(Image by Salman Metobo from Pixabay )

A promising local program that provided doula services for African American women in Los Angeles County is no longer taking clients after a number of contentious staff departures. Some of the women were fired, and at least one other left in solidarity.

Doulas — professional, non-medical advocates who support women from the prenatal stage through the postpartum experience — are increasingly considered part of the solution toward healthier child births. Earlier this year, the insurance company Health Net contracted with a local nonprofit called the Association for Wholistic Maternal and Newborn Health to cover the costs of doula services for 150 African American women in L.A. County who use Medi-Cal.

The doula pilot program was an effort to address the high mortality rate among black women and babies — black women in L.A. County are three times more likely than other women to die of pregnancy related complications; black babies in L.A. County are three times more likely to die before their first birthday than white babies.

However, after less than a year of operation, the program has derailed.



Health Net has cut funding to the nonprofit after doulas accused the program leaders of racial insensitivity and a hostile work environment. "This came as a shock to us that they intended to terminate the program," said Chibunna Nwaobia, chairman of the association's board.

But documents provided to LAist show tensions within the nonprofit.

In emails and formal complaints submitted to the association's board, staff members — who are mostly African American — raised concerns about pay, inappropriate comments about their race, hair and bodies, and a fear of retaliation from the association's director, who is white.

Three employees who had leveled complaints were fired, and another resigned.

"In an organization that was funded by someone who wanted black women to support black women in the community, to feel like they can't express anything in the safety of the program means the program is not functional," said Sayida Peprah, a former doula supervisor who was among those dismissed from her job.

The association's leaders denied the allegations. Its director, Cordelia Hanna, said any allegations of racial or cultural insensitivity were "false or exaggerated," and were influenced in part by "professional jealousy and anger."

"The persons who were fired because of unprofessional conduct, and insubordination, and because they were trying to hijack the program and take it away from the association to receive the funding for themselves in their own organization," she charged in an email response.

It's unclear what will happen to the 150 women the program intended to serve or the women currently in the program following the tensions and infighting at the organization. Doula services can cost several hundred to several thousand dollars, and are often not covered by health insurance.

In a written statement, Health Net said it will seek a new provider for the women.

"We will continue our project with the doulas who work with us, but are transitioning to a new community organization that's more philosophically aligned with our approach to the program," Health Net Medical Director Dr. Pooja C. Mittal wrote.

THE DIFFERENCE A DOULA MAKES

Of the 18 births the program's doulas have assisted with so far, less than 10 percent required c-sections, according to Health Net. The national average for black women and c-sections is 35 percent.

Michelle Sanders joined the pilot program to offer her services as a doula and help women make informed choices about their pregnancies.

"We provide support in the form of information and education, physical support and emotional support to birthing people," Sanders said.

Some doulas do work for free if clients can't afford to pay them.

"Sometimes the only payment I get is this mom is holding her baby and they are both here alive and they're gonna go home together," Sanders said.

She was among the doulas who were fired in October. "I was terminated for speaking out about things that were inappropriate and culturally incompetent and that was not OK for leadership," Sanders said.

Michelle Sanders demonstrates how to make "padsicles," a type of birth aftercare. (Courtesy of Anietra Richard)

Her dismissal was a loss for clients like Anietra Richard. Sanders was by her side at Long Beach Memorial Medical Center through a grueling 40-hour labor.

"Without her support, I believe my baby probably would have died," Richard said. "I feel like because we don't have a lot of knowledge, you get taken advantage of. You get forced into situations you should never have to be in."

Research shows moms who work with doulas are less likely to have a cesarean section or preterm birth and could use fewer pain medications.

While Richard did eventually have a medically necessary c-section, she says Sanders' support was indispensable. Her daughter Leona is now two months old, healthy and breastfeeding.

"She's quite a character," Richard says. Her nicknames include "snooty toot," "crabby patty" and "Mommy's little turkey." "She loves sleeping during the day, staying up all night."

