, to correct the name of the Black Health Initiative at Children’s Hospital Colorado in a photo caption.