While pregnant with her firstborn, Ana Rodney looked forward to a nine-month journey that culminated with a joyous return home from the hospital with her baby.
Then reality hit, and Rodney found herself suffering alone.
Rodney, 37, delivered Aiden, 7, under traumatic circumstances. He was born three months premature, weighed one pound, five ounces and spent six months in the neonatal intensive care unit at the University of Maryland Medical Center. All the while, she endured personal tragedy, unemployment and homelessness.
“Nobody really knew how to help me,” Rodney said. “And so, it left me feeling very isolated and angry and sad.”
From the pain, Rodney created MOMCares, an organization that provides doula services, workforce training and support specifically for Black mothers and families. Founded in 2017, it has grown to employ one part-time staffer and four full-time staff members — all of them doulas — and now Rodney is in discussions with area hospitals and county governments about contracting out the organization’s services. Rodney has also since added another addition to her family: Asher, who is nearly 2.
Doulas are trained companions that provide support to people during and after pregnancy as well as other health care-related experiences. While they are not medically licensed, they can assist medical professionals and enhance the experiences of their clients.
Rodney is seeing soaring demand for MOMCares’ doula trainings, which she attributes in part to increased awareness of racial disparities in reproductive health care and in maternal health compared to when she started working as a doula 15 years ago. “Nobody was talking about morbidity or mortality the way they are now.”
Baltimore officials have long seen doulas as a possible way to alleviate pregnancy-related mortality and improve city families’ quality of life. Data from the U.S. Centers for Disease Control and Prevention shows that pregnancy-related deaths among Black people exceed those of every other racial and ethnic group.
In Maryland, the numbers follow national trends. Among communities across Baltimore, the Black infant mortality has dropped, but it still exceeds the city’s overall rate and the rate among white people, according to data from B’more for Healthy Babies, a city health department initiative. And while pregnancy-related mortality in the city also has fallen by 35% in the last decade, some of the progress was lost during the coronavirus pandemic, which prevented many families from accessing in-person care, according to the agency.
Rebecca Dineen, assistant commissioner for maternal and child health at the city health department, said several trainings and programs over the years have been centered around doula support, which she considers a key component in reducing pregnancy-related mortality.
Dineen said doulas serve a similar purpose in the U.S. as traditional birth attendants do in other countries.
“Having trusted people at your side in a hospital setting … someone who might not be a skilled attendant, but might advocate for you, have a birthing plan to support you, is extremely important,” Dineen said. “It’s based on a rich tradition of birth attendants. But we don’t have a lot of people who have time to do that in this country.”
One flaw to the system, Dineen said, is the reimbursement rate for those who take on the work of providing this service, which in Maryland is available to Medicaid recipients. Medicaid reimburses for eight visits, and provides a flat $350 rate for labor and delivery, whereas the market rate for doula services in Maryland is between $1,700 and $2,500, Rodney said.
“Without having another source of income, you’re not going to make a living by being a doula,” Dineen said. She currently is lobbying the state for more at-home pregnancy visitation services to qualify for Medicaid reimbursement.
Dineen said doulas and other birthing paraprofessionals can fill several roles in a family’s pregnancy journey — as educators, advocates and birthing coaches, for example — and help families set up for long-term success. In Baltimore, such assistance may be especially crucial.
Researchers at the University of Baltimore’s Jacob France Institute, in a study that assessed data from 2010 to 2020, found that the percentage of babies born with an “unsatisfactory” birth rate of 5.5 pounds or lower stayed mostly stagnant in the city overall but worsened in predominantly Black areas, including Cherry Hill and southern Park Heights. “Low birth weight and pre-term mortality have a lot to do with maternal health and genetic factors,” Dineen said.
Rodney said MOMCares looks to cater to the mothers and families who identify as financially unstable and who could use additional support outside the hospital. They are on-call around the clock and can help cover basic needs once the baby comes home, such as grocery shopping, transportation and diaper refills. They can also be present for parents at the bedside during birth and are trained to focus on the birthing person’s experiences and needs — something that many Black parents say has been disregarded to their detriment.
“We do really try to educate them on their body, to know the signs, because you get into these rooms and someone’s speaking to you and telling you stuff and they’re not explaining it to you, they’re not using words that you understand, and you’re terrified,” said Jordan Tobias, a doula and MOMCares’ program director. “You want to do what they say because you trust them, and sometimes that’s not the way to go.”
Rodney had been a doula for years before Aiden was born but ultimately realized not enough of them were Black or trained to serve the Black community, in which pregnancy-related health risks are more common. Six months after Aiden’s birth, she scraped $60 together and rented a space for her and other parents in her network to congregate and share experiences. They laughed, cried and traded stories: Rodney’s first “healing circle” was born.
The circles include Reiki practitioners, massage therapists and acupuncturists who may understand postpartum stress in a way others can’t, Rodney said. She faults broken health care and wellness systems for failing to save her sister, Bobbi, who died due to a birthing complication.
“This idea that the mom is the martyr and is the one that fades into the background when the baby comes in, that we’re no longer important, I literally saw it with my sister,” she said. “So that’s when I really put boots on the ground. It was like, OK, this healing circle is cute, but we need to really address it.”
From there, Rodney learned how to write and apply for grants and began building what eventually turned into MOMCares. She said more funds became available during the coronavirus pandemic as a result of the federal government’s pandemic response that allowed her to onboard more staff and host more doula trainings. In the last two years, MOMCares has trained around 50 doulas and has served more than 500 people across its programs. The organization prides itself on its ability to fundraise to cover the costs for mothers, parents and caregivers that may otherwise fall through the cracks.
Another part of the organization’s success, Rodney said, is its sense of urgency to get new and current clients connected with services right away and its person-centered model that caters to what the birthing person wants and needs. Rodney said even her own experiences with medical professionals left her feeling undervalued.
”We know that there is no one blanket response to a family. … And so we pride ourselves in making sure that we’re putting in systems that honor that, and make it easy for our families to access the specific needs that they want,” she said.
Aside from ensuring safety during labor and delivery and helping parents build successful and stable homes, Rodney said the organization strives to put itself out of business.
“We really just want equity. We want to be safe, and we want doulas to be recognized as a profession, that is equal and just as important as the other people in the medical team,” she said. “I just want to create an environment where Black women get to celebrate their birth and come home with their babies, and live happy lives. And there’s not all this warning and fear around birth.”