Birth workers supporting Black and Latinx women find their work even more critical in the pandemic.

By Kelly West

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From inside a small closet in an even smaller bathroom, Denise Washington is teaching women to advocate for their health care. Sitting at a fold-out table in the makeshift office she uses as a quiet space away from her husband and four children, Washington advises one of her pregnant clients about what to expect in the hospital during her delivery. 

“It’s okay to ask questions,” she says over a Zoom call. “It’s okay to say no if you don’t want something done to your body.”

Washington is a doula, a person who provides guidance, education, and support through pregnancy and childbirth, and she is studying to be a Certified Professional Midwife, which would allow her to deliver babies without supervision from another medical provider. She works with women of color throughout pregnancy, labor, and postpartum, and she knows what it’s like to be marginalized by the health care system. As a teen mother with no support and no resources, she did as much research as she could on the birth process before she went into labor. But once she got to the hospital, what happened next was out of her control.  

“I went into labor at 35 weeks, and everything I didn’t want happened. I had an epidural, they broke my water without my permission, they used a vacuum to get [the baby] out,” Washington says. “It was a very traumatic experience. I went through postpartum depression for a couple of months… It was just the most horrible thing I had been through in my life.”

Denise Washington set up a make shift office in the closet in her bathroom, where she conducts her meetings and appointments with her birth work clients. Washington lives with her partner and four of her five children, so she needed a quiet place to make calls. [Photo by Kelly West]
Denise Washington set up a make shift office in the closet in her bathroom, where she conducts her meetings and appointments with her birth work clients. Washington lives with her partner and four of her five children, so she needed a quiet place to make calls. [Photo by Kelly West]

At the time, she was living in a shelter for pregnant teenagers, and her experience with her own birth led her to want to help other young women in her situation. She asked the director of the shelter if there was some way to help, and the director told her she could go to the hospital and help support the girls when they gave birth. 

“I thought it was weird, but I was like… okay?” 

The first night she showed up at the hospital, she was given only a room number and a name. 

“I walked in and she was about fifteen, and she was in the room all by herself. The lights were bright and she was curled up in a ball on the bed. She just looked so scared. I sat there for a little while by her side. But by the end of it, she wouldn’t let me go. I held her hand through over half of her labor and through her delivery.”

That was more than 20 years ago, and Washington’s commitment to birth work hasn’t slowed since. She became a birth coach and developed her own childbirth classes. When she moved to Texas and saw how few maternity care options were available for Black and Brown women in her community, she decided to start a nonprofit, Delivering Unto You

Denise Washington does a home visit with a family she supports as a doula who recently had a newborn. Washington is studying to be a midwife while juggling her birth work, part-time job, and caring for her family. “This work has always felt personal to me because I’m serving women who look like me, and I understand what they are going through because I went through it myself.” [Photo by Kelly West]
Denise Washington talks to Brandon Maxwell about caring for his newborn daughter. Washington is studying to be a midwife while juggling her birth work, part-time job, and caring for her family. “This work has always felt personal to me because I’m serving women who look like me, and I understand what they are going through because I went through it myself.” [Photo by Kelly West]

She keeps a part-time job with the IRS so she can pay her bills and offer services for free or reduced cost when needed. She also works with another organization, Mama Sana Vibrant Woman, a nonprofit dedicated to helping BIPOC (Black Indigenous and People of Color) access culturally appropriate care in pregnancy and childbirth. 

While the COVID-19 pandemic has brought new attention to racial disparities in health care, women like Washington and Tiek Johnson, operations director at Mama Sana, have been experiencing those disparities their entire lives. 

“That’s the thing about having the same lived experience,” Johnson says. “You feel it personally.”

In the United States, Black women are three times more likely to die from causes related to pregnancy than White women. The institutional racism that pervades the U.S. has significant impacts on the health care system, from the implicit bias of medical providers to a lack of access to health insurance, which disproportionately impacts Black and Latinx communities. Washington has seen this firsthand.

“There’s a lot of underlying racism that goes on,” she says. “It’s been taught that Black women are stronger and don’t feel as much pain. When they express that they are in pain, they’re not listened to. So, having someone there that can be the voice and be an advocate, especially in a hospital setting, is so crucial.”

To support BIPOC navigating this system, Mama Sana provides free prenatal groups, childbirth workshops, and wellness clinics, as well as birth-companion support all led by birth workers of color. Their services are offered in Spanish or English, and are intended to foster a supportive community that empowers the participants to advocate for their health care. 

