New doula program uses advocacy to target racial gap in maternal mortality in Fort Worth
Sofia Pimienta had a rough childbirth with her first son in 2020.
The medical staff, she said, broke her water too early, administered an epidural early, and insisted on a C-section, which she didn’t want but accepted.
When she was pregnant with her second son she decided to hire a doula. A doula is a non-medical professional who provides support with information preparedness, guidance, companionship and coaching during and after a pregnancy.
Pimienta is Colombian, and her husband knows limited English, so she had to find a bilingual doula, which was difficult. She had given up hope to find a doula until in February she came across Paradigm Doulas, a doula training organization, which is led by Yenny James who is in charge of United Way’s Community Doula Program. She applied and was given Jasmine Gregory as her doula.
Gregory was not bilingual but still taught Pimienta and her husband exercises, helped Pimienta understand her rights as a hospital patient, and made sure hospital staff members asked for consent before they touched her.
During that pregnancy, Pimienta applied in May to train to become a doula herself through the United Way of Tarrant County’s Community Doula Program. In June, she had her second son, and in July she became a member of the program’s third cohort.
Pimienta said she needed the advocacy of a doula during her pregnancy, and she now hopes to provide that same support for others. She sees the success in the program in graduating as many doulas as possible who will pass on their knowledge for the betterment of mothers and the community.
“If I want change, I’ll have to be the change,” Pimienta said.
Pimienta was among 120 doulas who graduated in October from the Community Doula Program.
Their mission is to address concerns about maternal mortality and health in Tarrant County, particularly among women of color. After a year of training doulas, more work will be done to support maternal health through the United Way’s plan to open a business academy to help doulas become entrepreneurs. TeamBirth, a new communication tool, is also being implemented in hospitals.
Making an impact where they ‘live, play and pray’
In 2022, the United Way was allocated $1.96 million from Tarrant County in American Rescue Plan Act funds to form a Maternal Health Initiative to train hospital staff and community-based doulas to ensure at-risk women of color have healthier pregnancies.
According to the 2024 Texas Maternal Mortality and Morbidity Biennial Report, Black women are 2.5 times more likely to die during pregnancy and childbirth than white women in Texas. The program will target Fort Worth’s 76104 ZIP code, which has a population that is about 38% Black and 43% Hispanic and was identified in a 2019 study by UT Southwestern Medical Center as having the lowest life expectancy in Texas.
Regina Williams, interim CEO of the United Way of Tarrant County, said the energy of each newly certified doula to serve their community was shown in their excitement during October’s doula graduation.
“I always say every one of us has an opportunity to make a positive impact in the communities that we live, play and pray in, and that’s what I saw that day,” Williams said.
The success of the program and improved maternal health in Tarrant County relies on the improved experiences of mothers from pre-birth to postnatal stages, Williams said.
Empowered, thriving families
Williams says the goal of the program is to bridge the gap between people and available medical resources. One of the biggest steps was the establishment of TeamBirth, a communication system to provide better transparency between women, their medical providers, and doulas during labor, delivery and postpartum. The model already exists in over 150 hospitals across the United States.
It was developed and tested by Ariadne Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, both located in Boston. TeamBirth is part of Delivery Decisions Initiative, a research and social impact program focused on transforming childbirth care around the world.
TeamBirth will be in seven hospitals within Tarrant County, including the JPS Health Network, Baylor Scott and White All Saints Fort Worth, and multiple hospitals in the Texas Health Resources system, including Texas Health Fort Worth, Texas Health Southwest, Texas Health Arlington Memorial, Texas Health HEB and Texas Health Alliance.
Trisha Short, a senior clinical implementation specialist at Ariadne Labs, says TeamBirth was created to provide equitable care and to center women in the birthing process.
TeamBirth focuses on two core components, a series of huddles with patients at key decision points during the labor, birth and postpartum period, and anchoring the information discussed during that huddle on a shared planning board that hangs in the patient’s room. The planning boards are the outline of structured communications between nurses, doctors, and the patients, Short said.
TeamBirth will result in information often only shared between staff being a part of the huddles between nurses, doctors and patients. The system gives the patient a say in the process, which will be acknowledged by the staff.
Short said the system will include the input of doulas who have built a relationship to support and elevate mothers’ voices. Doulas will be empowered to bring their skills and expertise to help facilitate shared decision-making between the patient and the care team
“Our goal is to propel empowered and thriving families,” Short said. “And the birth experience is a piece of that puzzle in the larger picture.”
Hospitals have been preparing to implement the new system since May 2024 and will have an official launch in January.
Business academy for doulas
The United Way wants to establish a business academy to help newly-trained doulas gain the skills and resources to start their own businesses, Williams, the interim United Way CEO, said. The academy, which is in the development stages, will help improve economic opportunities for families and neighborhoods and will partner with community organizations, like Workforce Solutions, to help doulas in their entrepreneurship journey.
Sofia Pimienta plans to start her own doula business. She wants to teach birth classes, teach mothers their rights, and help bilingual families with their birth plans.
“Lady” LyTisa Greene is one of the October graduates of the doula program who says the training is critical in her own business as an entrepreneur. She is a holistic health practitioner who does Reiki, a healing technique to reduce stress and anxiety. She also is a business consultant and owns a streetwear brand called FLAWEDUP LLC.
Greene was a teenage mother in 2001 with little knowledge about pregnancy or the birth process. She is originally from North Carolina but has lived in Fort Worth since 2015. She participated in a “Baby Love Program” in 2001 which helped Medicaid-eligible pregnant women during and after pregnancy. Greene said the program did not provide the same resources a doula would provide.
Maternal health would be improved if there is more focus on how to help mothers understand their bodies, better prepare for parenthood and spend more time in meditation, while also providing better access to resources for every pregnant woman, says Greene.
“The world needs to exist and so in order for it to exist, we have to have positive maternal health in place,” Greene said. “We need to make sure that these mothers are still able to function, able to live, able to get the proper care for their family, after the baby gets here, as well as while they’re carrying the baby.”
This story was originally published December 12, 2024 at 11:34 AM.
