This is an opinion column.
Neither woman, truth be told, knew a doula from, well, anything. Even though both had actually long done what doulas do—provide non-medical guidance to expectant parents through the rigors and risks of childbirth and often postpartum and advocating for them with sometimes-skeptical doctors and hospitals.
Nadia Gramby was in Human Resources at Faulkner University—frustratingly so, frankly—when she recalled the vivid childhood memory of helping deliver babies while growing up in Daphne. “I had suppressed it,” she says now.
This was after her pastor, in a conversation about her future career path, offered “a prophetic word.” “He said God would reveal to me some gifts I did not know I possessed,” Gramby recalls. She initially thought the gift would be her own HR firm. “That wasn’t happening,” she says.
Mariah Alyce was on hiatus from the University of Alabama after informing dad she wanted to change majors—from kinesiology to “something to do with women and African American studies.” Dad wasn’t feeling it. His not-so-subtle suggestion? “Maybe you need to sit out a bit.”
She did so, which freed her to join her pregnant aunt who was stationed in Washington, D.C. (the aunt’s husband, also in the military, remained stationed in Georgia) to help her through the delivery and postpartum.
“God works in mysterious ways,” Alyce says. “If I was still in school, I would not have been accessible to her. Thankfully I was in a place where I could be that village she needed.”
Now, Gramby, who lives in Shelby County, and Alyce, from Tuscaloosa, are among the swelling number of doulas in Alabama. ICan of Huntsville boasts nearly 1,400 members of its private doula Facebook group.
The number of African American doulas— descendants, as it were, of the “midwives” who, as far back as four centuries ago, guided enslaved women through painful, natural births—is growing, too.
The need for them now is as paramount as ever.
Particularly in Alabama, where we go to costly, holier-than-thou lengths to “save” babies—stripping from women here the right to make choices about their own bodies, their own lives. Yet we do little, so little, to birth healthy babies or keep them alive for at least a year.
The March of Dimes gave us an F last year for our preterm death rate of 12 percent, third highest in the U.S. behind Mississippi and Louisiana.
Then there’s our infant mortality rate: 7.4 deaths per 1,000 in 2017. Lower, thankfully, than it was the previous year (9.1) when it was, yep, worst in the nation. But the drop is nothing to celebrate because the rate is still dramatically higher than the national average (5.8).
And this: black babies in Alabama (who represent 30 percent of the children born in the state) die at twice the rate (11.3 per 1,000) of white babies. That should surprise absolutely no one.
Complicated, multi-layered answers to the disparity usually begin with poverty, defined as a household income of $26,000 or less for a family of four. Less access to healthy foods and limited-to-no proximity to high-quality healthcare are paramount, too. In Alabama, one in four children lives in such conditions.
Add the clear and calculated stress of simply being black and the impact of stress on the already-stressful act of childbirth, it’s easy to see why black doulas are in demand.
“[Black mothers] want someone who identifies with them, who trusts and understands their culture and what they’ve dealt with in life,” says Gramby, who launched her practice, Crown of Glory, last year.
A 2016 study of medical students and residents at the University of Virginia revealed some racial discrepancies in pain management on the part of medical professionals can be attributed to bias. Many white medical students and residents, research showed, believed myths such as black people’s skin being thicker than white people’s skin and thus less subject to pain.
“A lot of [black] women experience discrimination in the healthcare field, especially when they’re pregnant,” says Gramby. “Their pain is minimized. Some are told they’re being ‘dramatic’ when they’ve definitely had a medical complication. Clearly, there is a disconnect between medical providers and black women; our concerns are not taken as seriously [as white women].”
Not long after returning from Washington, D.C., Alyce took a job at a Tuscaloosa hospital. She also helped friends with their pregnancies. “I tried to be the village they needed,” she says. “The village our grandparents used to talk about.”
Last November, seven months after completing a doula training course and four months after her first client’s due date, she left the hospital to be a doula full time. “It became a conflict for me,” Alyce says. “I asked myself, ‘Am I willing to sell my sisters out and watch them have complications to protect a job? Or fight for women?’ It was time for me to step away. Not saying anything bad about the hospital, but certain things can be done differently.”
Gramby’s recollection of delivering babies when she was young was the “aha moment” leading her down a path of discovery and recovery, a journey grounded in her own deep Christian faith. “God allowed me to go down some dark things in my life that I didn’t understand before,” she says.
An only child, Gramby was raised by her mother, who, just prior to the start of her daughter’s senior year in high school, said she was moving to Atlanta. “Out of the sky,” Gramby says. As would almost any senior-to-be, Gramby stayed behind, living under the love and care of both sets of grandparents. After graduation, she enrolled at Alabama A&M to study psychology.
“My aunt took me to college and set up my dorm room, all those things parents should do,” Gramby recalls. “Because I was so loved I didn’t feel the void I should have. It should have been a huge red flag that your mom leaves you at such a pivotal time.”
The void soon became manifest and Gramby’s relationship with her mother grew “toxic”. Her mother stole money from her, Gramby says, during her freshman year and began showing signs “something was wrong.”
Gramby met her future husband at A&M; they later had a son and were married. Neither of her parents was present for her son’s birth or the wedding. “I wasn’t able to have my dad give me away,” she says. “Things about growing up I dreamed about didn’t quite happen for me.”
In time, the something Gramby detected in her mother’s behavior was diagnosed as mental illness. To this day, though, only her grandmother knows the specific diagnosis.
“[My mother] still hasn’t told me,” Gramby says. “She swore my grandmother to secrecy because of the shame in black culture. The shame we put on each other over, say, a chemical imbalance or financial situation. It creates too much toxicity and makes you feel like you’re not good enough. Like you never measure up.
