Shafia Monroe shows how to do an African headwrap during a doula workshop. The program seeks to train doulas, or pregnancy and birth coaches, to serve African American and low-income women. Credit: Angela Peterson

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Tyanna McLaurin bends down and with a little help hoists 3-month-old Muntasir Mahdi onto her back.

She wraps a bright cloth around him and, with a few twists and tucks, secures him in place — as she saw countless women do in her years in the Peace Corps in Ghana.

"Babies carried on their mothers' backs never cry; they hear the mother's heartbeat," Shafia Monroe tells the women gathered at the Body and Soul Healing Arts Center in Milwaukee's Sherman Park neighborhood.

"Look at that," Monroe says as McLaurin stands upright with the child. "That's a happy baby."

Monroe is leading a first-of-its-kind training in Wisconsin aimed at reducing infant and maternal mortality by encouraging women of color to become doulas, or birthing companions, and midwives.

The four-day program, offered by the Portland, Ore.-based International Center for Traditional Childbearing, draws on the centuries-old traditions of African and African-American midwives.

"When they eradicated the black midwife in the South, for various reasons, we lost that pillar in our community that kept us connected to our traditions and our spirituality," said Monroe, the center's founder and a certified midwife.

"We're just re-empowering women to know what they've always known," she said. "We're working to bring back the wisdom of that legacy."

Doulas, depending on their practice, offer a range of services to mothers through pregnancy and postpartum, from education and emotional support to attending doctor visits and accompanying them through the birth.

They are not midwives, who are licensed clinicians. But many who take Monroe's course go on to seek that additional training.

Research suggests that employing doulas positively affects birth outcomes for mothers and infants, according to Katy Kozhimannil, an assistant professor at the University of Minnesota School of Public Health who has studied their use.

"There is ... unequivocal evidence that having a doula or continuous support during labor is associated with better outcomes — with lower rates of C-sections, epidural use and episiotomies, higher rates of spontaneous labor, and higher Apgar scores — and there are really no drawbacks," she said.

However, low-income and minority women, who have the highest rates of infant and maternal mortality, often face barriers to access, including cost and the availability of providers who can relate to their cultural experience.

In Wisconsin, for example, there are only two certified African-American doulas, and one woman of color in the Wisconsin Guild of Midwives.

The guild is sponsoring the training, which costs $800 a person, with financial support from the March of Dimes and several other organizations and individuals. Most of the women have received a scholarship.

"There is an unbelievable disparity in birth outcomes between black and white communities, and this is not OK," said Guild President Marijke van Roojen, a licensed and certified midwife in Appleton.

In June, for example, the City of Milwaukee issued a report showing that black babies in the city had three times the mortality rate of white babies.

Systemic racism

At least two states, Oregon and Minnesota, have recognized the potential for cost savings and allow Medicaid reimbursement for the use of a doula.

Monroe's program, which is just a first step in the process of doula certification, emphasizes breast-feeding, nutritional education, and early and consistent neonatal care.

She walks students through the five main causes of infant mortality: genetic defects, prematurity, low birth weight, sudden infant death syndrome and accidents. But Monroe adds another: systemic racism, a view that is gaining traction among researchers.

Angst brought on by poverty, lack of education and opportunity, and proximity to violence "puts stress on all the organs, including the placenta" causing some babies to be born too early, she said.

Friday's session opened with a prayer for 5-year-old Laylah Petersen, the Milwaukee child killed by a gunshot Thursday as she sat on her grandfather's lap just a mile away. Her death is emblematic of the violence that negatively affects poor and minority mothers and infants, said Monroe.

"Babies don't do well when communities are stressed," she said.

The course is a mix of intensive study and hands-on experiences, much of it aimed at building connections and "sisterhood" among participants.

On Saturday, the women made herbal teas and natural remedies and balms for such ailments as back pain and insomnia with Healing Arts founder and Alice's Garden director Venice Williams.

Later in the day, they practiced wrapping babies on their backs, and a slow, tandem dance aimed at getting laboring mothers to relax and breathe and push.

"Keep breathing, it's the most important part, the most important part," they sang and laughed in pairs tethered to each other by scarves. "You push, and then you sigh. You push, and then you sigh."

'More peaceful, relaxed'

On Sunday, Monroe focused on the business aspect of the service — how to attract clients and set prices. Many doulas who want to serve low-income clients offer sliding scales or secure grants.

The weekend's participants, most of them women of color, have come from across the state and Illinois for the training. They represent a range of educational backgrounds and experiences. Some have children; some don't. Some work in health care, and some have birthed children with the help of a doula or midwife.

For Tamara Thompson-Moore of the Town of Windsor in Dane County, it was the most beautiful of her five experiences in childbirth.

"It was not a medical crisis," she said. "It was the most romantic birth I could have had."

"It was just a lot more peaceful, relaxed," said Sahar Mahdi of Milwaukee, who has a nursing degree from the University of Wisconsin-Madison and gave birth to two of her three sons with midwives. "The body could just do what it was intended to do."

Like all of the women here, she wants to make sure others — especially low-income and minority women — have that same option.

"I want to empower them so they can make decisions for themselves," said Mahdi, who is studying to become a midwife at the Authentic Birth Center in Wauwatosa.

"I love working with women. I love life. I just want others to have that same positive experience."