After losing twins, Long Beach resident Cassandra Carter approached the birth of her daughter, Nyomi, last November with anxiety. She wanted support for herself and her husband, Adewole, that extended beyond routine medical care.
“Getting pregnant as a Black woman, I wanted a team around me that made me feel safe,” she said. “I know all about the mishaps that Black women experience.”
Carter, a therapist and self-described hippie, hired Yvette Perry, a doula and co-founder of Divine Birthing Services LLC in Lancaster. Perry helped Cassandra craft a detailed birth plan.
“I was worried about postpartum depression. Mrs. Yvette knows a lot about how postpartum affects men as well,” Carter explained.
Perry was present the day Nyomi was born. She held the baby when Carter or her husband needed a moment and even set up candles in the birthing suite.
“Whatever I needed for my comfort, she was there,” Carter said of Perry. “She was there as an advocate and voice. I had a really serene birthing experience because I had someone extra who wasn’t tied to me as my family.”
Perry, a doula for nearly six years, said preexisting conditions, poor communication and dismissive hospital care heighten health risks for Black mothers.
“Sometimes, Black mommies are not being heard. They don’t know they have rights. They don’t know they can say, ‘no,’” Perry explained. “Doulas empower them. We are there to educate them.”
Perry’s concerns reflect a broader public health crisis. According to the Centers for Disease Control and Prevention’s 2024 maternal mortality report, non-Hispanic Black women in the U.S. died from pregnancy-related causes at a rate of 44.8 deaths per 100,000 live births.
In California, Black women experience the highest pregnancy-related mortality rate — about four times greater than other women, according to statistics. From 2021 to 2023, the leading causes of pregnancy-related deaths included cardiovascular disease, COVID-19, hemorrhage, sepsis, amniotic fluid embolism, and pulmonary embolism.
The Centering Black Mothers in California report found that structural racism — including barriers to high-quality health care, and chronic stress— disproportionately harms Black women.
In a statement to California Black Media (CBM), the California Department of Public Health (CDPH) said maternal mortality disparities stem from multiple factors. The department said addressing structural racism, listening to Black women’s experiences and reducing provider bias are key to closing the gap.
California began covering doula care as a Medi-Cal benefit in 2023, providing eligible patients with support during pregnancy, childbirth and the postpartum period, according to CDPH.
Whitney Dotson of Inglewood wanted an expert on pregnancy, labor, and delivery to guide her and her husband, Anthony, through the birth of their son, Anthony III. So, she hired Perry for doula support.
“It’s always more comfortable when you can have a second opinion,” she said. “Knowing she was better versed in what the options were, made me more comfortable.”
Dotson, 39, had a healthy pregnancy but faced recommendations common for expectant mothers over 35. Her doctor advised inducing labor at 39 weeks, but she hoped to carry to full term.
“I wasn’t comfortable with that,” she admitted.
Perry provided Dotson with information about induction guidelines and alternatives, helping her understand her options and communicate her preferences.
Then, Dotson returned to her doctor.
“I said, ‘I don’t want to — and this is why,’” she recalled. “He agreed and pushed the induction date back a week.”
Perry also advised Anthony on how he could support his wife during and after the pregnancy and during Anthony III’s birth. She also reminded Dotson to change birthing positions — from her back to her hands and knees.
Before Saveneh Martinez became a doula with Fierce Advocates in Contra Costa County, she was a new mom, uneducated on aspects of birth, which led to her first child, Colton, being placed in a Neonatal Intensive Care Unit.
“I didn’t know my choices,” she said.
Martinez called it “lifesaving” for expecting moms to have a doula.
“It should be a medical right,” she said.
California Perinatal Quality Care Collaborative (CPQCC) Senior Associate Medical Director Kimberly D. Gregory said research suggests that doulas decrease the pre-term birth rate and the likelihood of a C-section.
“Having a doula is a proactive thing to do,” she said.
Efforts are being made across the state to reduce maternal deaths.
CDPH’s Title V Action Plan aims to reduce pregnancy-related deaths among Black birthing mothers from 49.7 to 42.3 per 100,000 live births by 2030 through improvements in patient-centered care, expanding community-based perinatal teams, and addressing the social factors that contribute to poor maternal health outcomes.
CDPH’s Black Infant Health (BIH) Program and Perinatal Equity Initiative (PEI) have already begun to make headway.
“BIH’s prenatal group model improves key intermediate outcomes for participants, including increased social support and empowerment, better stress management, reduced depressive symptoms and gains in health knowledge and behaviors such as safe sleep practices and reduced smoking,” the CDPH told CBM.
“PEI’s early implementation results show progress across several participant-reported areas, such as improved birth experiences, breastfeeding initiation, and coparenting skills among fathers and partners,” the CDPH statement continued.
Gregory said the California Pregnancy Associated Review Committee examines maternal deaths and develops guidelines to help hospitals improve care. One of its main recommendations focuses on how hospitals respond to hemorrhaging, a leading cause of pregnancy-related deaths.
Gregory said CMQCC also created standard clinic care practices for cardiovascular disease and sepsis, two more drivers of maternal mortality, but widespread implementation across the state is pending.
She noted that although there are 800 maternal deaths a year in the U.S., there are also 3.6 million births.
“Most people will do well,” she said. “But you should know about complications like preterm birth. You should know about complications like diabetes, preeclampsia and postpartum depression.”
Martinez said doulas help to make birthing the transformative experience that it is, instead of a routine clinical transaction.
“Being able to feel heard, seen, safe, respected, and just being able to create spaces for them to be held as well,” she said.
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.
