Black women in the United States face a maternal mortality rate approximately three times higher than that of white women, according to the Centers for Disease Control and Prevention. That number has persisted across income levels, education levels, and geography. One of the most concrete responses to it, at the individual level, is the doula.
LaToshia Rouse, a certified birth and postpartum doula and owner of Birth Sisters Doula Services, has spent years working with families through pregnancy, labor, and the postpartum period. Her work spans emotional support, information delivery, community resource connections, and advocacy inside hospital rooms where patients do not always know they have the right to push back.
What a doula actually does and why it matters for Black women
A doula’s role is distinct from that of a midwife. Where a midwife manages the clinical side of birth, a doula focuses on the emotional, informational, and physical support that clinical providers do not have the time or scope to offer. Rouse describes the two roles as complementary. A midwife handles physiological birth. A doula handles everything around it, including making sure the patient understands what is happening, what their options are, and who to call when something feels wrong.
That informational function carries particular weight for first-time mothers and for families who may not know that hospital quality varies significantly. Not all maternity wards operate with the same standards, resources, or staff training on cultural humility. Part of Rouse’s prenatal work involves helping families understand where to seek care and what to look for when evaluating a provider or facility.
The C-section disparity and the doula’s role in advocacy
C-section rates are one of the clearest data points in the racial disparity conversation around maternal care. A New Jersey study found that Black women were 25% more likely to have C-sections than white women. The Leapfrog Group’s 2025 Maternity Care Report found that one in five hospitals shows significant disparities in C-section rates across racial groups.
Rouse sees those numbers play out in clinical practice. Hospitals operate under time pressure, particularly for patients classified as high-risk, and that pressure can push providers toward interventions before all alternatives have been considered. Rouse uses a framework called BRAIN, which stands for Benefits, Risks, Alternatives, Intuition, and Nothing, to help her clients slow down and evaluate any proposed intervention before agreeing to it. The goal is not to refuse medical care but to make sure the decision is actually informed.
She recalls one client whose baby moved to a breech position late in pregnancy. The hospital scheduled a C-section, but Rouse introduced the client to repositioning techniques and exercises that can encourage the baby to turn. At the final appointment before the scheduled surgery, the baby had repositioned. The client delivered vaginally. Rouse is candid about why cases like this matter. Many patients do not know that non-medical options exist for certain scenarios, and without a doula present, those options may never come up.
Red flags in maternity care and how to recognize them
Rouse identifies several patterns that expectant mothers should watch for when assessing a provider or facility. A provider who dismisses concerns or does not take time to explain decisions is a warning sign. High rates of interventions without clear clinical reasoning deserve scrutiny. A hospital‘s attitude toward support people in the delivery room reflects its broader culture around patient-centered care. And facilities that have not invested in training around cultural sensitivity are less likely to deliver equitable care to patients from diverse backgrounds.
Beyond individual advocacy, Rouse sits on advisory boards and contributes to research to ensure that Black patient perspectives shape the policies governing maternal care at a systemic level. The decisions that affect care on the ground are often made by people who have never experienced that care directly. Her presence in those spaces is the same work she does in the delivery room, making sure the right voices are in the room when the decisions get made.
