BOMB Doulas address disparities in care among BIPOC birthing people

When I first learned about the Birth Outcomes Made Better (BOMB) Doula Project, it was right around National Public Health Week and I thought, “Hooray! This could be a wonderful feature to celebrate public health!” 

I didn’t get in touch with the individuals heading up the Doula Project soon enough and Public Health Week came and went, but Black Maternal Health Week approached so I thought “Hooray! This will be a wonderful feature to celebrate Black Maternal Health!” 

Then that week came and went before I connected with the program managers.

Nicole Miles, MA, CD, CLC

While it’s sometimes nice to synchronize projects with events and holidays, it finally dawned on me that  this work is always relevant.  

Once we touched base, City of Milwaukee Health Department Maternal and Child Health Division Director Erica Olivier, BA, MS and City of Milwaukee Health Department BOMB Doula Program Manager Nicole Miles, MA, CD, CLC accommodated me for nearly an hour sharing what led them to maternal health, the details of their program and the challenges they’re working through.

Inspiration for this work 

Miles was 11 when her little sister was born, and she was involved in many of the aspects of her mother’s perinatal care. Having a natural inclination toward this work, Miles decided that she wanted to become an obstetrician. After being exposed to other care models during her undergraduate studies though, she pursued doula work and is currently a student midwife.  

Olivier spent much of her career working in social and human services. In this work she says the focus was typically reactionary.

“I’ve spent a long time seeing the worst case scenarios,” Olivier begins referring to substance abuse, infant and maternal death, etc. “How can we do a better job of preventing this from happening? There is something really important about pregnancy and birthing and going all the way into reproductive planning.”  

In her current position, Olivier is impassioned to mobilize preventative interventions. Having teamed up with Miles– who Olivier praises for having tenacity, passion, and insight (which was clearly evident in our interview)– they are excited to transform doula work from a grassroots operation, and something that has come to be seen as a “luxury reserved for wealthier white women”,  to a service that is simply normal, expected and accessible for all.  

BOMB Doulas  

To our knowledge, the BOMB Doula Program is one of the only city- and county- funded birth support initiatives.

The pilot program was approved in 2019, but the COVID-19 pandemic derailed some of their momentum, Olivier reports.  

“We took a pretty big hit,” she says. “But we made the best out of the circumstances.”  

Currently, the health department employs four doulas who serve the entire City of Milwaukee. In addition, the program is in the process of hiring doulas for community-based positions. These community-based doulas will serve 50 families in the 53206 zip code, an area with the highest infant and maternal mortality rates in the county. For scale, Wisconsin has the nation’s highest infant mortality gap between white and black babies, according to data compiled by the CDC 

There is a wealth of research showing the infant and maternal health benefits of having a doula present at any point in the perinatal period.  

When a client is enrolled into the BOMB Doula Program, they can expect access to wrap-around care services, thorough screenings like the Adverse Childhood Experiences (ACES), sensitive, respectful care, and weekly interactions with their doula up to 12 weeks postpartum. 

Miles notes that BOMB doulas have a unique setup working for the health department because they have access to resources that a private doula might not otherwise have, like Miles’s direct access to communication with other health care providers. 

What’s more, for generations, Black Indigenous People of Color (BIPOC) have been forced into silence and complacency which often affects the health care they receive. 

“A doula is going to put eyes on things that are happening,” Miles says, acknowledging the systemic racism embedded in health care and how that plays out into care provider/patient interactions. 

Doulas speak up for their clients, help guide patient questions, and sometimes even facilitate change of care when necessary. 

Olivier adds that doulas empower and advocate, creating safe spaces for patients to challenge the status quo. 

This isn’t to say that Olivier is encouraging confrontation; rather, doulas facilitate patient-driven care building the capacity for birthing people to become self-determined and aware of their rights to comprehensive, culturally-competent care. 

The BOMB Doulas also complete breastfeeding-specific continuing education and attend a monthly study group led by an IBCLC.  

The group currently celebrates a 100 percent breastfeeding initiation rate! 

Work to do 

There’s still so much room for racial equity improvement within all of the systems we find ourselves interacting.  

“That’s not a means of slander by any means,” Olivier clarifies. Instead, Olivier sees herself and the BOMB Doula Program situated to help care providers enhance their practices and shift their lenses. 

“Let me help you help them,” has become Olivier’s motto. 

The Foundation for Black Women’s Wellness recently published their work “Listening to Black Women” in the Wisconsin Medical Journal.   

Their report illuminates that “The present state of Black maternal and child health in Wisconsin is one of the most significant and urgent public health challenges we face. Turning the tide rests on our willingness to center, listen to, and position Black women and their communities as leaders and cocreators of the urgent changes we need.” 

Olivier comments that there is an unwritten power dynamic that a lot of providers don’t want to acknowledge. 

“It’s sad that we are at a state of accountability,” she says. 

Miles adds, “I should be in disbelief, but I’m not in disbelief,” when commenting on the way that BIPOC are too often dismissed and mistreated in their health care.  

She uses the example of procedures like epidurals being employed without the explanation of risks to the patient. 

 In her role, Miles has the capacity to document these recurring issues and provide feedback to the systems that need to be held accountable for best practice. 

Olivier notes that from a legislative standpoint, there is some movement around the awareness of doulas and support of healthy perinatal practices. She cites parts of the Black Maternal Health Momnibus Act of 2021 for instance. 

“We will see what this looks like and where this goes,” she comments. “It will take a lot of education, tough conversations and acknowledgement of a need for change to address the disparities in care to BIPOC birthing people; moreover invested stakeholders and change agents.”

Olivier continues, “We don’t want to lose the fidelity of what a doula is. [We need to] mobilize but also stay true to the work.”

“We are happy to see some progress, but we know there is a lot of work to be done still,” she concludes with cautious optimism.

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