In 2016, Black babies in Milwaukee died at three times the rate of white babies, according to Fetal Infant Mortality Review.

Although the overall infant mortality rate has decreased in the last decade, Wisconsin still has the highest mortality rate for infants in the country and the gap between white and Black babies born in Wisconsin is the largest in the nation.

These racial disparities are what motivated Milwaukee native Sabrina Foulkes-Thomas to be a doula, a lactation specialist and ultimately a midwife. For over a decade Foulkes-Thomas has served more than 600 families and in 2016 she became one of the first African American Certified Professional Midwives in Wisconsin.

“The infant mortality rates in Milwaukee are substantial and that is due to a lack of culturally competent research and a lack of providers who understand systemic racism and how it affects birth outcomes,” Foulkes-Thomas told Madison365. “We know that Milwaukee is a segregated city and we know that racism is a compounding factor in our infant mortality rates, so we’re not only battling women taking care of themselves and having access to prenatal care, but also racism which is compounded by stress, which is generational.”  

Foulkes-Thomas first learned about doulas when she decided to use one with birth of her daughter. After learning that doulas can improve birth outcomes and decrease postpartum depression, she began to do her research.

She went back to school for nursing and began to do her own doula work while also working with teenage moms at North Division High School and being a WIC peer counselor for the Health Department.

“It just became one step after another of helping families and trying to educate and empower,” she said.

Foulkes-Thomas is now working on her next step which is turning her business, Birth in Color, into an initiative and nonprofit that focuses on increasing access to out-of-hospital care to women of color and provides holistic educational resources for conception, pregnancy, and postpartum.

“I think a lot of people don’t realize that when you’re in the hospital setting the medical team is technically a kind of authoritative figure, even though they’re there to help you,” she said. “A lot of families don’t realize like they have the right to say this or the right to ask these questions and being a doula allows me to be a support person and an advocate who can create a bridge between those two dynamics.”

Right now Foulkes-Thomas’s primary goals for Birth in Color are creating mobile midwife clinics where women can receive out-of-hospital care, and raising funds that can be used to eliminate the financial barrier for women seeking to give birth at home or in a birthing center.

Foulkes-Thomas is also a member of a collective of midwives, Choice Matters, that are all BadgerCare providers, but the birthing center that they use is not covered by the state insurance program.

“I would hate for someone to be low-risk and a perfect candidate, but cannot give birth the way they want because they cannot afford it,” she said.

She has already begun to help women cover the cost of birthing centers and equipment needed for home births.

Foulkes-Thomas also stresses the importance of health education and preconception care, as predisposal to health conditions pose additional barriers to women of color qualifying for home births, thus reducing their options.

In order to give birth outside of a hospital a person must be considered low-risk, a classification that includes not giving birth prior to 37 weeks of gestation, not being insulin dependent, not having or exhibiting symptoms of preeclampsia and not birthing more than one child, according to Foulkes-Thomas. All of those risk factors are more likely to happen to Black women, she said.

“African American women run a higher risk for so many things and if we can catch people at the beginning and start doing preconception education, I really think we can start to change these outcomes with our birth and with infant mortality,” she said.

After completing her required number of births as a Certified Professional Midwife, Foulkes-Thomas hopes to begin educating other women of color on becoming doulas and midwives to increase the number of non-white out-of-hospital providers.

Ultimately she strives to not necessarily push more women of color to birthing outside of the hospital, but instead hopes to inform women of their options and encourage them to have more autonomy over their birthing process.

“This is my passion, so anywhere I can go and anything I can do, I do.” she said. “I just want to give people more information about their choices because it is a very personal choice.”