As an example of such criminalization, the practice of midwifery required a license in 1917 under the California Medical Practices Act (AB 1375), but restricted midwives from practicing any medical duties. The practice was essentially eliminated in 1949 when the Board of Medical Examiners lost the authority to issue certifications and the standards for obtaining a certificate were repealed. Both of these actions made obtaining a “valid” certificate nearly impossible.
Two decades later, in 1974, the Nurse Practice Act became law allowing nurse midwives, considered advanced practice registered nurses, to practice under the supervision of a licensed physician and surgeon. Today, it is not uncommon for birthing people to have both a nurse midwife, or a licensed midwife — who are able to practice without physician supervision — and a doula present during labor.
Doulas work in concert with midwives, doctors and nursing staff to assure that the birthing person’s needs are being addressed. Sykes explained that no matter what, a doula’s role is to support the birthing individual.
“But we also become extra hands, eyes and person for the nursing staff. Every facility that I’ve been to, the nurses have been just wonderful,” Sykes explained. “They appreciate the extra help because I realized they’re spread thin, too, in many cases, and they cannot give mom the attention she needs.”
Creating space within the healthcare system
Rhonda Smith, the Executive Director of the California Black Health Network (CBHN), explained that in order to achieve equitable care in the healthcare system, especially for Black women and people, there needs to be a change in the way healthcare is delivered across the board.
“I think the system and the culture has to change in order for us to see change in terms of the impact on individual health and outcomes. I think that in addition to the training, there needs to be some accountability,” Smith said.
When it comes to Black maternal mortality, Smith stated that the disproportionate impact on Black birthing people and fatal outcomes are “driven by racism.”
“I think it’s beyond implicit bias, but if you want to call it that, fine,” Smith asserted. “To me, it’s still racism, whether people are aware of it or not.”
As executive director of CBHN, Smith has led advocacy efforts for maternal health bills such as the expansion of medical coverage of doulas and the California Dignity in Pregnancy and Childbirth Act (SB 464). Smith also explained that part of the solution to achieving equitable care and overcoming racism in the healthcare system will be to create more of a workforce of Black doulas, an initiative she said CBHN would co-sponsor.
“There are systems that can be created. I think that is the most ideal thing — that it doesn’t get put on one community or one state or one part of our health care system, but all of it is like standard,” explained Dr. Sayida Peprah-Wilsom, co-founder of nonprofit Diversity Uplifts and member of the Sankofa Birthworker’s Collective.
“Which would mean that the insurance companies, private insurance, would also see doula support as an essential part of the maternal system and maternal care.”
A ceremonial experience
DeShawna “Shay” Wright described having a doula as like having a therapist who is concerned with the birthing person and the child’s wellbeing. Wright acknowledged that doulas are not doctors, but explained that they are very knowledgeable about labor and birthing processes.
After Wright delivered her baby, her doula Chantel Runnels, came to her house to perform a binding ceremony. Following the birth of the baby, the hospital gave Wright a postpartum girdle to help her uterus contract and return to normal size. Runnels binded Wright using a lightweight mesh material and performed breathing exercises with her to set a soothing and relaxing environment. Wright described the experience as ceremonial.