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Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2

BLACK VOICE NEWS — While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.
The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 first appeared on BlackPressUSA.

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CA acknowledges doula services as part of the solution to reduce maternal mortality

By Breanna Reeves | Black Voice News

The topics of Black maternal mortality and pregnancy-related death have become more prevalent over the last decade as the U.S. has been identified as having one of the worst maternal mortality rates among high-income countries.

report published by the Commonwealth Fund found that the U.S. had the highest maternal mortality rate among wealthy nations: 23.8 deaths per 100,000 live births in 2020. That rate is double for Black maternal mortality: 55.3 deaths per 100,000 live births.

While California boasts one of the lowest pregnancy-related mortalities in the nation, the latest available data from the California Department of Public Health (CDPH) that covers the period of 2017-2019 shows that the pregnancy-related mortality rate is 47.3 per 100,000 births for Black people compared to 11.1 for White people, 12.6 for Hispanic people and 14.0 for Asian people.

Available data for maternal mortality rates across race/ethnicity for Riverside and San Bernardino Counties are not available for public access. According to a representative from the California Department of Public Health, the agency “does not publish pregnancy-related death counts or pregnancy-related mortality ratios (PRMR) by race/ethnicity at the county or regional level to maintain data confidentiality and ensure statistical stability,” but noted that across the state, Black birthing people “continue to have the highest PRMR.”

The disproportionate rate at which Black women and birthing people die from pregnancy-related deaths is not new to Black doulas.

Chantel Runnels has been a doula for 14 years, something she said she was “called to do.” Family history of fatal maternal health care, a desire to see public health care change and her own pregnancy experience served as catalysts for her becoming a doula. She was introduced to the Sankofa Birthworkers Collective, an Inland Empire-based organization, through a friend who is a midwife.

A midwife is an individual who is medically trained to assist with labor and delivery and provides prenatal, intrapartum and postpartum care, as well as family planning care. The Sankofa Birthworkers Collective consists of a well-rounded group of birthworkers including licensed midwives, postpartum doulas, lactation specialists, maternal mental health experts and midwives-in-training.

“To be around other Black women who may have secondary or tertiary lines of work that affect Black maternal health care or are directly in Black maternal health care was really attractive to me,” Runnels explained. “To be a part of a community of women who live across the [Inland Empire], who come from different demographics, but want to support each other and just wanted to come together was super attractive.”

Married for nearly 15 years and a mother of four, Runnels provides services to a diverse clientele, some who pay out of pocket for private services, others who receive free services through community-based programs like Sankofa or through insurance programs like the Doula Access Program.

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

Runnels explained that as the need for doulas grows, doula training is that much more important to help ensure that they are trained to meet the needs of the community and have the availability to serve clients.

“This is why compensation for doulas is important, too, because the wages that doulas are paid can’t really compensate for the availability that’s required for the job,” Runnels explained.

As the state began to recognize the invaluable services provided by doulas, legislation to implement doula services throughout the state was introduced prior to the start of the pandemic.

Elevating, expanding, standardizing and compensating doulas in CA

In February 2020, Majority Leader of the California State Assembly Eloise Gómez Reyes (D-Colton) introduced Assembly Bill 2258 which aimed to lower maternal and infant maternal mortality rates in California by launching a three-year Medi-Cal pilot program to provide doula services in 14 counties with the highest birth disparities. The bill fell through when the COVID-19 pandemic shifted priorities in March 2020.

The momentum to introduce legislation that addressed maternal mortality picked up again when Governor Gavin Newsom budgeted funding for a Medi-Cal benefit, which will allow doulas to be reimbursed for full spectrum care rendered to Medi-Cal enrollees. I​n order to add these services as a benefit, the Department of Health Care Services (DHCS) is required to submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) and receive federal approval — essentially an agreement between the state and federal government on how their Medicaid program will operate and assures the state will abide by federal rules.

Over the last year, DHCS has worked with stakeholders from across California including birthworkers, doulas and community organizations to develop a comprehensive SPA that specifies what doula coverage will look like under Medi-Cal, including the scope of services. Following the first draft of the SPA, a coalition of stakeholders made recommendations for an updated version of the SPA that requested the need for specific language to define doula care and services.

