Even after a major push to lower Black infant mortality in Milwaukee, many babies aren't living to see their first birthday.

Kristy Bassel holds her daughter, Cali, who was born at 5 pounds, 9 ounces. Bassel said her doula, Evelyn Comer, left, made her pregnancy much easier due to her advocacy. Ten years ago, the Journal Sentinel reported that in Milwaukee babies die during their first year of life at a rate greater than all but six of the nation’s 53 largest cities. Today, Black health experts say a state of emergency remains.

Kristy Bassel was two months pregnant when she saw a flyer about doula services at her doctor’s office.

“I really didn’t know what a doula was, so I Googled it,” Bassel said. “I have a small support system because I lost both of my parents, so I figured I would call to find out what a doula could offer.”

After meeting her doula, she knew she was in good hands.

“She was there for me mentally and emotionally. She really cared about my needs, and I could talk with her about things I couldn’t talk with my own doctor about,” Bassel said.

Kristy Bassel, left, holds 3-month-old Cali while her doula Evelyn Comer, right, looks on at Bassel’s home in Milwaukee on Nov. 22.
Kristy Bassel, left, holds 3-month-old Cali while her doula Evelyn Comer, right, looks on at Bassel’s home in Milwaukee on Nov. 22.

And it made a difference that Evelyn Comer was also African American.

“There was just a higher level of trust with Eve because she’s around my age, and she knew what I was going through. She’s a mom, too, so she was more than a doula to me,” Bassel said.

RELATED: Black moms, their babies face higher health risk in Wisconsin, but Legislature won’t address it

Even after Bassel had her healthy, 5-pound 9-ounce daughter, Cali, three months ago, she stays in contact with Comer.

Kristy Bassel is pictured with 3 month-old Cali in Milwaukee on Nov. 22. This is Bassel's sixth child and she said that having a doula taught her a lot.
Kristy Bassel is pictured with 3 month-old Cali in Milwaukee on Nov. 22. This is Bassel's sixth child and she said that having a doula taught her a lot.

“I wish I would have known about doula services with my (five) other children. It’s really the best way to go,” Bassel said.

Black doulas, who support women during pregnancy, labor and birth, are one piece of a complicated puzzle that can help improve birth outcomes for African American women.

Concern over Black infant mortality is rising again in southeastern Wisconsin. Black health care professionals worry that infant mortality today is little improved in the past decade, even after a major push by city officials and others to make sure more kids make it to their first birthday.

In Milwaukee, 'things have gotten worse'

A decade ago, the Journal Sentinel’s Empty Cradles project revealed that the rate at which babies in Milwaukee were dying during their first year of life was greater than in all but six of the nation’s 53 largest cities.

At that time, Black infant mortality here was worse than in some undeveloped nations.

RELATED: Pandemic restrictions have 'added an extra layer of stress' for pregnant women. These doulas are helping.

RELATED: How Wisconsin organizations supporting reproductive health and parenting weathered the pandemic

RELATED: Medicaid coverage for doulas and the postpartum period, grants for Black women's health, all part of Gov. Tony Evers' budget proposal

Overall, Wisconsin had an infant mortality rate in 2008 of 6.9 deaths per 1,000 births. The rate for white moms was 5.9 per 1,000 births. For African American mothers, it was 13.8.

And since then? Milwaukee Health Department data tell a tragic story.

In 2017, Milwaukee had an infant mortality rate of 12.6 per 1,000 births. The rate for white moms was 3.6 per 1,000 births, but for Black mothers, it was 18.2.

In 2019 — the last year the city documented — the city's infant mortality rate was 8.4 per 1,000 births. The rate for white moms was 3.3 per 1,000 births. For Black mothers, it was 12.4.

“If you ask me if we are better off today than we were 10 years ago, I will say things have gotten worse,” said Patricia McManus, president and CEO of the Black Health Coalition of Wisconsin, which works primarily with African Americans, who statistically have the worst health outcomes.

After her organization lost a $750,000-a-year federal Healthy Start grant to fight infant mortality in 2014, McManus saw a noticeable change in the way infant mortality was addressed.

