Harambee Doula Care & Holistic Services Provides Crucial Support and Guidance During Pregnancy and Beyond: Support When Mothers Need It Most (Part 2 of 2)
Uchenna Jones (l-r), Tehmina Islam, Chandra Lewis
by Jonathan Gramling
Back in the 1990s, the Harambee Center was basically a one-stop shop for mothers and children. Head Start was there. Family Enhancement was there. The Madison Public Library was there along with other child-centered organizations including the Harambee Doulas. But all of that changed.
But while the center was demolished, the spirit of helping expectant mothers has been carried on first by Harambee Village Doulas, then Harambee Birth and Family Center and now the Harambee Doula Care & Holistic Services.
Harambee Doula Care is a combination of direct service to provide the expectant mothers the support that they need and training center to strengthen the knowledge base of existing doulas and allow more people to become doulas.
Doulas play an important role of support that is defined, in many ways, by the expectant mother.
“Doulas are not owned by a hospital,” said Uchenna Jones, a nurse and doula and co-founder of Harambee Doula Care. “They are hired by the client. And what is beautiful about it is if you look at the amount of contact hours, doulas have more contact hours than their doctors because we are not bound by any time constraints related to work. Ours is by fostering relationships. So when I go in to see a client, I come in with questions. But we spend a minimum of 1-2 hours just getting to know the client, know their partner and if there are children in the household, to get a sense of their needs, wants and desires as it pertains to their birth experience. And then our job as doulas is to make sure that they are in constant communication with their providers because that is really important. Doulas do not replace what is in place. We’re like buffers. We try to protect the environment in which the birthing person is going to have their baby so that it is safe for all.”
Doulas’ expertise — and their effectiveness — is enhanced by a life-long learner approach.
“I am a doula who became a nurse and now I am in the process of becoming a midwife,” Jones said. “I worked in the healthcare system for a long time as a nurse. You get to see a lot of different things. I’m a doula for 23 years. I’m the oldest active Black doula in Madison. I’ve done all of my care in Madison. So I have served over 1,000 different laboring bodies. It’s really interesting. You get to see a lot of different things. And one
of the things that is really, really important is providing information and learning information. As a new doula when I started back in 2002, I learned a lot from my training. But I felt like I needed to learn more. So I went back to school and became a nurse and learned more. And then it took me about five years to get on the labor and delivery unit. And when I got there, I learned even more. So if you’re really committed to this work, you can’t stop learning. I also joined because I wanted to see how the communication went between the doctors and the patients and all of this other stuff. From there, that’s how I fostered my relationships. I’ve got doctors on my phone, people with whom I connect. And if I am not sure about something, I can pick up the phone and ask those questions to improve certain lines of communication. I also help mitigate different levels of care because of what I know and who I know. So families that felt unsafe with a doctor, they were empowered to transfer their care to someone who does care.”
In order to facilitate that relationship, the doula must understand what is going on with the expectant mother through training and interaction with the expectant mother.
“Our training includes child birth education and medical intervention,” Jones said. “It’s really important to know what makes something that is low risk become high risk. It’s also important to know that we train our doulas that there is nothing wrong with the Black body. The Black body is not at high risk. Now we do things to the Black body that makes it high risk. But the Black body like all laboring bodies is not at risk. It’s really important to have that understanding. When you have that understanding, then you understand the system that creates those levels of stress. Now one thing that people don’t understand is that exercise is stress. Movement is stress. Work can be stress. And in general, anything in life can make you be stressed. Well with a birthing body, a pregnant body, stress really plays a critical role in the development of that young embryo, that fetus, that growing baby in the body. And if it is not protected and nurtured, that laboring body, that women’s body, that mother is not prepared to handle things around them, they can go into labor right away. And it’s not because her body couldn’t get to term. It’s because of the pressure. This mom is working a job and guess what? They are afraid they are going to lose their job. So they are doing everything they can but they get judged heavy.”
The doula has no direct authority. But they say that information is power and with the knowledge that they gain through the relationship with the expectant mother, they are able to interact with cclient and provider to work toward the healthiest outcome for mother and child.