The letter recommended revising the definition of a doula to specify the types of services and support they offer. Part of the letter recommended that the SPA add: “The doula care provided will offer any and all aspects of full-spectrum doula care, including prenatal and postpartum or post-pregnancy doula care, continuous presence during labor and delivery, and doula support during miscarriage, stillbirth and abortion. Doula care includes physical, emotional and other nonmedical care.”

Alexis Robles-Fradet is a Health Policy Analyst at National Health Law Program (NHeLP) in Los Angeles, CA, and drafted the coalition letter in April. Alongside Amy Chen, a senior attorney at NHeLP and member of the stakeholder group, Robles-Fradet has published several reports about the components of successful doula programs and pilot doula programs in other counties as part of the Doula Medicaid Project, launched in 2018.

One of the biggest challenges with finalizing the SPA has been the reimbursement rate offered. The initial proposed rate was one of the lowest rates in the country. Upon receiving the first draft of the SPA from DHCS, the coalition noted in the letter: “We do not believe this benefit will be successful if the reimbursement rate is $450.”

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

With the high cost of living in California and the amount of time doulas spend with their clients, Robles-Fradet explained that $450 is not a living wage and would be a barrier to getting the necessary workforce to cover Medi-Cal patients. Medi-Cal covered more than half of all births in California in 2019.

“Doulas deserve to be paid a fair wage. I know we talk about [a] living wage, but I think we should shift into thriving wages, like they’re doing great work and they’ve been doing this great work for so long,” Robles-Fradet stated. “They know how to support their communities.”

Robles-Fradet explained that listening to the doulas and making sure that the benefit will be equitable for them are important factors that will contribute to the success of the Medi-Cal benefit.

As a member of the stakeholder group, Runnels said that the group has worked “tirelessly” to demonstrate that the situation is nuanced. One of the first tasks for DHCS and the stakeholder group was to define doula services and qualifications since it isn’t defined in state law.

“The doula stakeholders did emphasize to us that the length of service in terms of time that they were spending with individuals needed to be considered since doula services typically last significantly longer than other visits with a licensed practitioner,” said René Mollow, Deputy Director of Health Care Benefits & Eligibility.

Mollow explained that doula services as a benefit will be offered through both the Medicare fee-for-service delivery system and Managed Care delivery systems, so doulas will need to be enrolled as Medi-Cal providers and will have contracts with Managed Care plans.

“The majority of covered populations in our program here in California are served through Medi-Cal managed care plans,” Mollow added. “So, that’s where we would expect to see the bulk of the services being provided.”

Following several stakeholder meetings, feedback from birthworkers and Governor Gavin Newsom’s revised 2022-23 budget, California’s current proposed reimbursement rate has increased to $1,154 with one initial visit paid at $126.31, eight perinatal visits paid at $60.48 per visit and one labor and delivery visit paid at $544.28.

“California is such a large state. We have so many births a year. The cost of living for doulas and families in San Francisco varies greatly to doulas and families that are serving Barstow,” Runnels clarified. “And so, helping them understand that the original rate…was embarrassing. Even other states do better than that. And the rate that they’ve come to now is still embarrassing.”

There are more than 400,000 births each year in California which is roughly one-eighth of all U.S. births, nearly half of which are paid for by Medi-Cal, according to the California Health Care Foundation. Comparatively, in 2020, there were 39,817 births in Oregon. In June 2022, Oregon updated its SPA to increase the doula reimbursement rate to $1,500.

“I am so grateful for the work that the State Plan Amendment workgroup is doing to really work on this,” Runnels stated. “[But] also, it still does not reflect how critical the role of a doula is in addressing maternal health care in the state of California, particularly for those most vulnerable, which are Black women.”

Stakeholder meetings are ongoing as the group continues to discuss the SPA and work on developing a Provider Manual. DHCS plans to publish a public notice and formally submit the SPA in September.

This article is the second in a series produced as a project for the USC Annenberg Center for Health Journalism’s 2022 California Fellowship.

The post Doulas: A Formal Part of CA Health Care System – Birthing While Black Part 2 appeared first on Black Voice News.

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Excerpt:

Photo Captions:

Chantel Runnels explains her role as a doula during a panel at the Inland Empire Perinatal Equity Provider and Community Summit at Cal Baptist University in Riverside, CA on September 16, 2022 (Aryana Noroozi for Black Voice News/CatchLight Local).

