Hillsborough's doulas offer TLC for new moms in need

By Nicole Hutcheson, Times Staff Writer
Published February 23, 2008

Maggie Renteria, a former migrant worker, now works with that same population as a doula to help the women with their pregnancies and with raising their infants.
	[Willie J. Allen Jr. | Times]

ADVERTISEMENT [Willie J. Allen Jr. | Times] Johneather Winkfield, 19, shares a moment with her doula, Rayna Degree, 41, as she holds her newborn daughter Faith Nevaeh Gambles. [Willie J. Allen Jr. | Times] Two-week-old Rasheed Smith takes a nap while his mother Christine Bynum, 25, takes advantage of the Doula program at the Lee Davis Health Center in Tampa

TAMPA -- Twenty-year-old Johneather Winkfield looks more like a cheerleader than a mother of two.

Seated on a chair in her living room, Winkfield swaddles her youngest, Faith Nevaeh, a plump infant the color of a candied yam.

Her middle name is "Heaven" spelled backward. "I got a testimony with this baby," she declares.

A decade or so ago, a healthy baby could indeed be seen as a divine act in this section of east Tampa. Back before revitalization came to Belmont Heights, it was simply the projects and a dangerous place for black babies in the city.

In the 1990s, for every 1,000 black babies born in the inner city area, 16 died -- a rate three times that of white babies. Then, the national average ranged from 7 to 9 deaths per 1,000 births.

Obesity, poor prenatal care and untreated sexually transmitted diseases were largely to blame, health officials say.

Today, though, the number stands at 12 deaths of black babies for every 1,000 births. It is still higher than the state or national averages, but nevertheless an improvement.

One of the most effective measures Hillsborough County started to help drive down the number: providing doulas, or birthing assistants, to expectant mothers like Winkfield, an ancient practice long reserved for the rich.

Hillsborough's success has prompted other Florida city and county health departments in Pinellas, Miami and Tallahassee to launch similar programs.

"Hillsborough County was identified as one of the highest areas in the state for infant mortality," said Sue Garcia, who oversees Hillsborough's doulas.

"We knew there was a really strong, unmet need."

* * *

Doulas fall somewhere between a midwife and doctor. They tend both physical and mental needs, before, during and after birth.

They do everything from helping a woman decide if she wants drugs during birth and warning about the dangers of substance abuse to giving labor massages and dispensing advice on infant nutrition.

Winkfield, a child care worker at an after-school program, is breastfeeding her second time around as a mother with the help of her doula.

Rayna Degree visits weekly, showing Winkfield how to get Faith to latch on and giving her a healing breast salve.

And while private doula services can cost in the thousands, community programs like Hillsborough's are free to the women who need it most.

Since the program's inception nine years ago, infant mortality rates for Hispanic women in Hillsborough also are down to about 6 deaths per 1,000 births, according to the county's health department. That's about the same rate for white babies.

The national rate is less than 7 deaths per 1,000 births, according to the latest figures available.

The doulas also report more healthy postpartum visits, screenings for postpartum depression and mothers breast feeding.

Hillsborough's program costs $480,000 and has 10 doulas, who served 871 clients last year. Besides one-on-one consultations, weekly birth and parenting classes also are offered.

To become a certified doula requires completing a 50-hour birthing class and postpartum care, as well as skill tests.

Pinellas County started its doula program two years ago to combat high C-section rates and repeat teen births, said Judi Vitucci, executive director of Pinellas Healthy Start Coalition.

"We're always looking for effective interventions," she said. "We decided to try it, and doulas have been successful."

* * *

Outreach, however, is key. Doulas can help only the women they know about.

On a recent day at the Lee Davis Health Center in Tampa, Rayna Degree approaches pregnant women. She has a motherly nature and asks if they'd like to learn about doulas.

After puzzled pauses, most allow themselves to be led into a small room the center set aside for doulas. On this day, doula Bettye Jordan is questioning Christie Bynum about her 2-week-old son, Rasheed.