“There was one mom whom I cared for,” Jones said. “It was really crazy. They put certain things on the chart. But she was barely eating. She was carrying twins. And she was taking marijuana. Just listening to that, you think the worst things. But in reality, she was taking it because encouraged hunger. It allowed her to eat. She wasn’t able to eat. She was throwing up. She was having a lot of different health-related issues pertaining to her pregnancy. But the provider was not giving her what she needed. So someone in her circle advised her and she took it. And it made a difference. She was able to eat. But is that the level of care as a doula that we would give? Not necessarily so. But as doulas, we are aware of that information. We understand. So now, what our job is is to bridge that communication with the provider and say, ‘Hey, is there something else that she can have? Is there something else? Maybe we have to refer her to a nutritionist so that she can walk through what she can eat and what she can’t eat?’ We assume that all pregnant people know how to eat for pregnancy. No! That’s not true. So it’s really important one, for those who want to be doulas to be properly educated. Two, for that doula to continue to educate themselves. Three, to give the latest information to the clients that they serve. Four, to bridge the communication between the client and the provider because the provider is the one who is going to be helping in the delivery of that baby.”
According to Jones, it is important for doulas to be present with the expectant mother and to understand her individually as well as the system under which she lives and her circumstances.
“Moms are increasingly becoming homeless, not just with a baby in their tummy,” Jones said. “We’re talking about children in tow. And I’m like, ‘What is happening?’ And unfortunately, if they are in a single-headed household, maintaining the finances as one person with no children is tough enough. Don’t talk about the mouth that needs to be fed and the mouth that is going to be fed. It’s even harder. And we don’t have the appropriate resources to ensure the success of that particular individual. Now it’s so easy to blame them. ‘Oh, it’s their decision-making.’ Yes it is. But also you should look at the systems in place that also reinforce those lifestyles and reinforce the options that are available. Whether they are good or bad, we’ll leave that up to the individual. But it is really, really tough.”
It’s all about the doulas being there to support the expectant mother and help facilitate the pre-natal, birth and postpartum experiences the way that the mother wants them to be.
“We have to meet them wherever they are,” Jones said. “It’s just different. And being patient with them and getting a better sense of what is going on and how we can help them. A lot of them need a lot of resources. Some of them need their basic bills paid like a phone bill. We all have phones, that sort of things, not having enough money for that. And we’re not even talking about food shortages or getting the right food because junk food continues to be cheaper than healthier food. Or the healthier food may not taste as good as the junk food. And rent is ridiculously getting higher. So the rent keeps going up. Where are they going to pull that money from if the money that they are making is not also increasing. And we’re not even talking about transportation to get the appointments. So a lot of these moms miss a lot of these appointments or have to have a lot of rescheduling.”
It’s that personal touch that can make all of the difference in the world.
“There is something about being in person that makes all the difference,” Jones said. “But that’s the beautiful part about doulas. Doulas can have prenatal visits anywhere. I’ve had prenatal visits over dinner, walking in the mall, walking in the park, having the client bring their family to the park so the kids can run around and be free while I get the opportunity to talk with them and find out what they need. Sometimes, a lot of us doulas, we have to be very resourceful and also pay attention.”
And that relationship can also have a positive impact on the level of care that the expectant mother receives.
“We have doulas who have gone on prenatal visits for clients because they needed another person who could hear and empower them to say what they are feeling,” Jones said. “We help them with their birth plans, which is very, very important so that the hospital knows the kind of care that this individual is wanting. And sometimes, it’s the reminder. Doulas serve as a reminder of, ‘Oh yeah, I really need to take care of this person.’ Why do you need a reminder? Generally, it should be everyone is taken care of really well. But I don’t know how many times I have heard clients say, ‘You know, ever since you walked in here, they are coming in more. They are making sure that I have what I need. They are actually asking me. But before then, I didn’t see anyone.’ The extra set of eyes just watching can make a difference. It’s not that we are actually doing something in the sense that we have our own set of medicine. It’s just the presence. It’s just being present and knowing that we are for the client. Our presence keeps the system accountable.”
While doulas play no official role before, during and after birth, their knowledge, expertise and personal touch can make all the difference in the world for healthy maternal outcomes. Friend, supporter, advocate, whatever is needed, the doula is there to help the system work — on behalf of the expectant mother — for the best outcome possible for mother and child. And healthy outcomes early on help to facilitate healthy lives for both mother and child. And that’s what it is all about.