After receiving and reviewing a draft of the State Amendment Plan, a coalition of stakeholders and advocates drafted a letter in response, outlining changes to the plan such as defining a doula’s role and recommending an increase to the offered reimbursement rate of $450. (Graphic by Breanna Reeves).

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Black Artists in America, Installation Three Wraps at the Dixon Gallery and Gardens

TRI-STATE DEFENDER — With 50+ paintings, sculptures and assemblages, the exhibit features artists like Varnette Honeywood from Los Angeles, whose pieces appeared in Bill Coby’s private collection (before they were auctioned off) and on “The Cosby Show.” Also included are works by Alonzo Davis, another Los Angeles artist who opened one of the first galleries there where Black Artists could exhibit. 

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By Candace A. Gray | Tri-State Defender

The tulips gleefully greet those who enter the gates at the Dixon Gallery & Gardens on an almost spring day. More than 650,000 bulbs of various hues are currently on display. And they are truly breathtaking.

Inside the gallery, and equally as breathtaking, is the “Black Artists in America, From the Bicentennial to September 11” exhibit, which runs through Sunday, March 29. This is the third installment of a three-part series that started years ago and illustrates part of the Black experience through visual arts in the 20th century.

“This story picks up where part two left off,’’ said Kevin Sharp, the Linda W. and S. Herbert Rhea director for the Dixon. “This era is when we really start to see the emergence of these important Black artists’ agency and freedom shine through. They start to say and express what they want to, and it was a really beautiful time.”

With 50+ paintings, sculptures and assemblages, the exhibit features artists like Varnette Honeywood from Los Angeles, whose pieces appeared in Bill Coby’s private collection (before they were auctioned off) and on “The Cosby Show.” Also included are works by Alonzo Davis, another Los Angeles artist who opened one of the first galleries there where Black Artists could exhibit.

“Though [Davis] was from LA, he actually lived in Memphis for a decade,” said Sharp. “He was a dean at Memphis College of Art, and later opened the first gallery in New York owned and operated by black curators.”

Another featured artist is former NFL player, Ernie Barnes. His work is distinctive. Where have you seen one of his most popular paintings, Sugar Shack? On the end scene and credits of the hit show “Good Times.” His piece Saturday Night, Durham, North Carolina, 1974 is in this collection.

Memphis native James Little’s “The War Baby: The Triptych” is among more than 50 works featured in “Black Artists in America, From the Bicentennial to September 11” at the Dixon Gallery & Gardens, the final installment of a three-part series highlighting the impact and evolution of Black artists through 2011.

Memphis native James Little’s “The War Baby: The Triptych” is among more than 50 works featured in “Black Artists in America, From the Bicentennial to September 11” at the Dixon Gallery & Gardens, the final installment of a three-part series highlighting the impact and evolution of Black artists through 2011.

The exhibit features other artists with Memphis ties, including abstract painter James Little, who was raised in a segregated Memphis and attended Memphis Academy of Art (before it was Memphis College of Art). He later moved to New York, became a teacher and an internationally acclaimed fixture in the art world in 2022 when he was named a Whitney Biennial selected artist at the Whitney Museum of American Art in New York.

Other artists like Romare Bearden, who had a Southern experience but lived up North, were featured in all three installments.

“During this period of time, he was a major figure,” said Sharp. “He wrote one of the first books on the history of African American art during a time when there were more Black academics, art teachers, more Black everything!”

Speaking of Black educators, Sharp said the head curator behind this tri-part series and Dixon’s partner in the arts is Earnestine Jenkins, Ph.D., an art history professor at the University of Memphis, who also earned a Master of Arts degree from Memphis State University (now UofM).  “We began working with Dr. Jenkins in 2018,” he said.

Sharp explained that it takes a team of curators, registrars, counterparts at other museums, and more, about three years to assemble an exhibit like this. It came together quite seamlessly, he added. Each room conjured up more jaw-dropping “wows” than the one before it. Each piece worked with the others to tell the story of Black people and their collective experience during this time period.