“I try to break those barriers down for a lot of women and families who may not have a perfect situation but want to make their situation better for their child, starting with birth.”
Gramby believes many of her clients are drawn to her because of her life experiences.
“They need someone who’s been through things and come out on the other side, who can relate to them,” she says. “They don’t need anyone who had a perfect life and whose faith was not tested. God really gave me a crown of glory out of my storms. He allowed my faith to be tested so I could be a walking testimony to women—even though it would not have been my choice.”
Gramby and Alyce discovered doulas while searching the Internet for their next career move. Alyce found a People magazine story about Grammy-winning entertainer Erykah Badu, who revealed being a doula since 2001. “I was like, ‘People do this? This is a job?’,” she says now with a laugh.
Alyce now serves clients throughout the state, including Huntsville and Birmingham
“It’s crazy,” she says. “I always wanted to be in healthcare and the things being a doula encompass I was already doing. I was doing it before I knew there was a space for it.”
Some spaces in the traditional medical community embrace doulas as an integral part of the birth team, some not so much. Alyce says she’s not experienced any negative encounters with doctors. “I try to go in and let them know I’m not coming to take over their job,” she says. “I want to make it easier for you and not traumatizing for my client. Because I show respect, I receive mutual respect.”
[Last summer, not long after a Huntsville OBGYN announced she would no longer work with doulas, my AL.com colleague, Kyle Whitmire, shared the wonderful doula experience he and his wife had for the birth of their two children.]
Gramby prefers home births, using a midwife (“They actually catch the baby,” she says) and an assistant, as do most of her clients. Easier to control the environment, she says; if a client’s own doctor is not on call when it’s time to give birth, “You get who’s there,” she says.
“If that doctor’s not on board with the type of birth you want you run the risk of them forcing interventions, like medications and C sections. Some hospitals are very aggressive towards doulas, they’re demeaning and go against anything we try to do. Some clients want to be mobile at birth. They don’t want to lie on a bed. Some doctors use scare tactics to say it’s not safe.”
Gramby describes Princeton Baptist Medical Center as “awesome and doula friendly.”
“They get it,” she says.
Both women provide prenatal and labor services, as well as postpartum. Alyce is also a certified lactation counselor. Gramby also offers placenta encapsulation, which, she says, helps mothers recover with the loss of blood that comes with childbirth and avoid “baby blues” and postpartum depression, which can occur up to a year after birth.
Fathers are sometimes skeptical, mainly because of the cost (both women offer various packages of services ranging up to close to $2,000). “Dads typically ask, ‘Do we really need that?’, Alyce says. “They want to know where their money is going. I do my best not just teach them but actively involve them.”
It is particularly vital that postpartum doula care includes the father, Gramby says. “The entire family unit,” she says. “So, it remains whole. No one talks about the baby’s impact on the marriage. We forget about the dad. Or even mom. Everybody wants to see the baby. No one is checking on mom and they certainly aren’t checking on dad. The goal is to ensure they are empowered to carry on with this new life. He’s now carrying a family when his job may not provide paternity leave.”
“I have more dads contact me postpartum than moms,” says Alyce. “They’re like, ‘Help! Why is she still crying?’ A lot who were skeptical at first now call me ‘sis’. They are as important to me as the mom and the baby.”
Studies show doulas to have a positive effect on healthy births and infant mortality, especially for African American women. Yet only two states, Oregon and Minnesota, require Medicaid coverage for doula services. New York, New Jersey, and Vermont are trying to birth legislation to improve access to doula care.
Alabama? Not sure our legislators know doula from, well, anything.
Perhaps they’ll surprise me. Perhaps lawmakers on both sides of the aisle will see elevating Medicaid doula coverage is a sound, easy demonstration that we actually do care for the women of our state. All women, particularly poor women. Women for whom low infant mortality is too often an unwelcome guest at the family reunion.
“The enemy definitely tries to come in when you are trying to bring life forth,” Gramby says. “The work we are here to do on earth he wants to stop. When you are someone helping to usher in life, things come against you to try to stop that.
“I’ve had clients hemorrhage and come close to death. I don’t want to ever be in a room He has not called me to be. Part of this work is knowing who you are and making sure you’re healed before you step foot in someone else’s like to help them bring life. It’s not just pretty pics on Instagram.”
“If you don’t know who you are and who you are in this role, it’s hard,” adds Alyce. “I’ve been in situations where if I didn’t have a God to call on, I don’t know what I would have done. When you’re bringing life in this world, anything can happen. There have been times when I’ve held my breath and prayed.”
Both women offer sliding, income-based scales for services. Clients who may not be able to afford a doula are also encouraged to add the service to their gift registry. “Tell your friends and family you’d rather them pay for doula than buy pretty clothes, shoes or hair bows.”
Gramby says that while Medicaid in Alabama currently pays for doula services, reimbursement amounts are spotty. “I don’t know what I’ll get paid, I may get a hundred dollars,” she says.
And yet she’s hopeful, largely due to the faith that guided her to this path.
“I believe we can turn it around,” she says. “If I didn’t, I wouldn’t be doing the work. Part of what God has assigned me is to make sure His crown of glory is displayed through the whole state. We’ve been last in so many things, it’s time for us to become first in something.”
In healthy, thriving infants and their parents.
A voice for what’s right and wrong in Birmingham, Alabama (and beyond), Roy’s column appears in The Birmingham News and AL.com, as well as in the Huntsville Times, the Mobile Register. Reach him at [email protected] and follow him at twitter.com/roysj
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