Alvarez Spark Innovation Award Recipient Hali Ledet participated in the Changemaker Institute and works with local organizations like Birthmark Doula Collective, Sista Midwife Productions, and the New Orleans Maternal Child Health Coalition to explore ideas for how doulas can address the racial disparities of birth outcomes among New Orleans families. She is pursuing her Master’s in Public Health in Maternal Child Health. 

My middle school and high school years marked the beginning of the Black Lives Matter movement that, though was began and led primarily by black women, seemed to often center around experiences of black boys and men. I’ve come to believe that this has to do with the misconception in our society that we don’t need to worry about black women and girls because their enduring resilience has shown us they can fend for themselves. This rhetoric is harmful and strips black girls and women of their humanity through its assumption—that they do not require the same care, nurturing, guidance, and support that all human beings do. I’ve seen the consequences of this in the treatment of black pregnant and birthing people. As a black woman from the Deep South, I have never been forced to reflect as deeply on the intersections of my race, gender, class, and geographical background as I have attending a predominantly white institution in a majority Black southern city during these socially tumultuous times. I’ve had to think deeply about who I am and how I can most effectively use my position in life to lift up those who lifted me. Because the fact of the matter is, it is rarely women like me, with whom I share a common background, who are sitting next to me in the lecture hall. It is often women like me who are serving food in the dining hall or mopping the floors of the residence halls, who make up a disproportionate number of our city’s lowest-paid workers, and who are living below the poverty line. As I mentioned in my first post, it is also they who possess higher rates of severe health morbidities than their white counterparts; whose children are born too early at higher rates only to die too soon at higher rates as well; and whose lives are more likely to end as a result of bearing or giving birth to those children.

Black women and their families are resilient, but they need nurturing to thrive. I wanted (and still want) to build something that nurtured and healed Black families across generations. I applied to the Alvarez Spark award because I figured a way to do this was to start a business that addresses perinatal disparities by providing doula services explicitly centering Black families and works to deconstruct the stereotypes that harm them. When I thought business, my mind immediately jumped to marketing and promotion. I wanted to put cards and fliers and pamphlets in people’s hands to elicit a response. I wanted to know whether or not people liked my messaging, whether it made them want to hire me. I wanted to know if the people I wanted to serve the most believed in my vision and mission. But then I realized I didn’t yet have a vision or mission fully mapped out. I also realized I had a business idea, but no business experience. So I applied to the Changemaker Institute (CI) along with my cofounder and partner, William Smith.

CI changed things for me. For one, it introduced me to the world of entrepreneurship and made me consider things I would never have considered myself. Suddenly I was forced to think about the realities of budgeting and business models and branding and pitching. But I was also provided with a safe space to assess the strengths and weaknesses of my idea, with mentorship and guidance, and with the support of all sorts of other innovative, kind, smart, and wonderful people with a similar desire to create positive change using new ideas. In this space, working with my partner, my ideas began to transform. In the process of creating our mission, vision, core values, and plan for the future, I began to realize which parts of my original concept really mattered, and which parts were less important. In the end, it boiled down to two things.

The first was my definition of the word “doula,” and how my concept of what doulas should do differs from widespread understandings of their work. “Doulas” have been around for as long as humans have been procreating and leaning on one another in the process. We are social creatures who know that it “takes a village to raise a child;” we also know that it takes a village to facilitate the process of bringing one into the world. Only with increasing human mobility, as families have moved further apart and villages have grown into cities, have we shifted away from the concept of childbearing and rearing as a community effort and responsibility to an individual one. But our need for community support did not disappear with these changes. The modern doula was born out of a recognition of this fact. If you have no sister or mother or aunt or cousin to be with you through labor, answer your questions, or quell your fears, you can simply hire a woman to do it in their place.