One of the last artists about whom Sharp shared information was Bettye Saar, who will turn 100 years old this year. She’s been working in Los Angeles for 80 years and is finally getting her due. Her medium is collages or assemblages, and an incredible work of hers is on display. She’s married to an artist and has two daughters, also artists.

The exhibit catalogue bears some of these artists’ stories, among other scholarly information.

The exhibit, presented by the Joe Orgill Family Fund for Exhibitions, is culturally and colorfully rich. It is a must see and admission to the Dixon is free.

Visit https://www.dixon.org/ to learn more.

Fun Facts: An original James Little design lives in the flooring of the basketball court at Tom Lee Park, and he makes and mixes his own paint colors.

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Grief, Advocacy, and Education: A Counselor Reflects on Black Maternal Health

SAN DIEGO VOICE & VIEWPOINT — Last month healthcare leaders, birth workers, and community members gathered to honor the legacy of Charleston native Dr. Janell Green Smith, a nurse-midwife and doctor of nursing practice who died in January from childbirth complications. She had participated in more than 300 births and specialized in helping Black women give birth safely.  

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By Jennifer Porter Gore | Word-In-Black | San Diego Voice and Viewpoint

In 2024, the number of U.S. mothers who died as a result of pregnancy or childbirth dropped compared to 2023. But while slightly fewer Black mothers died that year, they still had three times the mortality rate of white women.

South Carolina’s rates of maternal deaths outpaced even the national rates. In fact, the state’s overall rate of maternal deaths between 2019 and 2023 was higher than all but eight states and the District of Columbia.

Last month healthcare leaders, birth workers, and community members gathered to honor the legacy of Charleston native Dr. Janell Green Smith, a nurse-midwife and doctor of nursing practice who died in January from childbirth complications. She had participated in more than 300 births and specialized in helping Black women give birth safely.

Her death shocked the community and her colleagues who are determined to address concerns about Black maternal health. The event also covered the importance of protecting mental health during grief and of men’s role in solving the maternal health crisis.

As both a therapist and a father, Lawrence Lovell, a licensed professional counselor and founder of Breakthrough Solutions, discussed ways the event’s attendees could process their grief over Green Smith’s death. He also shared ways male partners can advocate for women’s maternal health during pregnancy and childbirth.

Lovell spoke not just as a therapist but also as a father whose own family had briefly crossed paths with Green Smith. The event, he said, emerged organically from a moment of collective mourning.

Despite the grief, “it was still, like, a really beautiful event, a much-needed event, and it almost felt like we were all giving each other a collective family hug,” says Lovell.

His connection to Green Smith, Lovell says, was brief but meaningful during his wife’s pregnancy with their second child. Green Smith was practicing at the same birthing center where they had their child. She began practicing in Greenville a short time later.Even that short connection carried significance for Lovell, given the small number of Black maternal health professionals.

Lovell did not initially plan to become a mental health practitioner; he chose the career path after graduating from college, when someone suggested he consider psychology. His interest deepened when he noticed how few Black men work in mental health.

“Being Black man and playing football in college, there weren’t a lot of people that look like me talking about mental health,” says Lovell. “[I wanted] to give people that look like me an opportunity to work with someone that looks like them.”

Working with Expectant and New Parents

Lovell often counsels couples preparing for parenthood by, helping partners understand what a successful pregnancy, childbirth, and postpartum recovery look like. That often means helping women manage postpartum depression.

As a man, Lovell says, it’s “humbling” that a woman “just trusts me enough to work with me through their pregnancy or their postpartum recovery.”

In his work, Lovell has noticed how few men understand pregnancy before they experience it with their partner. Because early pregnancy symptoms are often invisible, he says, men may underestimate how much support a mom-to-be actually needs.

“Sometimes they may not realize they don’t know much about pregnancy and what to expect in those three trimesters,” Lovell says. “I tell a lot of the men that just because you can’t see [she’s pregnant] doesn’t mean that she won’t appreciate your intense support in that first trimester.”

Education about pregnancy and postpartum recovery, he says, can change how men support their partners.

Teaching Advocacy in the Delivery Room

Another major focus of Lovell’s counseling is preparing men to advocate for mothers during labor.

“Helping men understand what pregnancy looks like: what delivery is going to look like, and what are the realistic expectations that I should have of myself in postpartum,” he says.

