ORLANDO, Fla. — During a prenatal appointment in late October, Keshia Lockett sat down with Brittany Castro and her husband Anthony to chat with the couple about what they could expect when Brittany went into labor. 

“[I’m] absolutely here to educate, advocate, to support you guys – both of you – throughout labor,” Lockett told Castro. In her practice, called Empowered Black Doula, Lockett coaches expecting parents through pregnancy, birth, and in post-partum.

Lockett joined the profession in 2019, at a time when growing awareness about maternal and infant mortality had brought doulas – viewed as one answer to maternal and infant health disparities across the country – into the spotlight. 

“[Doulas] can work with the mother throughout her pregnancy, give her some evidence-based information, or direct her on where to find it, for things like birthing positions and things that aren’t typically talked about with their O.B. provider,” said Caroline Valencia, director of Maternal and Infant Health Initiatives at the March of Dimes.

Doulas may work with their clients to develop a “birth plan,” prompting clients to identify in advance things like who they want in the room during labor and whether they want to use pain medications during birth.

Before Castro delivered her baby, Lockett helped her and her husband practice assisted birthing positions and taught the couple how to use a rebozo – a long cloth wrap – to lift Castro’s belly and relieve contraction pain.

Beyond physical, emotional, and educational support, doulas can serve as advocates in the delivery room – an especially important service for Black women, who report poorer communication from doctors and less trust in the healthcare setting during labor than white women. 

“Black women often are not heard, and therefore they have a higher risk for pregnancy complications,” said Valencia. “There are stories that have a national presence, like Serena Williams having a condition and knowing that her blood would clot, and telling the providers after her birth that something was wrong, and they weren’t paying attention to her.” 

A Spectrum News analysis of maternal and infant health outcomes reported by the Florida Department of Health found deep disparities in birth outcomes for Black babies. 13.3% of Black babies in Central Florida were born underweight between 2018 and 2020, versus 6.9% of white babies. Similarly, 13.8% of Black births were preterm during that period, compared with 9.2% of white births.

Neonatal deaths, meaning infant deaths recorded within the first 28 days of birth, are measured per 1,000 live births: while the neonatal death rate for white infants in Central Florida was 3.2, the Black neonatal death rate was over twice that, at 7.45 per 1,000. (This analysis is based on data on Orange, Brevard, Osceola, Flagler, Lake, Marion, Seminole, Sumter and Volusia Counties). 

Lockett mostly works with women of color and says about 90 percent of her clients are Black. She sees herself as an advocate for women in labor, making sure their concerns are communicated to doctors on-call and stepping in to ask clarifying questions before a procedure.

“If the provider comes into the room and they’re wanting to do certain things, I’ll be like, ‘Hey, what is this, what are the risks, what are the benefits?’” said Lockett. “I’m kinda like that middle man, and sometimes I have to be that person that says, ‘Hey, I know her birth plan and she says she doesn’t want to do this, or she doesn’t want to do that.’” 

Research suggests that having a doula present during childbirth improves infant and maternal health. One study, published in the Journal of Perinatal Education, found that babies were four times less likely to be born with low birth weight and two times less likely to experience a birth complication involving themselves or their baby when a doula was present for prenatal care and during delivery.

Other research shows people who receive doula care also experience lower rates of postpartum depression and anxiety than those who give birth without a doula’s assistance.

“I struggle with anxiety, so I knew I needed ews 13.a doula,” said Castro, who delivered her baby in November. Having someone knowledgeable to talk to about pregnancy eased her fears about labor and birth.

As demand for doula care rises, some states’ Medicaid programs have begun to recognize the service and reimburse for it. In 2018, Florida became the first state in the south to expand its Medicaid program to reimburse for doula care, although on a limited basis. 

Meanwhile, networks of Black doulas are growing to meet the interest in their services. 

“I really enjoy having a group of my peers who understand culturally what it means to provide doula care,” said Averjill Rookwood, who is based in South Florida and is a member of the National Black Doulas Association. In addition to her doula practice, Rookwood consults with healthcare groups to make hospitals more “doula friendly” and lobbies employers to adopt doula benefits that private insurers may not otherwise provide. In Central Florida and on the Gulf Coast, Lockett has created an annual summer event called the Black Doula Tour – led by doulas and attended by expecting parents. 

“We’re here for a reason,” Lockett said. “You do not have to wing your birth.”

Alice Herman is a Report for America Corps member, covering health-care equity for Spectrum News 13.