The modern doula benefits private individuals, her presence is fleeting, and she is unfortunately most accessible to those at the higher rungs of the social ladder, for which the stakes in her absence may be much lower. But my team was never advocating for modern doulas—I never wanted to be a modern doula. We were advocating for community doulas, with permanent roots and roles in the lives of families, with training that comes from the people themselves, with connections to local community organizations that work to address social determinants of health and dismantle systems of oppression. The community doula is more effective because she understands her client’s needs and background on a fundamental level; more efficient because her use takes burdens and responsibilities off of individuals and reassigns them to communities, institutions, and systems; more sustainable because community support enables and is an inherent component of the work she does; and more just because her primary obligation is not to simply satisfy individual clients, but work towards the betterment of entire communities. We have reason to believe this approach will work because there exists established evidence on the value of doulas in producing tangible improvements of birth outcomes. Their use has been found to be associated with a decreased use of medical interventions in birth, greater satisfaction with birth, increased initiation of breastfeeding, and increased use of good practices in infant care. By shifting the conception of doulas from employees of individual people to activists within their communities, systemic change is enabled.

The second thing I realized about Birthlight is that it is a company by and for Black families. Explicitly, intentionally, unapologetically (though of course not exclusively—everyone deserves a doula). The vision is straightforward—Black families freed from reproductive oppression. In the process of trying to launch Birthlight forward, I’d fallen into the trap I mentioned in my previous post. I was always thinking how to be bigger, bolder, newer and shinier. But at its core Birthlight isn’t about any product or package, it’s simply about treating Black pregnant and birthing people right and building a world in which Black pregnant and birthing people are treated right. And that starts with making sure they’re heard.

Birthlight was born out of my New Orleans experiences, and it will forever be a child of New Orleans. But right now as I apply to midwifery programs and my partner applies to med school, our capacity to scale up to the level we originally planned is limited. And there’s a very real likelihood that this time next year, neither of us will be in the city enough to commit to some of the more time-intensive components of our business model. And that’s okay. Because we’re still working towards our vision in other ways that remain true to our mission. This is being achieved through collaboration with and support of other local organizations with shared principles and goals, in addition to my offering individualized full spectrum doula services.

I’ve gone back to my roots, to the source that brought me here in the first place.  Sista Midwife Productions was instrumental in introducing me to the field of birthwork—it’s where I trained to be a doula, and where I met my mentor Nicole Deggins, who is SMP’s founder. I currently assist SMP with two ongoing, intertwining projects that get to the heart of Birthlight’s two tenets. The first is a statewide initiative to create a perinatal community health worker program that will train community health workers to serve residents within Louisiana’s nine administrative regions throughout the perinatal period. If established, this program would essentially integrate community doulas into the Louisiana’s existing health system statewide.

The second project is the expansion of The Birth Story Project, which began in 2018 in collaboration with High Heal Productions. TBSP consists of monthly birth story circles, which are women of color safe spaces meant to provide Black women, whose voices are often ignored, with the chance to have their stories heard. This allows for radical truth telling that celebrates the beautiful experiences Black birthing people in Louisiana have had while also recognizing the trauma others may have gone through in their pregnancies and births. Stories are recorded and transcribed with permission so that they may be used in advocacy efforts. In the upcoming weeks, we will be introducing a new component of TBSP by launching a survey I spent the summer creating. This survey is for all people who have ever given birth in Louisiana, regardless of race, and is meant to be an accessible, anonymous tool that parents in the state can use to make sure their voice is heard. Going forward, the story circles and survey data will be used as steppingstones to create change within a birth system that currently does not respect Black people. They will also be used as a call to action to support the first initiative I talked about. Those interested in learning more about the birth story project and the survey can text “BIRTHSTORY” to 484848 to sign up to receive updates. Those who’d like to take the survey can go to this link to sign up to receive a link when it launches. That link will also take you to a page where you can watch a sample of our videos.

 

The past year has been a year of transformation and rebirth for me in more ways than one. I’ve learned about how to start something. I’ve also learned how to stop and re-evaluate. How to self-reflect. How to ask for help. How to help others. For anyone looking for advice, mine would be to just start. You’ll get somewhere, even if it isn’t where you anticipated. I’m coming out on the other side of this journey more optimistic than ever. There is, as always, work to be done. But there are also people doing the work. I’m honored to be one of them, and am forever grateful to the guides, mentors, friends, and partners that have been there with me along the way. Thank you to the Taylor Center, CI, Sista Midwife Productions, Ashlee Walker and my partner Will Smith for believing in me and sharing the vision. If you’d like to get involved in the fight for equitable maternal child health, contact me at hledet@tulane.edu to join the NOLA Maternal Child Health Coalition!