At the time, Mayor Tom Barrett called the loss of this funding a "significant setback," especially when additional resources were needed to tackle the problem.

“Infant mortality is a community issue, and it has to be addressed as such, and that means understanding the needs of the woman and the needs of the family. That’s the way we were doing it,” McManus said. “I don’t know how they are doing it now, but it is not working.”

While the overall infant mortality rate was down for African American babies in 2019, the 4-to-1 gap between white and Black babies was the widest margin ever documented by the city.

“When you factor in that fewer babies are being born overall (in the city) and the gap is widening, that’s why I say things are worse today,” McManus said.

Infant mortality statistics do not include stillborn births or miscarriages. They only include babies who took their first breath and had their first heartbeat but did not live to see their first birthday, said Karen Michalski, project manager for the Milwaukee Health Department.

The federal government has set a goal for all births regardless of ethnicity to be five deaths or less for every 1,000 births, Michalski said.

But there is a long way to go to reach that lofty goal, especially in the city's impoverished neighborhoods.

In the 53206 ZIP code on Milwaukee's north side, of every 1,000 babies born in 2019, 20 died. In 2017, it was even worse, when 29 babies died out of every 1,000 babies born. Nearly all the people who live in that ZIP code are African American.

Nearly 56% of Milwaukee’s infant deaths are due mainly to prematurity, according to the city's 2017 Fetal Infant Mortality Review Report. More than 21% of Milwaukee’s infant deaths are due to congenital abnormalities and 16% are attributable to a combination of Sudden Infant Death Syndrome (SIDS) and unsafe sleep, the report said.

Black mothers had double the number of stillbirths as white moms.

McManus said African American infant mortality is far more complicated than the medical community understands.

Care must begin before a woman gets pregnant, she said.

“We need to ask questions and make sure they are healthy enough to have a baby.”

Among the questions:

Do you have a safe place to live?

Are you in a healthy relationship?

Is your environment safe?

Do you have a support system?

“All of these factors matter and play a role in the outcome of the child,” McManus said.

Milwaukee County hospitals need to be more 'baby friendly'

One thing that could help: Milwaukee County hospitals could become more “baby friendly,” said Dalvery Blackwell, founder of the Milwaukee-based African American Breastfeeding Network.

“It gets back to institutionalized racism in health care settings,” she said.

Compare hospitals in Brookfield and Mequon with hospitals in Milwaukee, and you'll see stark differences in how the needs of infants and mothers are addressed, Blackwell said.

Hospitals that are not as baby-friendly may take the newborn to the nursery right after delivery depending on the health status of the baby. In these cases, the baby is placed under a warmer to stabilize the child, and nurses perform other assessments before the baby is returned to the mom.

Baby-friendly hospitals believe a healthy start begins with skin-to-skin contact right after delivery along with breastfeeding, staff training, action plans and curriculum for hospital staff, Blackwell said.

According to Baby-Friendly USA, the accrediting body and national authority for the Baby-Friendly Hospital Initiative in the United States, there are no baby-friendly hospitals in Milwaukee County. The closest is Ascension SE Wisconsin Hospital-Elmbrook Campus in Brookfield.

African American doulas are an essential advocate for African American mothers and their newborns, Blackwell said.

“It’s a win-win for the mom and baby because doulas reduce maternal stress, which is the No. 1 driver for premature Black births.”

Doulas have also been associated with decreased cesarean rates, shorter labor, and increased breastfeeding initiation, according to the 2019 report Experiences of Community Doulas Working with Low-Income, African American Mothers.

According to Blackwell, Black infant mortality rates remain high in Milwaukee because:

  • Providers don’t listen to Black mothers. Even tennis great Serena Williams, who had complications after a cesarean birth, felt ignored by doctors when she told them she felt short of breath. Williams was brushed off twice by medical staff, but she kept advocating for a CT scan. The scan showed several blood clots in her lungs.

  • Maternal stress. Chronic high blood pressure, depression and anxiety associated with poverty and racism often go untreated and unnoticed and can lead to poor birth outcomes. "As a Black woman, you are more likely to receive substandard care regardless of social-economic status," Blackwell said.

