In May 2020, East Fork held a raffle for Sistas Caring 4 Sistas (SC4S), a grant-funded community-based doula program whose goal is to improve maternal and infant health outcomes for people of color in Western North Carolina. Here, we’d like to tell you more about SC4S, give an update on how the pandemic affected those served by the program and those who provide the care, and share a bit about the impact that the $36,765 raised by East Fork customers had.

SC4S fights the disparities that women of color often face when giving birth by providing support to high-risk and low-income expectant mothers and advocating for the quality and success of their medical care. Doula care is proven to lead to positive birth experiences, decreased interventions during labor, and decreased cesarean rates. SC4S doulas support mothers throughout their pregnancy, providing childbirth education, accompanying them to prenatal visits, along with being present to support during labor and birth, supporting breastfeeding, and offering postpartum care and peer support for women who face mental health and/or substance abuse challenges.

SC4S was founded in late 2016 by members of the Mothering Asheville movement, a collaborative effort of clinical healthcare providers, community organizations and residents committed to eliminating inequities in infant mortality in Buncombe County by advocating for institutional policies that address structural racism, implicit bias, access to care, and social determinants of health. At the time, babies born in Buncombe County to women of color were three times more likely to die in their first year of life than white babies. The women pursued doula training, intent on providing the physical and emotional support and education they hoped would help eliminate infant and maternal mortality inequities.

To date, SC4S doulas have helped with approximately 120 births and there are, at this writing, several more women who are part of the program who haven’t given birth yet. And there are always new referrals through the Mountain Area Health Education Center, which houses SC4S’s office, through outside agencies and through word of mouth, as well.

The Road Ahead

“There has been a lot of growth,” said Cindy McMillan, the program’s Director of Marketing and Education, stating that in addition to SC4S’s services being in higher demand, the pandemic has also brought a number of clients who are experiencing homelessness. She noted the difficulties they often face in staying in a shelter or in temporary situations that aren’t safe. “These situations are real and heartbreaking! The issues involving safe sustainable housing have led to life-threatening situations for some of our moms and the effects are not only traumatizing to the individual birthing person, but also to the life forming inside,” Ms. McMillan said.

Because their clients’ needs often extend to areas beyond pregnancy, childbirth and postpartum care, SC4S will soon become a 501(c)3 nonprofit organization, providing the same doula services, along with assisting clients with finding employment, childcare, sustainable housing, transportation and addressing food insecurity. SC4S also hopes to offer full-time employment to the doulas who are currently being paid on a per-client basis as well as training opportunities for all who would like to become Certified Birth Doulas.

SC4S’s future plans include opening what Ms. McMillan called a pre-game labor center to provide a place that is staffed by a midwife and a nurse where women can be supported by staff doulas as they progress towards active labor in an effort to avoid arriving at the hospital then being sent home if they are not quite ready for delivery. This service will not be limited to SC4S clients but, as Ms. McMillan explains, will be “utilized as a platform to unite our birthing community in a way that will connect and celebrate life’s beginning through shared community experience.” She noted that this type of support can potentially offset early medical interventions that can create complications, especially for a birthing person who may be seeking an unmedicated birthing experience.

Ms. McMillan credits the donations East Fork customers made with helping get the transition to nonprofit status started, as well as SC4S’ being able to bring in six new doulas by supporting in their training and certification. Two of those doulas live and work in Cherokee, a part of the Western North Carolina region that SC4S has long wanted to offer support in the program’s growth towards equitable birth work. The donations also made pay raises possible for the three doulas, Ms. McMillan among them, who founded SC4S.

As for adjustments SC4S had to make during the pandemic, they involved embracing the same technology many of us did, regardless of the work we do. “We did childbirth classes over Zoom, we used tablets or phones when we weren’t able to be there when the mothers were in labor. It was a lot of virtual visits all around,” Ms. McMillan said. There were some socially-distanced in-person meetings with their most vulnerable clients, she added, along with the news SC4S got in August that doulas were allowed to be present again in the hospital setting.