Family’s experience highlights high mortality rate of Black babies, as Oregon pushes for culturally responsive care

When LaTasha Williams learned she was pregnant in fall 2021, one of the first things she felt was fear.

She hadn’t planned to have another child. Her husband, Willie, was on a waitlist to have a vasectomy in a few months. They were raising four children already and were mid-move from a suburb of Portland to Vancouver, Washington. But in that moment, LaTasha was thinking of the child she never had the chance to raise: Her daughter Essence, whom she had delivered 11 months prior, just 20 weeks into her pregnancy, and who lived only seven minutes in her parents’ arms.

“​​Emotionally, I wouldn’t be able to go through that experience again,” she said. “There was no excitement, it was just counting the weeks making sure that everything was going to be OK.”

As 2022 began, LaTasha battled familiar health challenges that she had faced during her last pregnancy: high blood pressure, gestational diabetes, and a shortened cervix. But this time, she delivered a healthy baby boy, Mekai, born a month early, but who spent only a few hours in the neonatal intensive care unit.

The difference, LaTasha said, was the care she received. In her son’s case, she was treated and monitored carefully by a Black OB-GYN, kept on bed rest, and assisted by a certified doula who advocated for her before, during, and after the birth. With Essence, she had experienced a far less rigorous care regimen: All prenatal appointments but her initial ultrasound were delayed in the chaos of the pandemic’s first few months.

Although Essence was anything but a statistic to her family, her premature birth and death form a thread in a lopsided tapestry of pre- and postnatal care in the United States — in which Black mothers are three times as likely as white women to die in childbirth, and Black fetuses and infants die at rates far outpacing those of nearly every other race. Oregon mirrors these trends: Black infants are more likely to be born underweight, and both they and their mothers have a lower chance of surviving that first year of life than white and Hispanic ones.

Greater access to doulas is one piece of the myriad improvements that researchers and advocates say could lead to better outcomes for these children and their families. Doulas are certified health workers who, through advocacy and education, can support more productive prenatal appointments, help with breastfeeding and monitor mothers for postpartum risk factors, to name a few examples.

For years, doulas have been trying to expand their footprint in Oregon, which is considered a pioneer for being the first state in the nation to make them eligible for Medicaid coverage. But low pay rates and bureaucratic hurdles to certification and reimbursement have stalled efforts to boost the workforce and reach the most at-risk populations who would stand to benefit the most. This year, however, doulas have a champion in state Sen. Lisa Reynolds, D-Washington County, who is leading the charge on a multi-bill “Momnibus” package that seeks to support perinatal health in a variety of ways, including expanding access to doulas.

Reynolds’ package includes legislation to protect young families from housing loss and eviction, increase access to perinatal and infant behavioral health care, and expand the Oregon child tax credit. The half-dozen bills are moving through Senate committees.

“That first year of brain growth offers tremendous potential when we set the stage right, and obviously tremendous risk when things don’t go well,” Reynolds said. “I’m going to use the metaphor of, let’s put a fence at the top of the cliff, instead of sending all those ambulances to the bottom of the cliff, which is what we are doing as a state.”

Her legislation was shaped in part by the work of the Congressional Black Maternal Health Caucus, which is working at the federal level to improve birth outcomes and reduce maternal mortality. Other states have also introduced “Momnibus” packages that have similar goals.

The congressional caucus states it has helped boost maternal and infant health funding by $200 million since 2023; about $10.5 million has come to Oregon since 2022, according to the caucus’s budget tracker.

After her experience working with a doula, LaTasha said she wishes all women could experience that care during their pregnancy. Desha Holden-Nelson, the Portland-based doula who worked with her, provided advocacy and emotional support throughout. Even today, the two women maintain close ties.

“Immediately there was a family bond,” LaTasha said. “She was truly an advocate for me.”

A crisis entrenched

Inside their Vancouver home, the Williams family keep a plastic tote filled with mementos of Essence. Her hospital bracelet. Molds of her tiny face, hands and feet. A miniature urn, smaller than a golf ball, inscribed with the words: “God has you in His arms. I have you in my heart.”

