A Doula Network That’s Saving Lives

JOEL BERVELL: Omare Jimmerson is the executive director of the Oklahoma Birth Equity Initiative and was previously the deputy director of Parks, Culture, and Recreation at the City of Tulsa. She was also a cofounder and served as program director of Strong Tomorrows, a school-based initiative for expectant and parenting students that provides guidance, support, and information. And she sits on numerous nonprofit boards in Tulsa and is currently the board chair for Reading Partners. Her master’s degree in public health is from the University of Oklahoma. The Oklahoma Birth Equity Initiative aims to equip families to have healthy births with dignity and reduce challenges, which sounds very straightforward, but in reality, not so much, and in this episode, we’ll talk about the complexities and the strategies.

Omare, thank you so much for being here.

OMARE JIMMERSON: Thank you for having me.

JOEL BERVELL: So Omare, you are an on-the-ground expert and advocate in a place that many of our listeners may not know about, so I just want to give a quick snapshot of your city. Tulsa is home to about 400,000 people, with approximately 15 percent of the population Black, 15 percent Hispanic, 5 percent Native American, 2 percent Asian, and about 6 percent of the population identifying as one or more race. The state of Oklahoma is similarly diverse, though not so many groups are concentrated in a single area like Tulsa itself. And infant mortality in this state is rising, so your mandate is very clear: birth equity is in your organization’s name, and your work is not just limited to Tulsa, although that is where you do most of the work to fuel the statewide effort.

But I really want to begin with the origins of the Birth Equity Initiative, founded about six years ago, and I’d love for you to set the stage for listeners by describing the local climate at the time, and some of the challenges for parents and women seeking prenatal care. And I also want to point to the data that’s very stark — that Black mothers are experiencing pregnancy loss at a rate nearly 10 times higher than white mothers.

OMARE JIMMERSON: Yeah. So here in Oklahoma, Black women are 3.2 times more likely to die than their white counterparts, and Native women are 2.8 times more likely to die than their white counterparts. So back in 2019, as you mentioned in my bio, I was running the program Strong Tomorrows, which serves expecting and parenting teens, and just starting there with that population, a lot of people make the assumption that teens who become parents happens by happenstance, that they’re all accidents. But a lot of those pregnancies are actually planned, and whether they’re planned or not, they’re still humans and they should be treated as such.

And so, what I was finding is a lot of our students were going to their clinical visits and being treated as less than, which was requiring our case managers to have to leave the school, being available to other students to go and support them. And in my own journey, when I learned about doula work, many years before I had my own kid, I was intrigued and wanted to have the opportunity for myself. While I was never afforded that opportunity for many reasons, mostly financial, I did find an organization that specialized in community-based doula programming and looked to them, and was able to get a grant to expand that work here in Tulsa to be able to support those teen parents.

JOEL BERVELL: I love that, that’s incredible. And you have a very strong community partnership model. How was that strategy identified as a necessity for the success of the project and how has it been evolving?

OMARE JIMMERSON: So I truly believe that you can’t do something to people without having their voice at the center of it all. And so, I also come from a collaborative mindset, and I think what better way to plan how we want to attack an issue, that is such a large issue on a system level, than to have those very people at the table who it is affecting the most is the most important. Again, that started with the teens that we were serving. As the program evolved from just being a doula program, we also wanted to have the providers at the table so that they could hear the voices of those who they were serving. A lot of times they get stuck in the data piece of it all, and separate the humanistic sides of how this is playing out with those who they are serving.

So in the community-based doula model, we found, actually, from an organization based out of Chicago, we partner — we call them our doula sister cousins — we partner very closely with an organization based out of the Bay Area, SisterWeb. They have just grown to look to other doula organizations to see what’s working and what’s not working and seeing how . . . And of course, you may have to tweak that for your own communities, I don’t believe in reinventing the wheel, but to make sure it makes sense before we move forward.

JOEL BERVELL: And I’m curious about how your initial mission aligned with what you’ve heard from clients at the beginning. Did you find yourself having to adjust the work and offerings of the initiative based on community and client feedback?

OMARE JIMMERSON: Yeah. One thing I will say is doulas, traditionally and historically, have been for the haves, and what I found is those communities that we were targeting with our no-cost services didn’t really know or understand what doula services were. So we launched a really heavy campaign to educate the community on what doula work was, also what work and issue we were trying to solve for as an organization. I think the inclusion of the hospital quality work is what came out of community feedback, talking about the way, and not just our clients, but also doulas and the way that they were treated when they went into hospitals, especially during COVID, it was completely different. We’ve made a lot of strides to now doulas are counted as the care team and not as one of the plus-ones that a client is allowed to bring into the room.

