Black History Month 2026 | From the Desk of Maddy the Doula Lady
The Black Maternal Health Crisis Is Not a Mystery. The Solution Is Growing From Within.
Louisiana has the highest maternal mortality rate in the nation. Black mothers are dying at nearly four times the rate of white mothers. And more than 80% of these deaths are preventable. This isn't a mystery — it's a failure. But the solution is already taking root in our communities.
I'm going to share some numbers with you. They're hard to read. But we need to look at them, because these aren't just statistics — they're mothers, daughters, sisters, friends. They're women who should be here raising their babies.
And then I'm going to tell you what we're doing about it.
The Numbers We Can't Ignore
Sources: CDC National Center for Health Statistics, 2023; Louisiana Pregnancy-Associated Mortality Review, 2020
Let that sink in. In 2023, while maternal mortality rates declined for white, Hispanic, and Asian women, the rate for Black women actually increased slightly. Everyone else is getting safer. Black mothers are not.
And Louisiana? We're at the bottom. Dead last. Our state has a maternal mortality rate of 37-58 deaths per 100,000 births depending on the data source — compared to California's rate of just 4 per 100,000.
In Louisiana, 37% of births are to Black mothers — but Black mothers account for 62% of all pregnancy-associated deaths.
Black mothers in Louisiana are 2.5 times more likely to die from pregnancy-related causes than white mothers.
93% of pregnancy-related deaths in Louisiana were determined to be potentially preventable.
Source: Louisiana Department of Health Pregnancy-Associated Mortality Review, 2020
This Is Not About Individual Choices
Here's what people need to understand: this disparity doesn't disappear with education or income. Black women with college degrees have worse maternal outcomes than white women who never finished high school. Black women in the highest income brackets still face higher risks than white women in poverty.
This isn't about making better choices. This is about a system that wasn't built to keep Black mothers safe.
Chronic stress from racism — known as "weathering" — causes physiological changes that increase health risks during pregnancy.
Implicit bias in healthcare leads to Black women's pain being dismissed, their concerns minimized, and their symptoms undertreated.
Lack of culturally competent care creates distrust and discourages Black women from seeking care or speaking up when something feels wrong.
Systemic barriers — transportation, childcare, work schedules, insurance gaps — make consistent prenatal and postpartum care harder to access.
The problem is systemic. The solution needs to be too.
What the Research Says About Doulas
Here's where hope enters the picture.
Study after study shows that doula care — continuous physical, emotional, and informational support during pregnancy, birth, and postpartum — improves outcomes. And the benefits are even more pronounced for Black mothers and those facing socioeconomic barriers.
Lower cesarean rates: Doula-supported births have significantly fewer cesarean deliveries, which carry higher risks of complications and mortality.
Fewer preterm births: Continuous support is associated with lower rates of preterm delivery and low birthweight babies.
Higher breastfeeding rates: Doula support increases breastfeeding initiation and duration, with long-term health benefits for mother and baby.
Reduced postpartum depression: Emotional support during birth and postpartum decreases rates of depression and anxiety.
Better birth experiences: Women with doulas report feeling more respected, heard, and in control of their birth experience.
Sources: American College of Obstetricians and Gynecologists; National Health Law Program; The Lancet eClinicalMedicine, 2022
The American College of Obstetricians and Gynecologists (ACOG) has stated that continuous labor support from a doula is one of the most effective tools to improve labor and delivery outcomes.
But here's the problem: only about 6% of U.S. births involve doula care. And historically, doula services have been most accessible to middle- and upper-income white women who can afford to pay out of pocket.
The communities who need doulas most have the least access to them.
The Solution: Community-Based Doulas
This is where the model has to change. And this is what we're building at Mary's Hands Network.
Community-based doulas are doulas who come from the communities they serve. They share similar backgrounds, cultures, and lived experiences with the families they support. They're not outsiders coming in to "save" anyone — they're neighbors helping neighbors. They're sisters supporting sisters.
— Dr. Noelene K. Jeffers, Johns Hopkins School of Nursing
Research is increasingly pointing to community-based doula programs as a key strategy for reducing racial disparities in maternal health. When mothers are supported by someone who looks like them, understands their cultural context, and can advocate effectively within the healthcare system, outcomes improve.
