Note: This article is the first in a new series here at The DONA Doula Chronicles to feature some of the wonderful content in DONA International’s quarterly magazine, International Doula. “A doula acts as an important conduit: An interview with Sherry Payne, RN, MSN, CD(DONA), IBCLC” by Carrie Murphy, CD(DONA) appeared in the June 2015 edition of International Doula. The magazine focuses on information, resources, interviews and insights specifically for doulas. It is available free to DONA International members. — AG

A doula acts as an important conduit
An interview with Sherry Payne, RN, MSN, CD(DONA), IBCLC
by Carrie Murphy, CD(DONA)

We all have our birth worker heroes. From the inimitable Penny Simkin to the legendary Ina May Gaskin, there are generations of women (and men) who spurred this work, forging the path for a more supportive, family-centered birth culture. My own birth hero is Sherry Payne, a registered nurse with a master’s degree, DONA certified birth doula, lactation consultant and soon-to-be certified nurse midwife, who is revolutionizing birth for her community of African-American women in Kansas City, Missouri. Sherry’s amazing work is a source of inspiration and motivation for my own doula practice, as well as my outlook on what it truly means to make birth better.

I was lucky enough to talk to Sherry about her own journey to birth work, her incredible commitment to changing the face of perinatal inequalities and why it’s important for all doulas to understand the myriad racial disparities that affect pregnant people and their babies.

You are a nurse and lactation consultant, in addition to being a doula and studying to become a midwife. Can you tell me a little about what led you to birth work and specifically, what inspired you to become a doula?

I was inspired to become a doula because of my first homebirth experience. I had my first homebirth with my fourth baby in 1989. It was such a remarkable experience that I went on to have five other homebirths. I was so amazed to learn what my body could do on its own. I had three hospital deliveries that just could not compare to my homebirths. I immediately wanted to get into birth work.

I became a doula and started attending other people’s births, especially homebirths. I started nursing school, became a labor and delivery nurse and am now working toward becoming a midwife. I really appreciate my doula roots and call upon that experience now as a doula trainer. I wrote and teach my own birth and postpartum doula courses and am currently submitting them for approval by DONA International.

Tell me about your nonprofit organization, Uzazi Village. What caused you to start it, how is it working now and where do you see it going?

Uzazi Village was founded in 2012 by me and a small group of women committed to improving birth outcomes in the urban core. I am the Executive Director of Uzazi Village and oversee its direction and vision. We have a three-pronged approach to decreasing health disparities in communities of color: culturally congruent community-based education and services to pregnant women in the community, anti-racism training and cultural respect training for clinicians and service providers, and support, guidance and nurturance for candidates of color entering the perinatal fields.

Our Sister Doula Program training at Uzazi Village is specific to our community. The doula candidates come from our community and serve our community — that is our model. That way, the care and advocacy they receive is culturally appropriate. This is a critical, but often missing, component of healthcare. Our mothers are often deemed unknowledgeable and can be taken advantage of and are often manipulated. Just having a doula in the room who looks like the mother, but also knows the system, really changes outcomes. We contract with local insurance agencies and Medicaid Managed Care Organizations (MCOs) to provide doulas to low-income mothers. Our community has never had the benefits that doula utilization has been shown to produce, because they were inaccessible.

I don’t believe uncompensated doulas are the answer because those programs are not sustainable. I believe strongly that doulas should be compensated for their valuable work. Using a model of third-party payer reimbursement makes doulas accessible to populations they never have been accessible to before. We want to see doula reimbursement become universal. We collect data so that we can demonstrate the value that our Sister Doulas add to our more socially and medically at-risk clients.

What are some of the barriers that aspiring doulas of color experience? How about practicing doulas of color?

Barriers for doulas of color might include cost of training (our doulas have the option of working off their training with us, so that cost is not a hindrance to those who want to do this work), accessibility of training (which often does not occur in the urban core, where we are located), training that does not include a culturally congruent component (ours is culturally specific and addresses health disparities) and a client base that is unknowledgeable about what a doula is, because there has not been previous access or exposure. Practicing doulas may also encounter social tensions in being hired by dominant culture clients.