Is his navel progressing okay?

Yes, the 25-year-old mother answers. But his skin is dry, she notes, and baby lotion hasn't worked.

Jordan, a zaftig woman with braids to her waist, looks down at the baby and ticks off advice:

Don't bathe him every day. Use olive oil instead of lotion. And put a few drops of alcohol into his navel -- it won't hurt him.

In many ways, a doula's job seems more like what a grandmother or favorite aunt would do. But for many clients, who are already facing poverty and other obstacles, familial support is not always available.

On Jan. 25, Winkfield's grandmother dropped her off at Tampa General Hospital because her legs were hurting. Once there, though, the doctor told Winkfield she was in labor.

By then it was late at night and when Winkfield called home, her grandmother was asleep, her mother was at a night club and the father of her child was too far away in Sarasota.

So Winkfield prayed, and called the only other person she knew would come: her doula.

"She was holding me and holding my legs. She was praying and saying 'Keep pushing,'" Winkfield said.

Doulas believe every woman deserves to have someone in the delivery room, and Degree knows this better than most.

She was alone when she had her first child at age 16. Her mother's supervisor did not allow her to leave work to be with her daughter.

"I told the doctor it hurt," recalled Degree, 41. "He told me, 'What do you expect from a baby having a baby?'"

Degree is like many doulas with personal experiences that lead them to the profession.

Maggie Renteria, a doula at the Ruskin Health Center, is a former migrant worker, who fled to a shelter after leaving an abusive marriage. When the mother of three heard about the doula program, she enrolled in classes and became certified.

Now, she focuses on reaching the area's Hispanic migrant population, many of whom have never been to a doctor.

Once, Renteria went to the hospital where a Spanish-speaking client was in labor but refused to push. Doctors were panicked. Renteria explained that in Mexico, most women don't deliver sitting up with their feet in stirrups.

I put her on the edge of the bed -- squatting," Renteria said. "And it was quick."

* * *

For most doulas the job doesn't stop at teaching about birthing and babies, but also extends to helping clients with school and job applications.

In the process, the doulas often become role models.

"I want to be a doula because of her," 22-year-old Katrina Mc-Griff said, talking about Bettye Jordan.

For girls who appear serious, Degree will pay for books and let them take her certification class for free. It usually costs $360.

"I see these girls and think about myself at that age," Degree said. "Somebody gave me a chance, I want to give them a chance."

Training doulas for public health programs has become a priority for DONA International, a doula certification organization based in Indiana. Private doulas still outnumber those working in public health, but there is hope that the numbers will continue to increase.

"People are seeing that this really does make a difference ...," said Debbie Young, president of DONA International. "And so state monies are being put toward it, which is very exciting."

While state funding has flowed to many doula programs like Hillsborough's, some have fallen victim to recent budget cuts. After operating for more than five years, Osceola's program was terminated in October.

A common criticism: Doula programs don't go far enough.

Consider McGriff, who wants to be a doula. She was back at the clinic recently for a pregnancy test after giving birth to a baby boy two months ago.

The test was negative, but the doulas couldn't help but feel that they had somehow failed.

"I was feeling I didn't do my job correctly as a child birth educator," Degree said. "I didn't give her enough."

But it's going to take a lot more than a few classes on contraception to stem the tide of repeat births, Garcia said.

"I think the answer is for a woman to have high enough regard for herself to think for herself," she said. "But in this society it doesn't happen."

Nicole Hutcheson can be reached at nhutcheson@sptimes.com or (727) 893-8828.

FAST FACTS
"Doula" is Greek and means woman's servant, throughout history the woman who probably helped the woman of the house through childbearing. In the early 1990s, a small group of child birth experts came together to form DONA to provide a unified curriculum and certification process for doulas.

For more information on Hillsborough's doula program, call Achieve Tampa Bay at 813-239-1179 ext. 271 or 272.

[Last modified February 23, 2008, 00:13:05]