Culturally specific maternal health care for Black and Indigenous women key to reducing harm for birther and child

Octavia Treadway’s middle son was a drummer before he was born.

“He actually started drumming in the womb,” said Treadway, the co-executive director of

You’re Carrying Someone Great

, a nonprofit that, once launched this summer, will focus on the prenatal and postnatal health of Black and brown parents and children.

“We would be at church and the choir would start to sing and play, and he would just be going crazy. It was just his thing … he was born, he came out and as soon as he could pick something up, he literally just started banging it.”

Treadway is a mother of three sons, but she didn’t always feel supported during and after her pregnancies. During her first pregnancy, Treadway said she “pretended to be sick” in order to stay for two extra days, since she felt she didn’t have the ability or the education, as a teenage mother, to support her son.

Octavia Treadway Later, during her pregnancy with her third son, Treadway was told to “calm down” by a doctor, and responded by “stepp(ing) out of character” to tell the doctor that asking her to “calm down” was “completely unreasonable.”

“I can talk right now about my birthing experiences and still feel my nervous system clinch or rise or fall,” Treadway said.

“Sixty percent of the deaths that we see in the maternal health space, particularly for Black women, are just about listening,” said Brittany Wright, a doula and family wellness advocate based in the Twin Cities.

Wright has firsthand experience not being listened to.

Brittany Wright When she gave birth to her daughter in Boston, Wright said, she felt “a strange sensation” after laboring for 12 hours at home, and went to the hospital in order to receive treatment. She was unable to walk, so her then-husband used a wheelchair to bring her into the hospital. Workers at the front desk told Wright that she had to get up and walk to her room if she wanted to be seen.

She was also told that, since this was her first time giving birth, she just wasn’t “used to” labor and delivery. Later, after Wright began shaking and convulsing and lost control of her body, medical personnel, according to Wright, finally “realized there was, in fact, something wrong.” What was wrong, in Wright’s case, was an infection that had led to a fever that had crossed the placenta. As a result, Wright’s daughter was born with a fever.

Jasmine Funmaker, a Native American doula, also had a negative experience during her first birth.

“The hospitals don’t see the birth as a ceremony,” said Funmaker, who is also a cultural home visitor at the Division of Indian Works.

“Indigenous culture sees pregnancy as a ceremony – birth as a ceremony, (the) breastfeeding journey as a ceremony. The connection really isn’t there with hospitals or public health. It’s kind of just a rush and in and out thing.”

Jasmine Funmaker Part of this rush, Funmaker said, takes place when hospitals rush birthing parents into cesarean sections when their labor is perceived to be taking too long. Funmaker believes this happens because there is more money to be made by talking birthing parents into surgery, rather than waiting. During her own first pregnancy in 2019, Funmaker was “talked into induction” by medical personnel who said her child was too big, and she would break a bone on the way out if she delivered vaginally.

“They just use a lot of scare tactics to get you to do what they want,” said Funmaker. “Now that I’m more educated, I know that … the first birth is always going to be longer, because your body is learning how to give birth.”

This wasn’t the only negative part of Funmaker’s first birthing experience. Medical personnel, she said, did not listen to her or her support team of doulas before her son’s birth.

“I had been in a year in recovery at the time from opiates. And then they were still trying to talk me into taking Suboxone. I said ‘Why would I take Suboxone while being pregnant? And they’re like, ‘Oh, well in case you have a relapse while you’re pregnant.’ And I was like, I’ve been a year sober … I’ve been doing this on my own. I feel strong enough and … I know that I won’t relapse while pregnant.”

Instead of listening to her, Funmaker said, medical personnel took her away from the friend she had brought along for support, claiming that this would be a more “private (space) to talk.”

“I (felt) like they (wanted to) take me away from my support so that I could say yes. So I had to really advocate for myself all while I was pregnant,” said Funmaker.

