In the 21st century, with all of the medical advances and progress made throughout the decades, it’s hard to believe babies are still dying at alarming rates. But it’s happening across the globe and close to home alike.
A few years ago, Nicole Miles traveled with a group of women to the Dominican Republic to volunteer in a public hospital. She was on the island to provide doula support — comforting and coaching scores of women through the birthing experience, in a region where pain medication often was unavailable unless brought to the hospital by the patients themselves.
Miles was in awe of the strength displayed by the women, many of whom had traveled hours by bus, just to give birth at the facility.
“Some of the women had to come alone and go back [alone] with their baby,” Miles told Technical.ly. “I knew this work was necessary. There was a shift in us being there. I knew then this is what I am supposed to do.”
Miles is a certified birth and postpartum doula, certified lactation counselor and newborn care specialist. Outside of her private doula services, Miles currently serves as the doula program manager with Birth Outcomes Made Better (BOMB), under the Maternal and Child Health Division at the City of Milwaukee Health Department.
While volunteering as a doula in the Dominican Republic may seem like a far cry from Miles’ work with birthing persons back home in Milwaukee, the city shares similarly concerning poor birth outcomes as the underdeveloped country — including high infant mortality rates, especially in communities of color.
A focus on birth outcomes
Nationally, there are an average of 5.6 infant deaths per 1,000 live births, according to the latest CDC data. But in Milwaukee’s 53206 ZIP code — largely considered the city’s most underserved neighborhood — these rates climb even higher.
In 2018, 53206 experienced an average of 23.4 infant deaths per 1,000 live births, a number par-on-par with the Dominican Republic. The island nation had an average of 23.5 infant deaths per 1,000 live births. Miles said while some deaths are inevitable — due to birth defects, sudden infant death syndrome, or maternal pregnancy complications — these are still staggering statistics. But they’re hardly a surprise.
“People point out the ZIP code  but this has been an issue for years,” Miles explained. “It’s not necessarily neglect. Sometimes transportation is an issue, someone may not have childcare. People who may be low income may not have access to jobs.”
The rate of poor birth outcomes and infant mortality and the number of people experiencing poverty run in direct parallel, Miles added: “There are structural barriers to care.”
Providing access to doulas of color is one strategy used to break down those barriers. In 2019, after the city declared racism a public health issue, Milwaukee County implemented legislation to fund the Birth Outcomes Made Better doula program.
The initiative was launched to improve maternal and infant mortality rates, as well as to provide a more diverse range of mothers’ options to receive pregnancy and postpartum support, increase breastfeeding education and promote pathways to positive parenting experiences, socioeconomic stability, and healthy lifestyle behaviors, such as safe sleep practices and mental health.
BOMB is hoping to serve at least 50 women across 53206 with new grant funding received from the Milwaukee County Department of Health and Human Service, though its team of six doulas continues to serve eligible women and families across the region.
Doulas guide birthing people through the prenatal process and beyond, though Miles said many people remain confused or unaware of a doula’s role in the greater community. Definitively, a doula is a trained professional who provides nonclinical emotional, physical, and informational support for birthing people before, during, and after labor and birth. But to Miles, it’s so much more.
She said the profession harkens back to a time when pregnant women gave birth surrounded by their mothers, grandmothers, and sisters. In earlier times, women were expected to “lie-in” after giving birth and bond with the baby. Today, many women are expected to snap back and often return to work, sometimes mere weeks after having their babies.
Now that most women have their babies at hospitals, the lines of communication surrounding pregnancy and childbirth have changed, Miles said. Her mission? To advocate on behalf of birthing people, help them reestablish autonomy around their bodies and birthing experience, and set them up for postpartum success.
“We help them ask questions and take onus for their care and body,” Miles explained. “People are still siloed. They may not always be aware of the resources available to them. We are trying to bring back that communal care.”
Maternal health at risk
Miles is passionate about women taking control of their prenatal and postpartum health, especially in communities of color. She said a long history of systemic abuses in healthcare systems has led many Black and brown women into silence around their birthing journeys. For example, many women who receive public assistance may feel like they don’t have a right to speak up, and wind up settling for sub-par care — or enduring a negative experience in the least. They’re issues celebrities Serena Williams and Allyson Felix have brought attention to in recent years.
Such experiences have resulted in women receiving early inductions, unwanted C-sections, episiotomies, formula feeding their babies when they wanted to breastfeed, or maternal patients ignoring their inner intuition when something is wrong, putting mothers’ overall health at risk.
Miles wants to change all of that.
“There’s a lack of information and a lack of transparency,” she said. “You go to a hospital and your doctor is an authority figure. Some people don’t know they can ask questions.”
Miles has worked as a doula for more than 10 years. In her current role with BOMB, she hopes to connect and collaborate with other community organizations and improve the availability of personalized, integrative care for women across Milwaukee.
“I think that doulas are a piece of the puzzle, but we are not going to be the answer to everything,” she added. “It’s a systemic issue, within the structure of healthcare. Having a doula is putting another eye on the experience. Women should get the highest level of care, and wraparound services. We should want better for ourselves and our families.”
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