The other piece of that, as you talk about infant mortality, based on what we’ve heard here in our community, we expanded as a regional partner with Queens Village, which is a program that is designed to reduce the stress of systematic disparities that we see, especially in the Black culture, systematic racism and the stress that we have to deal with on a day-in-and-day-out basis.

JOEL BERVELL: Yeah. Speaking of that, how are those factors beyond the health care system — so things like the social determinants of your health, housing, transportation, food insecurity — how are those influencing the disparities that you’re seeing as you’re having these conversations?

OMARE JIMMERSON: So doulas are more than just the person who’s there to help through the birthing process. We find that our doulas do a lot of resource connecting, whether it’s diapers or helping find a place for them to live, transportation to different appointments, so they’re filling in this gap. We also try to partner with other organizations. One thing I will say about Tulsa is it’s very different when it comes to the resources that we have available to our community because of our philanthropic community. We’re kind of an anomaly in that way. And so, trying to get the doulas educated on the other offerings that are in the community so they’re not trying to reinvent the wheel that’s already been created and saving them on burnout from trying to solve everybody’s needs.

JOEL BERVELL: Yeah. On that note, what were some of the most requested supports that you were hearing from doulas?

OMARE JIMMERSON: I think right now, the two big ones are transportation and then diapers. We have actually been able to raise a little bit of money to be able to solve for those issues, but we are a part of a bigger effort, where each one of our clients has the opportunity to apply for an emergency assistance fund, which we know we’re blessed to do. But the thinking behind that is maybe you need something for baby that you’ve not been able to get, let us pay a couple of your bills, whether that be rent or some utilities, so that you can then fill that gap on what you need for baby.

JOEL BERVELL: Was that surprising to you, or was that something that you were maybe expecting to see?

OMARE JIMMERSON: No, not surprising at all. With the housing market, our community is in the same situation as the rest of America, and especially because teens are one of our priority populations that we serve, they don’t typically qualify for a lot of the housing assistance that is available, so there are very few resources for them to solve for that problem.

JOEL BERVELL: How, if at all, is technology being played into supporting expecting mothers and families, whether that’s information or connections with other people?

OMARE JIMMERSON: I think the way that we have used it is a lot to increase access to information. Social media, we’ve tried to play to our advantage to educate the community. I will say that once we launched that targeted campaign across Tulsa, our referrals increased by 70 percent. Something that we are working on currently . . . So typically, clients who are seen and cared for by our doulas that work here, the average touchpoint is about 30 per client by the time they enter prenatal care, and then we follow them all the way through postpartum care, one year. So in that, basically, in the prenatal side, a client typically walks away with the same education they would have from a child birthing class that they could go and take, and a lot of our hospitals have stopped offering that. So we actually are working right now to figure out a way to make some of those handouts digitized, to be able to easily pick it up and pull it up on your phone instead of trying to keep up with loose papers that are everywhere.

JOEL BERVELL: Yeah, that makes a lot of sense. And as you’re talking about this, I know we’re speaking at the community level, I’m always curious about policies and systems. When you were first getting into this, were there systemic or policy barriers that you identified earlier on, whether it was in health care, insurance, government supports, that made you realize that this work was urgent?

OMARE JIMMERSON: Yes. We’ve been successful in pushing for two specific policies here in our state. So I guess it’s been a little over three years ago, we were able to push for postpartum expansion with Medicaid. So now, women can receive care for 12 months postpartum, which before, it was dropping off right at six weeks. And doctors are not incentivized to get clients to come back for that postpartum checkup, and we know that that’s where a lot of the issues happen. The majority of maternal issues and deaths happen on the postpartum side, so we want to make sure that women are coming back. There’s still some things that need to be worked out. The enrollment gets complicated, but we’re working to try to figure out ways to streamline that for women in the state.

And then, the other thing that we have been able to successfully work with the state on is doula Medicaid reimbursement. So that’s been in place for probably almost two years now. But I think it speaks to the dedication of our health care authority and making sure that we were at the table to set the guidelines, and not just pushing those things out on people and not understanding how doula care works. And I think a really good example of that is doctors are typically compensated more for C-sections, and they were setting up the pay structure the same for a doula. However, doulas spend more time on a natural birth than they do on a C-section. So being able to inform them and help them come up with those policies, and then being able to have contact people who we work with directly at each one of the health care organizations that are contracted with the state has been very helpful.

JOEL BERVELL: Has that reimbursement impacted uptake, attracted more moms?