And it’s not just Wright and Funmaker who have had negative experiences with hospital births. Nationally, Native American and Black women,

according to the CDC

, are twice as likely as white women to die of pregnancy-related causes. And when there isn’t a death, bias and discrimination can still lead to harm. A

survey commissioned by Blue Cross Blue Shield Minnesota

revealed that more than half the respondents — all Black birthing people in Minnesota — cited discrimination as having a negative effect on their health. The survey also indicated that many respondents had low confidence that their needs were being met, especially postpartum needs. While Blue Cross Blue Shield Minnesota funds MinnPost’s race and health equity coverage, it does not weigh in on editorial decisions.

Natalie Johnson Lee “The study … showed that the confidence in the medical system decreased after the first child,” said Natalie Johnson Lee, special projects director and consultant at NorthPoint Health and Wellness Center.

“(They) go in very innocently, very hopeful that this system is there to support them. And unfortunately in many cases, they find out that that system is not set up to care for them at the level of care necessary.”

At a press conference on April 3 regarding efforts to address maternal health in Minnesota, Dominique Jones, doctor of nursing practice and certified nurse-midwife at Hennepin Healthcare and member of the Minnesota Maternal Mortality Review Committee, highlighted the disparities present in Minnesota regarding Black and Indigenous birthing parents. While death during childbirth is rare in Minnesota, Jones said Black and Indigenous women are overrepresented among those dying during childbirth.

While Black women represent 13% of the birthing population, Jones said, 26.7% of women dying as a result of giving birth are Black. Indigenous women, Jones added, “make up about 1.7% of the individuals who are birthing in Minnesota,” but make up

12% of pregnancy-associated deaths.

Earlier, in February, the Black Maternal Health Caucus within Minnesota’s House of Representatives

released its legislative priorities

for the year. The contents of prioritized bills include adding morbidity — defined by the

World Health Organization

as “any health condition attributed to and/or complicating pregnancy, and childbirth that has a negative impact on the woman’s well-being and/or functioning” — to maternal health studies in addition to mortality, pay parity between doulas and midwives, and creating a certified midwife license in Minnesota.

While legislative efforts relating to maternal health care are pending during the current legislative session, community organizations and providers are working to fill the gaps in their communities.

At the Division of Indian Works in Minnesota, there are a plethora of programs that benefit Indigenous birthing parents and new families during pregnancy and after birth. These range from doula support via their Ninde Doulas program to family support and cultural home visitors to assist with parenting.

“Our maternal child health programs as well as our home visiting programs work hand in hand to support those families whether they’re prenatal, birthing, or postpartum,” said Shashana Skippingday, director of programs at the Division, who supervises maternal and child health programs, home visiting programs and the family violence prevention program.

Funmaker supports her clients by checking in — seeing if they have the necessary supplies for their baby, asking about their mental health and helping around the house as needed. What birth justice looks like for her, she said, is Indigenous people helping each other out and being “the village that every mom needs.”

As a doula and family wellness advocate, Wright too advocates for her patients — granting them culturally aware and appropriate birthing experiences. For one client, Wright cultivated a multigenerational birthing space where she was unhurried and able to give birth in her own time.

“We encourage(d) the mother to move around, to dance to the music and to really immerse herself in the music versus just focusing on the pain of the contractions,” said Wright. “As a result of doing that, she labored for 36 hours … no medical interventions, did it completely natural and she was able to do that because she had multiple people by her side rotating in and out, encouraging her, praying for her, cheering her on.”

But things could have been different.

Sierra Leone Williams “Had she been forced to lay on her back during that labor, she would have more than likely ended up having an emergency C-section because of the pace that her labor was progressing,” Wright said. “There are these practices in hospitals where it’s like, ‘Your labor should only go for a certain amount of time.’ If your labor is taking too long, they’re going to say, ‘Oh, well, your baby’s in distress and so you should really consider an emergency C-section.’ There is this cascade of medical (procedures) and interventions that happen that are completely unnecessary.”

Sierra Leone Williams, a doula and lactation counselor in the Twin Cities area, also indicated the importance of listening to Black females and families throughout the process of pregnancy and birth.

“People are not being believed about their pain,” said Williams. “The provider is giving advice on the person’s body as if (the person doesn’t) know what’s going on in their own bod(y).”

