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Louisville Eyes Bias Training, Doulas To Reduce Racial Disparities In Childbirth

Restrictions on abortion will mean more pregnancies carried to term, and more need for prenatal care.
John Ted Dagatano
Restrictions on abortion will mean more pregnancies carried to term, and more need for prenatal care.

Arthur Lemons III remembers his wife hysterically crying and begging the doctors not to give her a drug that would speed up the delivery of her baby. He remembers the drug not working, and then hearing that his baby’s oxygen was being slowly cut off.

Lemons’ wife was giving birth in a Louisville hospital, and had hoped for a vaginal birth. But he said, because the drug didn’t work, she had to get an emergency c-section.

“She did not want the drug — but they insisted, because was a time thing,” Lemons said. “Because of the situation and the way we look, I think that they took it not serious enough — they didn’t want to listen to her.”

Lemons said he thinks his wife was given that drug without her consent because she is African American, which he said put his wife and his baby’s life at risk. That experience brought Lemons to a Louisville Metro Department of Public Health and Wellness town hall meeting last week. City leaders and residents met to brainstorm solutions to the stark racial differences in infant and maternal mortality.

According to the Louisville Metro Healthy Start Program, infant mortality rates for African Americans in Louisville neighborhoods west of 9th Street are more than double the rate of Louisville overall, and more than triple the rate for white people. Babies born in these neighborhoods also have lower birth weights and pregnant women have more miscarriages.

There are a number of reasons why an African American woman is more likely to die during or after childbirth, ranging from factors like access to prenatal care, higher rates of chronic conditions and delivering at hospitals that have overall lower quality than facilities where white women tend to deliver. But experts say there are other reasons, too.

Implicit Biases

In addition to the well-established factors, emerging researchshows that the implicit bias that Lemons described does shape the care women get during and after childbirth.  An NPR and ProPublica investigation found African American mothers often feel devalued and not listened to, and that their pain isn’t taken as seriously.

That’s why the Louisville health department recently started training health providers in recognizing implicit bias that might shape medical decisions.

Ana Williams also attended the town hall, and was there to take back information to her clients. Williams is a therapist who works with many women of color who are either  pregnant or new moms. She said some of these women report not knowing what kind of care they’re supposed to get.

“They say that they remain silent sometimes just because of the power your care provider has,” Williams said. “A lot of stuff they’re not aware of, like, ‘I don’t know what questions are supposed to be asked of me or if I’m feeling something, what’s the protocol as far as getting my nurses to listen.”


Educating expectant mothers and teaching them to be confident advocating for their needs is another piece of the puzzle.

Lemons and his wife became active in the health department’s Healthy Start program before the birth of their second child. The program aims to arm soon-to-be parents with questions to ask at the hospital and teach women how to advocate for themselves.

The couple also connected with nonprofit Mama to Mama, which provides doulas to accompany pregnant women during delivery. Doulas provide support to women before, during and after a birth in part to reduce maternal and infant mortality. And a newer city project is looking to forge relationships with hospitals to put doulas in delivery rooms.

“We’re talking about advocacy, having someone else in the room, and really being able to speak up for yourself, because the doctors might not always know what’s best,” Lemons said.

Edward Ehlinger, acting chair of the Health and Human Services Secretary’s Advisory Committee on Infant Mortality, said the presence of doulas during birth has been shown to reduce infant and maternal mortality rates.

“[Doulas are] not well-accepted right now because people don’t know enough about them,” Ehlinger said. “Once they [health providers] realize they’re [doulas] are not in competition with nurse midwives or OB-GYNs, they’re actually there to support families, I think they will come around.”

Ehlinger is currently working with Louisville officials to measure how the city is working on reducing mortality rates and explore whether programs here could be replicated in other cities. That includes working with hospitals to be more open to the presence of doulas.

Lisa Gillespie is WFPL's Health and Innovation Reporter.

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