A doula is a trained professional who provides emotional, physical, and educational support to an expectant mother throughout the pregnancy, during labor, and in the weeks following the birth. A supportive member of a birthing team, they work to improve health outcomes. While doulas may be ever present (and accepted) now, the concept wasn’t quite as ubiquitous in 2006, when Brandi Sellerz-Jackson first became a mother at the age of 23. Now the mother of three boys—Jax, 13, Jedi, 4, and Jupiter, 1—she only learned what a doula was, and could do, by her second pregnancy, when she hired a birth doula. With her last pregnancy, the Los Angeles-based mother opted for both birth and postpartum doulas.

“I did things so very different this time, and it was amazing,” Sellerz-Jackson, co-founder of Moms in Color and creator of #NotSoPrivateParts, says. “For postpartum, there were literally just women coming in and out of our home for six weeks almost, just loving on us, bringing [us] food. My job at that time was just nursing Jupiter.”

The 37-year-old has seen first-hand the life-saving advantages of having a birth worker present throughout one’s pregnancy journey (and after). After feeling the pull to enter women’s work in 2015, Sellerz-Jackson hosted a breastfeeding event with her now business partner, Kelly McKnight. When a friend and birth worker approached her about becoming a doula, she decided to become a birth and postpartum doula herself, undergoing an initial four-day intensive with reading, homework assignments, and hours of pro-bono doula support.

Since then, she’s supported all kinds of births, including home, birthing center and hospital births. While each birth is unique, requiring her to serve as an advocate through pregnancy and the birthing process, Sellerz-Jackson has had to speak up while unnecessary recommendations were given to Black mothers. She’s had to intervene during a doctor’s attempt to expedite a birth through cesarean delivery, which happens more frequently to Black women, and a nurse prematurely discussing an epidural, among other eyebrow-raising incidents.

Sellerz-Jackson, like many other Black doulas, know their own concerns are warranted, and they’re seeing how their clients are combating the disturbing mortality rates for Black women and infants by placing their trust in Black birth workers.

While maternal and infant mortality affect people of all backgrounds in the U.S., the rates are alarming when they come to Black women and infants. Black women are 2.5 times more likely to die from pregnancy-related issues than white women, according to the Centers for Disease Control and Prevention. Regardless of a mother’s income or education level, African-American babies are twice as likely to die before reaching their first birthday than white babies. So, what exactly is the culprit?

While the individual reasons are layered and complex, the real root of this discrepancy is institutional racism—from the way the overall health-care system is structured to implicit racial bias perpetrated by health professionals.

Sumayyah Franklin, an Afro-Indigenous full-spectrum, traditional birth worker, stresses that the racial disparities aren’t new, they’re just more visible. “What’s killing us is racism,” says Franklin, a midwife and doula. “It’s the stress of racism, inherent ways in which society, and the systems created, are rooted in the devastation, oppression, destruction, and death of Black bodies.”

They’re seeing how their clients are combating the disturbing mortality rates for Black women and infants by placing their trust in Black birth workers.

What she believes will help keep these women and babies alive is African and Indigenous birthwork. Centering her ancestral and traditional knowledge, and passing this wisdom on to her students, is one of the many ways Franklin is decolonizing the birth landscape. Birthwork can be traced back to indigenous midwifery and well before the 1600s, when enslaved Africans were brought to the United States. As slavery persisted, enslaved African women served as midwives to both African and white women. But with the advent of modern medicine in the 1700s, obstetrics became dominated by white, male doctors. To honor this, she builds an altar, a space bridging the physical and the divine, for each of her clients to “honor their ancestors, honor that this is a ceremony, honor that this is sacred, and [note] that this is going to be a journey.”

Indigenous practices are also prevalent in the work Griselda Rodriguez-Solomon, PhD, a mother, doula, and Kundalini yogi, does alongside her identical twin, Miguelina Rodriguez, with Brujas of Brooklyn, a platform centered on womb wellness. An umbrella term used to describe a variety of healing techniques focused on women’s reproductive health, womb wellness ranges from obtaining a Pap smear to other modalities like womb-centered yoga practices. This type of healing work begins before pregnancy, she notes.

“We are very intentional about understanding that the work of addressing maternal mortality and morbidity doesn’t only take place in hospital rooms during labor,” says Dr. Rodriguez-Solomon, who teaches the course “Birth Injustice” at the City University of New York (CUNY). “There has to be a systemic overhaul. A reframing of the way we look at birth and the body, and Black people and bodily autonomy. For Brujas [of Brooklyn], we do that by addressing how we see ourselves and how we engage with our own bodies.”

When women are in tune with their bodies and aware of their agency, they feel empowered to make the best decisions for themselves and their babies, Rodriguez-Solomon shares. Rather than relinquish her power to a medical system that doesn’t always have her best interest in mind, she’s aligned with herself enough to tune out the noise and make the right choice.

Each of these birth workers are ensuring that those they work with can access and carry out a healthy and safe delivery. Though it varies by location, a doula can cost $800 to $2,500, and are typically not covered by insurance. But if an expectant mother meets certain qualifications, Medicaid programs in states like New York, Minnesota, and Oregon now cover the cost of a doula; while cities such as Baltimore and Milwaukee offer free or reduced-cost doulas to low-income women and people of color. Dr. Rodriguez-Solomon understands the challenges of affording a doula, and offers a sliding scale and a flexible payment plan for mothers in need.

Franklin, Sellerz-Jackson, and Rodriguez-Solomon know far too well the challenges Black women face daily and are committed to providing safe spaces for them during their most vulnerable (and transformative) time: childbirth. Though the data is still being aggregated, they’ve each seen a rise in the number of Black doulas, over the last two years in particular. Whether motivated by fear or empowerment, Black women are taking their wellness—and the health of their child—into their own hands with the support of an advocate that has their best interest in mind.

“I love seeing the shift with moms of color and Black moms,” says Sellerz-Jackson on more Black women choosing to have a doula. “Really letting people love on them. Knowing that they’re okay to love on them, that they’re safe. That they’re worthy of it. They deserve it.”

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