One common thread in improving maternal and child health outcomes is the promotion of breastfeeding — a practice that is less common among Black and Indigenous birthing parents. In a

CDC study analyzing births from 2020 to 2021

, which included data from 48 states and the District of Columbia, Black and American Indian/Alaska Native women were shown to initiate breastfeeding at lower rates than Asian, Pacific Islander, multiracial and white women.

“We find that there are generations of (Indigenous) families that do not breastfeed,” said Skippingday, adding the reasons range from trauma to simply not having seen breastfeeding before.

“It’s a big thing for us as educators to reclaim and educate our families and re-matriarchate that this is what was normal and it can be normal again,” Skippingday added.

LaVonne Moore, doctor of nursing practice at NorthPoint Health and Wellness, runs the

Chocolate Milk Club

, an educational support group that encourages Black birthing parents to breastfeed their children. The group also provides lactation home visits to parents of color free of charge.

Parents and children at Chocolate Milk Club monthly meetup groups known as “The Letdown.” “Chocolate Milk Club is a cultural model of care that I developed from research,” said Moore. “(It was) part of my doctorate work where I did community based action research and what I was looking for (were) tools to address health disparities. What kinds of things could impact or improve health disparities in regard to black maternal health? And breastfeeding was one of those tools that was not considered originally. Now people are considering it as part of the toolkit to address health disparities in our community. We historically were breast feeders, but because of our historical trauma, those numbers have decreased.”

This trauma, according to

an article by Shavon Johnson, MPH

, is a result of historical exploitation. During slavery, writes Johnson, enslaved Black mothers were often made to nurse white infants “at the expense of their own children.”

At Chocolate Milk Club, Moore outlines the benefits of breastfeeding, including the prevention of allergies, asthma, eczema in children, along with the benefits the practice has for the breastfeeding parent.

“It protects the health of the mother as well, so it pays forward,” said Moore. “It just has a thousand different benefits.”

In building Chocolate Milk Club, Moore has created a community of care that turns participants into advocates and educators themselves — with those who have breastfed their children assisting new parents with breastfeeding their infants.

Treadway said breastfeeding her younger sons allowed for a connection with them that she wasn’t able to have with her eldest, who was not breastfed.

“Having him so young, my oldest, it was just much more about like, ‘OK, you have this bottle, we gotta go, I gotta go to school, you gotta go to childcare,’” Treadway said. “It was very much like, ‘Let’s get it done so I can graduate, so you can be okay.’ This (was a) very regimented approach to things. Whereas, when I had my other two, there was more opportunity to lean into what it looks like in those first couple of weeks after birth and (to) really (connect) with my babies on a different level.”

For many of the birth workers interviewed, their own experiences with birth were marked by a lack of listening, where they felt unheard by providers. Some of them tie their ongoing support of birthing parents in their communities to these negative experiences — which have led them to want other parents to have better birthing experiences.

After giving birth in high school, losing her community and having little education about her own body, Treadway chose to focus on helping mothers and children as a doula and by leveraging her experience in the nonprofit sector.

“I wanted to work to make sure that no other woman had to have that kind of experience,” she said. “I was (always) the one that people were comfortable with asking to be in hard, vulnerable spaces with them. So becoming a doula matched up my concern for women and children with my ability to do hard things (and) to walk alongside people as they do hard things.”

By listening to birthing parents and providing them with education, resources and the ability to craft culturally affirming birthing experiences, these providers are making sure that Black and Indigenous birthing parents can have healthy, affirming experiences giving birth.

“What led me into health advocacy is not having a great experience, not feeling heard, not feeling listened to and being told that things I was experiencing in my body – that I knew were not normal — were normal,” Wright said. “Historically, it’s like you have to die in order for anybody to pay attention to the fact that you didn’t have a good birthing experience and that’s terrible.”

“It’s not enough to say, ‘Oh, we didn’t kill (someone), so everything’s OK’. (People who give birth) still have other injuries and complications as a result of them not being heard, listened to or issues not being addressed earlier and so morbidity is a key piece to addressing the disparity, because it’s not just about making sure that we don’t die. That is literally the bare minimum. We should be having joyous, empowering, birthing experiences where harm is not done and trauma is not inflicted.”

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