Why is it important that women of color have access to doulas of color? I frequently hear doulas say that they will support any woman, regardless of race or cultural background, but that attitude seems to be missing the point.

That attitude is missing the point. Though the willingness may be there, the opportunity to support women of color is often deficient. The training to support them in a culturally congruent manner is nearly always deficient, if not completely absent. It is important to understand a client’s cultural context when providing such personal care. Without that knowledge, the care is inconsistent and incomplete and may even be detrimental.

Statistics are clear that women of color, specifically African American women, have significantly worse outcomes during the perinatal period, including a higher likelihood of cesarean1 and a higher infant mortality rate for black newborns2. What role do you see doulas playing in helping to address some of the racial disparities in the perinatal period?

Our Sister Doulas have so much impact, just being in the room. Our doula clients are educated throughout their pregnancies about their birth options and their birth care. They understand what a full-term pregnancy is, why they should question inductions and why they should breastfeed their babies long term.

For our clients, the doula acts as an important conduit to breach gaps in knowledge, but also as a navigator to the health care system itself, which can seem overwhelming to individuals who are already marginalized and disempowered. Our Sister Doulas stand in that gap, advocating, educating, informing, assisting, comforting, strengthening and bringing their human presence to bear. That changes what happens in the birth room for the better.

Tell me about your Black Infant Mortality Awareness Walk. Do you plan to continue to raise awareness for this particular issue, and if so, how?

This past September, I set out to walk across my state and stop in towns and universities along the way to talk about black infant mortality. I set aside the first two weeks of September to walk about 175 miles across a midsection of Missouri along the Katy Trail, a hiking and biking trail. I made it 61 miles, about midway across the state, and had to stop walking after our support vehicle (a rented RV) was involved in a hit and run. No one was hurt, but the vehicle was totaled. However, I count it as a great success.

Uzazi Village raised several thousand dollars from supporters, I spoke in several venues around the state (even after the accident, I stopped walking, but kept all my speaking engagements), got countless radio interviews and newspaper articles, met some wonderful folks around my state who care deeply about this issue, met and spoke with legislators in my state capital and proposed to do it again next year. Folks were shocked to discover that black infant death rates in their local county might be two, three, even four times the national average for white infants. This issue is very near and dear to my heart because the rates of loss are much higher in my community.

I find that providers are often not aware of the disparities, nor are the communities that are impacted by them. I speak to mothers and fathers who have experienced infant loss who see their situation as isolated events, when it is actually a part of a national trend.
In 2015 the Black Infant Mortality Awareness Walk will go national. We have joined forces with the National Perinatal Taskforce to increase awareness and have local mini-walks, where funds are raised for local communities and draw attention to what I call a silent epidemic.

What advice would you give to others who are interested in increasing access to doula services for women of color? How about to those who are interested in racial justice and equity in the birth community?

All doulas should educate themselves on issues impacting communities of color. Doulas certainly can be a part of the solution to perinatal health inequities, but it does not occur automatically. Doulas need more education on what disparities are, how they are created and what it takes to dismantle them. Racial injustice and inequity will not fix themselves. It is tied to a deep sickness in our society that permeates the very fabric of our social structure. Doulas and doula work are not immune.

It would benefit the doula world to see anti-racism training embraced by our authoritative bodies, creating and leading structural change first from within. The birth community has no immunity to the systemic racism that impacts us all. Consider this: The women who would derive the most benefit from the services of a doula are still the least likely to access one. Until we work together to change that dynamic, we still have a long way to go to achieving health equity in communities of color. This is everyone’s problem, because as Martin Luther King Jr. so eloquently put it, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This is certainly the case when that injustice threatens infant survival.

About the Author:
Carrie Murphy, CD(DONA) is a doula, poet, freelance writer and birth activist living and working in Albuquerque, New Mexico. She also works as the Baby-Friendly Event Coordinator for the New Mexico Breastfeeding Task Force. Originally from Baltimore, Maryland, she earned her in creative writing masters in fine arts in creative writing from New Mexico State University in 2011.

1Getahun, Strickland, Lawrence, Fassett, Koebnick, Jacobsen, 2009

2CDC, 2014