OMARE JIMMERSON: We suspect over time, because all of that is just now starting to flatten out, what we are trying to do is anyone who holds our certification will be able to use us as a middleman to cut through all the red tape. Unfortunately, the way any Medicaid reimbursement is set up is for medical providers and those that are used to medical billing, and just myself trying to sign us up as an organization took me like three months to finally get somebody on the phone.

And so, even though Oklahoma is kind of middle of the road when it comes to doula reimbursement, at the end of the day, it’s $64 per visit. So at the most, you can get up to eight visits and then the birth, so we’re talking a little over $1,000 a client. And so, when you do the math on how much time and how much red tape people have to jump through, they may just say, “I’d rather do it for free.” So we’re trying to create this as a workforce development tool, while we’re also serving women, but we want the women who are providing the service to be able to take care of their families as well.

JOEL BERVELL: Yeah. I’m glad you touched on the workforce development, because as I talked about in the show open, you’re serving an extremely diverse group of parents, and I wonder how you have sourced, even trained a workforce that can respond to cultural needs?

OMARE JIMMERSON: So we recently partnered with our doula cousins, as I mentioned earlier, to write a curriculum called Blossoming Birth, and we’re super excited. The reason we decided to venture out and write our own curriculum is because what we saw is there was this disconnect from different cultures. We were seeing that we were losing a lot of our Native people that were going through the training at a certain point and couldn’t really figure it out. So when we wrote this curriculum, we were very intentional about contracting with Native women, midwives, our doulas here in the office all had a hand in writing the curricula. So they’re set up to be modular-based, so that depending on what type of community you’re going in, and not just race, also different experiences, so those who may have experienced substance use disorder, there are different modules that may apply to them, that different communities can use it and feel good about what they’re training people in.

JOEL BERVELL: What are some of those best practices that have emerged in training staff and doulas for culture responsiveness that would maybe even serve as a model not even just in Oklahoma, but more nationally?

OMARE JIMMERSON: So I think a couple of things. One, like I said, bringing in people who have lived experience to be able to help write those different things. That’s what the whole premise of community-based doula model is about, is identifying people with similar lived experiences to come in and serve. A community-based doula model is all about relationship building, and so you want to make sure, by setting it up with someone with a similar lived experience, you have something for them to connect on to start building on the foundation of that relationship, whereas with the traditional model, it’s more transactional.

JOEL BERVELL: Yeah, that makes a lot of sense. And then, how are you measuring the impact right now?

OMARE JIMMERSON: So all of our doulas, they love our data system, so we have a data system that they report different things on, what they’re educating their clients on, all the way up to the different things that they experienced through their birthing process. And we have been really blessed to see that the data that we’ve seen thus far is pretty promising. So Black women who have been served by OKBEI [Oklahoma Birth Equity Initiative] experienced similar preterm birth rates and low birth rates as white women in our county. So we are excited to see where this will go as we begin to expand Medicaid reimbursement and the support for doulas who don’t work here, but hold our certification, we’re hopeful that we’ll continue to gather more and more data to see on different populations.

I’m really excited to see what will happen in the Native population, that’s been kind of a hard nut to crack, for obvious reasons and trust. But being in a state like Oklahoma, where we have a lot of that population to serve and there are a lot of different health care systems that focus in those populations, we’re hopeful that we’ll be able to see some of the same outcomes.

JOEL BERVELL: Is that data also being leveraged to make the program more attractive to potential clients?

OMARE JIMMERSON: Well, yeah. We are not quiet about the differences that we’re making, one, with clients, also with funders so that we can serve more clients. Right now, we have eight full-time doulas and five part-time doulas, and so are looking to solidify funds to be able to get us up to at least 10 full-time doulas. And then also, with our workforce development, we just expanded the programming, so anyone in the Tulsa area that goes through the training now gets up to six months of apprenticeship, so by the time they finish, they are completely certified with the state and can go on to serve women.

JOEL BERVELL: And I know you briefly touched on, and you’ve talked about a little bit, that history of mistrust as well in the health care system. How has that shaped the way that families are engaging with your initiative, and how you’re addressing it as well with your doulas?

OMARE JIMMERSON: So we’ve gone through a lot of iterations on how we get referrals, but currently we’ve found the best way is for clients to self-identify, which means we have to do a lot of work on the back-end to get the information out there. But they come into our system and fill out a form, and let’s say they identify as more than one of our priority populations, they can pick whichever one they want to connect with, and as long as we have availability, we connect them with that request.

JOEL BERVELL: That makes a lot of sense. Looking ahead, what is the capacity of the Oklahoma Birth Equity Initiative to reach parents everywhere in the state to scale this?