Richard says she wouldn't have been able to afford a doula without the Health Net Community Doula pilot program.

THE ASSOCIATION RESPONDS

In an interview conducted before Health Net announced that it was cutting ties to the Association for Wholistic Maternal and Newborn Health, director Cordelia Hanna said her motives in promoting doula services "are that I care that mothers and babies are dying and they don't need to be."

A birth worker for almost three decades, Hanna said she started to focus on the African American community after she was hired to work for Pasadena's Black Infant Health program in 2002. She went on to found the Association in 2010.

"That's always somewhat challenging being part of this conversation and yet not being African American myself," Hanna said. "However, I've spent a lot of years talking and listening."

But, according to the documents provided to LAist, she clashed with some of the doulas. The association fired Sanders and two doula supervisors in October, and another doula resigned.

As the tensions continued, the doula supervisors sent a formal complaint to the Association's Board of Directors and the funders of the pilot program.

"We were met directly with retaliation," said Khefri Riley, a former doula supervisor.

She said the association began requiring employees to sign non-disclosure agreements in September.

"That meant a silencing. It was very disempowering," Riley said.

In an email sent in response to a request for comment on the allegations, Hanna wrote, "Our board wanted the employees to deal with the issues within the organization instead of gossiping and complaining two (sic) persons outside the organization and to the funder."

She added that Health Net "never gave me an opportunity to respond to the accusations made against me prior to their decision" to cut ties to the association.

Sayida Peprah is a clinical psychologist and birth doula. (Photo by Heidi Garcia and courtesy of Sayida Peprah)

The termination letters to Riley, Sanders and doula supervisor Peprah said they were let go because the program was being restructured and no longer had funding for their positions.

"Nobody is indispensable," board chair Chibunna Nwaobia said. "As long as somebody is [demonstrating] professional misconduct, that's grounds for dismissal."

The doulas say their termination was a retaliation for their complaints, including their claim that the pilot program was being mismanaged.

The Health Net program promised each of the 10 doulas hired by the association $3,700 per month, broken down by $100 for each prenatal and postpartum visit with a mother, and $1,250 for attending births.

But the complaints say the Association for Wholistic Maternal and Newborn Health took several months to attract clients to the program, which meant the doulas weren't taking home the money they were promised. They say it caused them financial hardship at times.

Part of the reason Sanders was attracted to the doula pilot program was "the fact that the pay for doulas was like the best rate I had ever seen." Instead, "I lived off my savings," Sanders said.

Board Chair Nwaobia attributed some delays in payment to Health Net.

The Association for Wholistic Maternal and Newborn Health started providing the doulas a regular salary this fall.

"I hope that we've set a standard for what is a living wage for doulas," Hanna said.

THE PROGRAM'S FUTURE

Khefri Riley holds two babies, Milly Simon and Neela Perera, from a mom's support group. Riley is a prenatal yoga teacher, birth doula and lactation educator. (Photo courtesy Khefri Riley)

All the doulas LAist talked to were proud of the work they'd done in the pilot program.

"That's the magic, the black girl magic," said Peprah. "Through all the struggle and adversity we can get stuff done."

Peprah and Riley also caution that doulas alone cannot solve every maternal health challenge facing black women.

For example, a survey of 100 black women in Los Angeles County found all the women felt they experienced racism that made their lives more stressful. They also expressed a distrust in the healthcare system.

"The doula is not the solution," Riley said. "The solution is self-empowerment and awareness of your rights at birth."

Both Health Net and the Association for Wholistic Maternal and Newborn Health say they plan to continue providing doula services for African American mothers.

"All women currently in the program will remain in the program," Health Net's Dr. Mittal said in a statement. "We are working on a transition plan to a new community partner that will minimize any effects on the doulas' work and the care the pregnant women they serve are currently receiving."

The Association also said it will seek new funding to continue providing doula services.

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