Each year, they celebrate her birthday. Willie and LaTasha talk to Mekai about his sister; when he sees her birth certificate, he points, saying “Sissy.”

For LaTasha, sharing their experience is an important part of the healing process. She’s found that when she talks about Essence, friends, family and strangers have shared their stories, too: of loss, grief and resilience.

They are all too common among Black and Indigenous families. The Black maternal mortality rate in 2023 was around three times as high as that of white women. Black infant mortality has been the highest of all racial categories over the last five years, according to the U.S. Centers for Disease Control and Prevention.

A variety of factors drives the disparities, and research indicates race touches many aspects of the care Black mothers receive before, during and after birth. Black women experience higher rates of uncontrolled blood pressure and diabetes, cardiac disease and other comorbidities that heighten the risk of poor outcomes during pregnancy and birth. Social determinants of health that are shaped by systemic racism, including food insecurity and health care access, play a role in those conditions. Even so, Black women are less likely to receive follow-up care after giving birth.

Higher socioeconomic status is no guarantee of a better birth outcome for Black and Native women: Those who are highly educated and wealthier still face worse outcomes than white women with less education and wealth.

LaTasha holds an MBA, but still faced common high-risk health factors during her pregnancy with Essence, though her cervical incompetence, a more rare condition, wasn’t known until after the birth. At the time of her one ultrasound in September 2020, she was already hypertensive and prediabetic, and was 37 years old. She was referred to a specialist in high-risk pregnancy.

LaTasha said she had to reach out to her doctors multiple times after her first ultrasound to get the appointment with the specialist and to ask about what she should do to manage and track her blood sugar and pressure. She received little input besides being advised to wait until 20 weeks, when she would have her second ultrasound and be seen in person for the first time since September.

Three days before her 20-week appointment, LaTasha was at the dentist’s office with one of her older children. She sneezed, and her weakened cervix gave way. Her water broke.

About 48 hours later, in Salmon Creek Hospital in Vancouver, Essence arrived. Fetuses have almost no chance of surviving outside the womb until developing at least 23 weeks; her organs were not developed enough to keep her alive. Her parents held her. They signed the birth and death certificates, made their keepsakes, and said goodbye.

In the immediate aftermath, LaTasha said, “There was a time where I could not do anything. For weeks, I didn’t get off the couch. There’s not a moment that goes by when I don’t think about her.”

Afterwards, the couple decided they didn’t want to try to get pregnant again.

“The biggest thing that’s heavy on my heart is grief,” she said. “Losing a child is very difficult. I always wonder, ‘What if?’”

High barriers, high rewards

Eighteen months later, LaTasha was in the final weeks of a pregnancy that was no easier than the previous one. She faced the same risk factors, plus more: a bout of Bell’s palsy that landed her in the hospital for several weeks while doctors ruled out a stroke and tried to identify the source.

This time, LaTasha had decided to seek out a Black OB-GYN. From her first appointment, she said, she was able to share her history, and her doctor set up a care plan accordingly, with biweekly ultrasounds, plenty of rest and a strict diet to manage her blood sugar.

The doctor also recommended that LaTasha explore doula services through Sacred Roots, a service housed within the nonprofit Black Parent Initiative, which focuses on supporting Black families with children under 10. While Medicaid covers some doula services, private insurance often doesn’t, and those mothers have no choice but to pay out of pocket anywhere from a few hundred to $1,000. Since many can’t afford that, some doulas work for free out of their desire to serve their communities.

Holden-Nelson is one of them. Her job as a specialist with the Multnomah County’s Healthy Births Initiative, meanwhile, provides the financial sustainability that the doula work doesn’t. When LaTasha was her client, Holden-Nelson attended her prenatal appointments, helped her with breastfeeding and advocated for her during the birth. LaTasha’s doctors decided to induce labor to stop her blood pressure from rising dangerously and to bring down the extreme swelling in her body.

“She said, ‘If you need me, you let me know,’” LaTasha said. “There was never a time that I felt ignored. When I had appointments, she always made it a point to be there to check in, after the appointment.”