In January, Mama Sana was hosting events like this perinatal support group in person. Now all the organization’s classes and groups have moved online. “Our resource list is constantly updating,” says Tiek Johnson, operations director for Mama Sana Vibrant Woman, “and we have more group clients than ever before.”  [Photo by Kelly West]

The need for these services has only grown in the wake of the pandemic, as more families become isolated, and health care becomes more difficult to access. As a result, Mama Sana’s birth workers have adjusted their practice to providing more online services, but they are also feeling the effects of the economic fallout, as other parti-time jobs they relied on for income have disappeared.

For the first few weeks in March, when schools and businesses closed under stay-at-home orders, Washington lost almost all of her income. She was temporarily laid off from the birth center where she was working as an assistant, she could no longer see clients in person, and the IRS offices had shut down. 

“For about two months, I was basically living off of favors and promises,” Washington says. “It was really scary. I didn’t know what was going to happen or what we were going to do pretty much on a day to day basis.”

Johnson says the staff at Mama Sana saw what a struggle it was for contractors like Washington, so they decided to use $6,000 of the money they had raised during their Amplify Austin campaign to provide emergency assistance. 

Tiek Johnson is raising her three-year-old son, Nyle, and works as operations director at Mama Sana Vibrant Woman. “That’s the thing about having the same lived experience,” Johnson says of her work at the nonprofit. “You feel it personally.” [Photo by Kelly West]

“That money they gave us really got me through,” says Washington.

At the same time, Mama Sana’s full-time staff were experiencing their own financial struggles many, like Johnson, are single moms using one income to support multiple family members. Some work side jobs that disappeared during the pandemic. Recognizing the need, the organization’s board of directors stepped in to provide a cash stimulus from their own personal donations.

“[The staff] were working to support the community at large, doing multiple added layers of work,” says Mónica Jiménez, an assistant professor at University of Texas-Austin and Mama Sana board member. “We wanted to make sure we supported them in whatever way we could.”

Johnson sees this collective effort as a natural extension of the community Mama Sana and its birth workers have built, both within the organization and without. “[The board was] holding us because they were able to, and then all of us together pivoting and holding our participants. It was really beautiful to see.”

Mónica Jiménez, with her partner Roger Reeves and their daughter Naima Jiménez-Reeves, is an assistant professor at University of Texas-Austin and Mama Sana Vibrant Woman board member. “One of the things about Mama Sana,” she says, “it’s so undeniable that the work is necessary and important.”. [Photo by Kelly West]

As things settle into a new normal, Mama Sana continues to support clients and the community, just as they always have. One tiny silver lining to a global pandemic may be that people are paying more attention to the issues of institutional racism in health care and birth justice.

“COVID has created an opening where people are much more interested in looking at the issue than they were before,” says Jiménez. “It’s in the atmosphere a bit more, and people are interested in this topic. That has everything to do with activists and groups like Mama Sana.” 

For birth workers like Washington, her services feel more necessary now than ever. As hospitals add new restrictions in response to the pandemic, women can no longer have an extra support person in the room during their delivery. Once a visitor enters the hospital, they can’t leave and come back, so some partners remain at home if there are other children to care for. 

“I’ve gotten a few calls from women considering an unassisted birth because going to the hospital is not an option for them,” says Washington, “And they can’t afford a midwife.”

Jiménez says there’s some concern that Mama Sana will lose donations because of COVID, so she and the board are working to shore up their individual donor base. And they have received some grants related to COVID. 

“One of the things about Mama Sana,” she says, “it’s so undeniable that the work is necessary and important.”

Denise Washington watches Romeo Johnson, 2, while his mother participates in a workout class for pregnant moms at Femme Power in Austin, Texas. Washington organized the class for some of her clients. [Photo by Kelly West]
Romeo Johnson, 2, tagged along while his mother, Chantier Johnson, right, and Kierra Son participated in a workout class for pregnant moms at Femme Power in Austin, Texas. Both women are clients of Denise Washington, who organized the class. [Photo by Kelly West]

In May, the Family Independence Initiative partnered with local community organizations to distribute $2 million from the City of Austin Equity Office. Mama Sana was one of the organizations that helped get cash for living expenses into the hands of more than 1,000 families in just three days. The organizations chosen by the city were mostly those working with marginalized communities, and Johnson says it was a thrilling experience to provide such direct and immediate help to people in their network. 

“We felt like Oprah,” she says, laughing. “It was the most intense 50 hours of my life besides labor.”

Organizations like Mama Sana are able to reach people in a crisis like this because they are so embedded in their communities. And even though the crisis is being felt in their own families, for birth workers like Washington, the work is too urgent to slow down.

“This work has always felt personal to me because I’m serving women who look like me, and I understand what they are going through because I went through it myself.”

Top photo: Denise Washington visits Ebony Maxwell who recently gave birth in the hospital and was feeling a little overwhelmed taking care of her newborn daughter. “You are doing fine,” she told her, and offered suggestions for how to get more sleep and ask for more help from her partner. [Photo by Kelly West]