What Mary's Hands Network Is Building
Mary's Hands Network is Louisiana's largest volunteer-based doula organization. We train community members to become doulas and match them with families across the state who need support — regardless of their ability to pay.
Here's what our community looks like:
230+ trained volunteer doulas serving families across Louisiana Regions 1-5
380+ families served — and growing every month
56% of our clients are Black — we're reaching the communities most impacted by the maternal health crisis
50% of our doulas are Black — our doula network reflects the communities we serve
This isn't an accident. We intentionally recruit and train doulas from underserved communities. We believe the solution to the Black maternal health crisis must come from within Black communities — supported by resources, training, and systemic change, but led by the women who understand these challenges firsthand.
Our Outcomes Are Proof
We track every birth. We collect data because we believe in evidence-based care and because these numbers matter. Here's what we're seeing:
| Outcome | MHN Families | Louisiana Average |
|---|---|---|
| Cesarean Rate | 21.5% | ~34% |
| Vaginal Birth Rate | 78.5% | ~66% |
| Breastfeeding Within 2 Hours | 82.4% | ~60% |
| Skin-to-Skin Contact | 76.4% | Variable |
| Breastfeeding/Combination Feeding | 84.1% | ~70% |
MHN data based on 83 births tracked 2023-2025. Louisiana averages from CDC and March of Dimes.
Our cesarean rate is 21.5% — compared to Louisiana's average of approximately 34%. That's not a small difference. Cesarean births carry higher risks of complications, longer recovery times, and increased risks in future pregnancies. Reducing unnecessary cesareans saves lives.
Our breastfeeding initiation rate is over 82% within the first two hours after birth. Breastfeeding reduces infant mortality, supports maternal health, and creates long-term health benefits for both mother and child.
These numbers are what happens when mothers have continuous support.
The Model: Neighbors Supporting Neighbors
Our approach is simple but powerful:
We train community members. Women from all backgrounds — many of whom have their own powerful birth stories — become certified doulas through our ICEA-accredited training program.
We match doulas with families. Every family who applies receives a doula, regardless of income or insurance status. We prioritize matching based on location, language, and cultural connection.
We provide continuous support. Our doulas support families through pregnancy, birth, and postpartum — attending prenatal visits, being present during labor and delivery, and checking in after baby arrives.
We connect families to resources. Beyond birth support, we help families navigate insurance, WIC, housing assistance, mental health resources, and more.
We also have mother-daughter doula teams. Generational knowledge passing down. Communities strengthening from within.
What Needs to Change
Doula care works. The evidence is clear. But for it to make a real dent in the maternal health crisis, we need systemic change:
Medicaid coverage for doula services. Louisiana Act 228 made it possible for doulas to bill Medicaid — but implementation has been slow. We're working to become Medicaid-enrolled providers so that every Louisiana family on Medicaid can access doula care.
Hospital partnerships. We partner with health systems like Baton Rouge General and Ochsner to integrate doulas into standard maternity care.
Expanded postpartum coverage. The highest risk period for maternal mortality is actually AFTER birth — yet Medicaid coverage historically ended at 60 days. Louisiana has extended coverage to 12 months, but implementation and awareness remain challenges.
Investment in community health workers. Doulas, community health workers, and peer support specialists from affected communities should be funded, trained, and integrated into healthcare systems.
You Can Be Part of the Solution
This isn't just our fight. It's everyone's.
If you're pregnant or planning to become pregnant, especially if you're in a community that faces higher risks, know that you deserve support. You deserve someone in your corner who will advocate for you, believe you, and stay with you through every contraction.
If you feel called to this work, we train new doulas throughout the year. You don't need a medical background. You need a heart for service and a willingness to learn.
If you want to support this work financially, every donation helps us train more doulas, serve more families, and expand to more communities across Louisiana.
The Black maternal health crisis wasn't created overnight, and it won't be solved overnight. But every mother supported, every doula trained, every cesarean prevented, every voice amplified — it adds up. The solution is growing from within our communities. And it's working.
Love,
Maddy the Doula Lady 💙
Join the movement to improve Black maternal health in Louisiana.
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Mary's Hands Network is Louisiana's largest volunteer doula organization, serving 380+ families across Regions 1-5.
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