  • Lack of trust in the health care system. This stems from the lived experiences of Black women. They often have not had a good relationship with a physician and not had physicians who looked like them. A new study suggests that when Black newborns are treated by Black physicians after birth, the mortality disparity between Black and white babies shrinks. "We have more and more women seeking Black physicians," she said.

The pandemic only made things harder on families.

“They were not prepared and equipped to handle the transition — from families not having the right technology at home so their children can learn to mothers not given adequate time to leave work to be at home with their children.

"They were stressed out beyond belief,” she said.

Stressful births led her to become a doula

Comer, 31, became a doula after three stressful births.

Her daughters all were born early due to preeclampsia, a serious condition some women develop during pregnancy. All were cesarean births.

Jalaiyah, 11, was born at 29 weeks; Gabriella, 6, was born at 35 weeks; and Abbyson, 5, was born at 35 weeks.

Comer did not have help from a doula for any of her births.

Before Jalaiyah was born, her doctor kept telling her everything was fine, she said, but something didn’t feel quite right.

“When I switched doctors at my first appointment, with a new doctor, he checked me out and wanted me to see a specialist,” she said.

The conclusion: Jalaiyah was not receiving enough oxygen and had low blood flow through her umbilical cord.

“Had I not switched doctors, I know my daughter probably would have died,” said Comer, who since has helped two dozen women give birth in Milwaukee.

Years later, Jalaiyah had a sleepover, and it came out that the mothers of all six girls at the house that night had had traumatic birth experiences.

After hearing the girls talk about what their mothers had gone through, Comer looked into becoming a doula.

When women are in labor, it’s hard for them to keep a clear head and be their own advocates, said Comer, who works at the WeRise Community Doula Program.

But doulas start assisting their clients well before they are in the delivery room. The first step is a meeting to discuss their needs and the needs of the family. Fathers are encouraged to be a part of the conversation.

Doulas do everything from informing women of their rights to rubbing their arms and giving them encouragement during childbirth.

“We are there for the mother because a lot of Black women don’t trust doctors. If you had a bad experience with a doctor or a health care system in the past, why would you trust them to give you a better health outcome now?” Comer said.

Too many 'tragic birth stories' in Milwaukee

“Eve was my rock,” Bassel said. “She was there for me every step of the way, and I felt that she understood where I was coming from because she’s a young mom, too."

Bassel, a mother of six, ages 14, 13, 11, 9, 3, and 3 months, said she is done having children, but because of Comer's example, she's interested in becoming a doula herself.

“I know what it’s like not to have a support system. A doula helps to fill out those parts when you just need someone to explain something to you or tell you what to expect.”

Black women need the support.

“If you are a Black woman in Milwaukee, you probably know a Black woman with a tragic birth story,” Comer said. “We have got to change that.”

James E. Causey started reporting on life in his city while still at Marshall High School through a Milwaukee Sentinel high school internship. He's been covering his hometown ever since, writing and editing news stories, projects and opinion pieces on urban youth, mental health, employment, housing and incarceration. Most recently, he wrote "What happened to us?" which tracked the lives of his third-grade classmates, and "Cultivating a community," about the bonding that takes place around a neighborhood garden. Causey was a health fellow at the University of Southern California in 2018 and a Nieman Fellow at Harvard University in 2007.

Email him at jcausey@jrn.com and follow him on Twitter: @jecausey.

How to find a doula

If you are a pregnant African American woman in need of a doula, you can contact the African American Breastfeeding Network by calling (414) 617-3441. You can also contact WeRise Project Director Kiara Schott at kschottt@gmail.com or call (920) 376-4840. You can also go to WeRISE Community Doula Program at http://aabnetwork.org/werise.  

Our subscribers make this reporting possible. Please consider supporting local journalism by subscribing to the Journal Sentinel at jsonline.com/deal.

DOWNLOAD THE APP: Get the latest news, sports and more

This article originally appeared on Milwaukee Journal Sentinel: Despite efforts, many Black babies in Milwaukee die during first year