Lovell encourages partners to be honest about their expectations for what will happen during delivery. He helps them prepare for the big day by discussing the birth plan and knowing how to quickly recognize problems. Clear communication, he says, prevents misunderstandings.

He regularly trains men to ask their partners detailed questions about their expectations during and after pregnancy. Advocacy in medical settings can be especially important and requires attention to details the mother may not be able to address.

“It’s always important to fine-tune things and truly understand what helps your partner feel most supported,” Lovell says. “Instead of guessing, you should ask.”

Lovell recalls a moment during the birth of his first child when he had to take that role.

During the delivery, “I felt like something wasn’t as sanitary as I’d like it to be,” he says. “I asked, ‘Hey, can you switch those out? Can you change your gloves?’”

Lovell has a succinct but powerful message he regularly shares with clients’ families, and he shared it with attendees at last month’s event.

“Just to believe women,” he says. “I’ve worked with different couples, and sometimes I’m not really sure that there’s enough empathy from the men.”

That includes how women express pain.

“If a woman says, ‘my pain is at a nine,’ just because how you would express yourself at a nine is different than how she’s expressing herself at [that level] doesn’t mean you shouldn’t believe her,” he says.

Empathy, he says, can change outcomes far beyond the delivery room.

“We’ve got to believe women when they’re talking about their experiences and their feelings and their pain,” he says. “I think there’s a lot that we can prevent if we empathize better.”

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Future of Florida’s Black History Museum in Limbo

JACKSONVILLE FREE PRESS — A proposal sponsored by Tom Leek, a Republican from Ormond Beach, has now passed the Senate in back-to-back legislative sessions. But the House version, filed by Kiyan Michael, a Jacksonville Republican, did not receive final approval in either year, effectively stalling the effort.

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Jacksonville Free Press

Plans to establish a long-awaited Black history museum in Florida are once again on hold after legislation needed to advance the project failed to clear the state House for a second consecutive year, despite repeated approval in the Senate.

A proposal sponsored by Tom Leek, a Republican from Ormond Beach, has now passed the Senate in back-to-back legislative sessions. But the House version, filed by Kiyan Michael, a Jacksonville Republican, did not receive final approval in either year, effectively stalling the effort.

Under Florida law, identical or similar bills must pass both chambers before heading to the governor’s desk. Without House approval, the legislation has been unable to move forward, leaving the project in limbo. Long journey, contested location.

The proposed museum, formally known as the Florida Museum of Black History, has been years in the making, with lawmakers and community leaders framing it as a long-overdue institution to preserve and showcase the state’s African American heritage .A central point of contention has been the museum’s location. St. Augustine — widely recognized as the nation’s oldest city and a site deeply tied to both slavery and early Black history — emerged as the leading contender. Supporters argue the city’s historical significance makes it a natural home for the museum. However, competing interests and regional considerations have fueled debate, slowing consensus among lawmakers.

While the Senate-backed measure has consistently advanced, the lack of alignment in the House has underscored ongoing divisions about how and where the project should take shape.

The holdup in the Florida House appears to be less about opposition to the museum itself and more about a combination of procedural bottlenecks, unresolved structural issues, and lingering disagreements over how the project should be formalized and governed.

Despite the legislative setbacks, Republican Gov. Ron DeSantis has publicly voiced support for the museum. Speaking last month during the unveiling of a statue of abolitionist Frederick Douglass in St. Augustine, DeSantis said the project would move forward “one way or another,” signaling an intent to see the museum built regardless of legislative hurdles.

The anticipated museum has already cleared several hurdles. St. Johns County signed an agreement last year with Florida Memorial University to use the land that once housed its campus last year’s legislative session netted $1 million in funding for St. Johns County to work on planning and design for the museum. However, its anticipated that a million $3 million is needed.

Still, without statutory approval to finalize key components — including governance, funding mechanisms and site selection — the project remains largely conceptual.
With the House bill failing again, the timeline for the museum’s development is unclear. Lawmakers could revisit the proposal in the next legislative session, but any further delays risk pushing the project back several more years. Advocates warn that continued inaction could stall momentum for a museum many see as critical to telling a fuller, more accurate story of Florida’s past. For now, the effort remains paused — caught between political support at the top and legislative gridlock within the Capitol.

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