Research has shown that having access to a doula is associated with better birth outcomes, including fewer cesarean sections, fewer premature births and shorter labor. Doulas also provide emotional support to mothers, which can have physical benefits by reducing stress.

Oregon tried to make them more accessible when it made doulas eligible for Medicaid coverage in 2014. But access has remained limited; in 2020, a Washington Post analysis of data from the Oregon Health Authority showed that doulas had been reimbursed less than $33,700 for 251 births in six years. In 2021, only about 7% of women who responded to an Oregon Health Authority annual survey reported having a doula with them in the hospital delivery room.

Today, doulas still face many challenges to make a sustainable living.

One aspect of that unsustainability is the unpredictability of birth, which can both make it more difficult for doulas to meet their own families’ needs and be available to enough mothers to sustain themselves.

“Babies don’t have a timeline,” said Alyson Day, a certified doula. “You don’t know when you’re going to be called in, or if it will be a six-hour or a 48-hour process.”

Pay is tricky, too. Medicaid payments are often slow and cumbersome. Some doulas have formed collectives to share resources and hire someone to handle billing, but many do it themselves.

Day is one of them. In February, she said she was still working on getting paid for a birth she attended in September.

“It would be nice for doulas to have the value of this work appreciated through a living wage that’s able to retain and also encourage more people to join,’’ Day said. “Because the data is there that it’s beneficial.”

A legislative push

Reynolds is making a bold push in her first term as a state Senator. A state Representative since 2021, she was appointed to the seat to replace Elizabeth Steiner, who was elected state Treasurer in November.

Reynolds said she wants to make a difference for kids.

“This is what drove me to run for office, and I will say what drives my work in the Legislature every day,” she said.

As a pediatrician, Reynolds said she has seen doulas’ impact most frequently in postpartum work, “even if it’s just allowing (parents) to get some sleep.” She also says she’s seen doulas serve a critical role in monitoring new mothers for health conditions like postpartum depression, advocating for them to receive appropriate treatment.

Her legislative package has racked up endorsements from some of the state’s largest family advocacy groups. Public hearings for the bills were packed with people testifying in support.

The doula bill, SB 692, would task the Oregon Health Authority with running a new grant program to support “culturally specific perinatal services and culturally competent perinatal services providers.” The grants could be used to cover individual workers’ training and education and to support community-based organizations that offer perinatal services, handle billing, and public education about doula services.

It would also make Medicaid recipients eligible for up to a dozen doula visits and lactation counseling. In addition to requiring insurance plans to cover doula services, it would also boost doula pay through Medicaid to the base rate paid in Washington — the highest in the country, according to its Health Care Authority — as a strategy to help disincentivize doulas from leaving Oregon. The Health Authority would also be required to report on barriers that doulas face to get paid through Medicaid.

The fiscal burden of these various proposals hasn’t yet been analyzed, but money looks to be the most likely political obstacle. Proponents, including Reynolds, say that such early interventions are preventive and can save the state money on more expensive solutions down the line, such as emergency care, substance use disorder treatment and criminal justice costs.

Holden-Nelson, who helped craft some portions of the legislation, said she was optimistic that it will receive support.

“It’s just amazing. It’s just the right time,” she said. “I’m not worried about it getting out of committee now, but I’m like, ‘Ways and Means, we need to step it up and put the money behind it.’”

LaTasha said she’s ready to lend her support to the legislative push if needed. Telling her tale of two pregnancies is about more than Mekai, whose laughter fills the house each day.

“This is the way I’m able to honor my daughter and her legacy,” she said. “By telling our story and how having culturally responsive care is important.”

InvestigateWest (invw.org) is an independent news nonprofit dedicated to investigative journalism in the Pacific Northwest. Reach reporter Kaylee Tornay at kaylee@invw.org.

This republished story is part of OPB’s broader effort to ensure that everyone in our region has access to quality journalism that informs, entertains and enriches their lives. To learn more, visit opb.org/partnerships.