OMARE JIMMERSON: So I can tell you right now, with that number of full-time doulas, we’re serving over 300 families a year.

JOEL BERVELL: Wow.

OMARE JIMMERSON: And with our workforce development, what we are doing right now — and this is where we’ve been partnering with the managed health care systems — is to get funds to go out and take our workforce development training on the road. And so, the plan is to go out and train a minimum, in partnership, of 30 doulas. But each community will be able to go on and continue training doulas as long as they want, or for up to three years with a license to the curriculum. So we are hopeful that, as long as funding is available, we will be able to go out and make doula services available to all communities.

And rural Oklahoma looks a lot different than here where I’m at in Tulsa, and so we’ve been very intentional, going back to one of your earlier questions about doing things with community, our first community that we have set up doula training in, we actually reached out to the community health department, held a stakeholders meeting to educate the community, those who have interest in this work, on what it is that we are bringing and offering to the community, and then allowing them to do a big communitywide education platform, similar to what we’ve done here in Tulsa, so that the community learns about it, and it creates the demand as we work with them and support them on pushing out the doulas as well through the training.

And I would say midwives play an important role: one, knowing the difference between a midwife and a doula. A lot of people get caught up on midwives just being able to catch babies, but in our state, we are doing a lot of work to try to change policies to increase the access of care that midwives can do in our state. Also, knowing that in rural communities, doctors are fleeing our state, not just in rural communities, but across our state, ob/gyns especially are fleeing our state because of the nature of the laws that have been put into place, and so we believe that . . . We’re not trying to replace doctors who have a specialty and can do different things, but what we’re trying to do is increase capacity for doctors to see patients. I know here, even in an urban city like Tulsa, it can take six months or longer to get in to see a specialist, and if you’re dealing with something, time is of the essence.

JOEL BERVELL: I know you’ve mentioned some, but are there other state or federal policies that you’d like to see change, that would make your work easier or more impactful?

OMARE JIMMERSON: That list could go on. But I think right now, under the current climate, what I’m really concerned about is protecting what we have. I feel like in a state like Oklahoma, that has so many other policies that are looming in the background, because we were experiencing some of these things here before the rest of the nation was, something that I had been kicking the can down the road with is expansion of doula services to private insurance, which there are a couple of states that have been successful in doing that. But maybe the time is now, and that’s the way I leverage it against what is happening so that we make sure that it is a priority. In my mind, I was thinking I need to solidify what we have and then move on to the next thing, but maybe it’s both-and.

JOEL BERVELL: Yeah, I agree, I think it might be both-and. This question’s a big one, but I’m curious what you think an equitable prenatal maternal care system looks like to you 10 years from now. What would it mean for you to have done everything that you could, in a perfect world?

OMARE JIMMERSON: In a perfect world, we would have no more Black and brown women dying at disproportionate rates. And I think what comes top of mind to me right now is . . . So we work with a program called Teen Birth, which at its core sounds like what doctors should be doing, which is basically where, instead of playing this game of telephone, which is so often our experience in the health care system, the nurse comes in and tells me what the doctor says, and then they take what question I had back to the doctor, and information gets lost in translation along the way. Whereas Teen Birth is more of a huddle, so the doctor and everyone in your care team, along with the patient, is there together having these conversations. And I think what that does is it makes the patient, at the end of the day, no matter what they look like, feel heard.

Maybe my goal was to have a natural birth, but something happens and everything changes, I have now had the opportunity to ask my questions, understand why the doctor is making the decision. And I think at the end of the day, it’s just people walking away feeling like they are human. So oftentimes, what we hear, and for many, it’s hard to believe, but you can’t deny the data, of people not feeling heard and appreciated during their birthing experience. And I talk often about Serena and Beyonce. Serena and Beyonce being in a hospital, everybody in the hospital, whether they’re in the cardiac unit or whatever, everybody knows they’re in the hospital, how can you not elevate the voice of someone who is honored in our country and community in that way? And so, you can’t deny the fact that this is happening to women just because of the way they look, no matter their education or economic level.

JOEL BERVELL: Absolutely. Well, Omare, thank you so much for being a part of the solution, for sharing your insights, and for the incredible work that you’re leading. I think what you’re doing is uncovering roots of inequities, building community-driven solutions, and trying to imagine what’s possible in the years ahead. Thank you for taking the time to talk with me, and for the way that you and your team are reshaping maternal and infant health in Oklahoma and beyond.

OMARE JIMMERSON: Thank you for having us and giving us this platform to share our work.

JOEL BERVELL: This episode of The Dose was produced by Jody Becker, Mickey Kapper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There, you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Joel Bervell, and thank you for listening.