W ELL NESS ‘SOMETHING DIFFERENT FOR ME’ During a June event at MAHEC, McMillan introduced Itiyopiya Ewart, whom McMillan assisted with the birth of her daughter through the SC4S program. “Having a doula for me was really important because with my son, I had a traumatic birth experience. And far too many women do. It’s very common for women to say, ‘I didn’t really feel comfortable. I felt pressured. I felt forced,’” Ewart said. Ewart described how McMillan offered “the knowledge that she had, the care that she had, the intention that she had in caring for me as a black woman — as another black woman that has had the negative experiences, that knows the data, that knows the reports and wanted to see something different for me.” As the relationship developed between the two women, McMillan offered active encouragement to attend childbirth classes, go for walks, maintain flexibility and practice other forms of self-care in preparation for labor and beyond. She also helped Ewart seek healing from past sexual abuse.
WIDENING GAP: As part of a presentation on efforts to improve community health, Hannah Legerton of the Buncombe County Department of Health and Human Services showed this chart to county commissioners on Dec. 3. While white infants’ deaths per 1,000 births have decreased in the county since 2010, black babies now die at a rate nearly four times that of white babies. Graphic courtesy of Buncombe County In health care situations, Ewart said, black women’s experiences and input are often dismissed. “Like, ‘You don’t know anything. You stay quiet and you
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stay in the corner and you let people take care of you how they feel they need to take care of you,’” she said. Overcoming those disempowering messages is central to the benefits a doula can offer any woman, Ewart said. But for women of color, it’s critical to have a care provider “that understands what racial injustice feels like. That they know, they can sense it in their bones, their DNA is vibrating it through the generations. There is something very powerful in the support that can be provided with that,” she said. “Itiy is very vocal, but I have so many clients I’m working with that are just as vocal,” McMillan added. “And I want to stop calling them my clients from now on, because I want to say they are my peers. These are my sisters. Sistas Caring 4 Sistas means something. We are all in this together. Females, it’s time for us to fix this issue that’s going on.” CAUSES OF DEATH Low birth weight, preterm delivery and sudden infant death syndrome are the “huge drivers” of infant mortality, according to Amanda Brickhouse Murphy, a certified nurse midwife who serves as the medical director for Mothering Asheville. SC4S doula services, McMillan notes, have been shown to address each of those conditions. “We reduce the cesarean [section] rates. We have less medical interventions during labor,” she says, adding that APGAR scores, which assess the baby’s condition, are also higher. And SC4S cli-
ents are more likely to breastfeed, which reduces the incidence of sudden infant death syndrome. “If a mom is healthy in her pregnancy and knows her power, moms are huge influencers on the health of her family,” Murphy says. Still, empowering mothers isn’t a cure-all. America’s long history of slavery, discrimination and ongoing institutional and systemic racism take a continuing toll on the health of black women and their children, Murphy says. “This toxic stress that comes from not only how she’s living and what she’s experiencing and what she has experienced in her past, but generational stress that’s coming from all those years of slavery, Jim Crow and continued racism, institutional and systemic — that’s almost more caustic because it’s hidden,” she explains. That’s why learning to listen to African American women has transformed her own practice, Murphy says. As part of building trust within the black community, Mothering Asheville providers asked women what they saw as the most important factors in health and well-being disparities. Their answers had nothing to do with specific medical or social conditions, Murphy recalls. Instead, she continues, “It’s this stress that they are feeling all the time, no matter if they are an immigrant worried about deportation or a black woman who’s worried about her son being shot. That’s what they said we got wrong. We didn’t ever ask them about that. We asked them about all our other checklists that we have to check off.” SHOWING UP Murphy recalls the program’s early efforts to connect with black women in Buncombe County. “We spent a year and a half just gaining trust before there was even any movement on what we were going to work on,” Murphy says. “We just kept showing up and sitting at picnic tables and having lunch and talking to whoever would talk to us.” Taking time to demonstrate Mothering Asheville’s longterm commitment was crucial, she adds, because many women in the black community have seen different health programs and initiatives come and go over the years. Another barrier was a history of negative experiences with local health care providers. “There are women who purposely don’t deliver at the hospital or don’t come to their care because they think that there will be judgment in one way or another,” Murphy explains. “For example, they might get a drug test, whereas someone else who’s a dif-