By Christina Fernández-Morrow, Hola Iowa
Des Moines, IA-Black Iowans are six times more likely to die during childbirth than white Iowans, and Black infants have the highest infant mortality rate in the state, according to the Centers for Disease Control and Prevention (CDC). As an Afro-Latina beginning her adult life in Iowa, these statistics terrified Paola Elena Acuña. “That is very scary as a Black and Latina woman who wants to be a mother and raise her children here,” she says.
Before entering motherhood, Acuña researched doulas and was struck by the difference they can make– it was literally life or death.
“There are a lot of myths and misconceptions, like doulas being for home births, which is completely false,” she recalls of her discoveries. In 2020, she attended online seminars and workshops to learn more. During her pregnancy in 2021, she hired a doula. “My experience with my doula was absolutely amazing. She educated me so much and made me feel very confident,” she says. “After I had my baby, I told her, ‘I want to become a doula and help more women.’”
With few Black doulas in Iowa, and even fewer who also spoke Spanish. Acuña saw an opportunity. Speaking flawless English and Spanish, she knew she could help two populations who face higher risks in the healthcare system. With her doula as her mentor, Acuña began her training in childbirth and labor support. The certification process includes attending at least three births: one vaginal and one unplanned C-section, in addition to coursework and exams. She learned evidence-based insights into the benefits of doula support, the history of childbirth, and practical hands-on techniques for birth and postpartum, along with career guidance. For Acuña who is also a certified lactation consultant, her training requires membership in the Childbirth and Postpartum Professional Association (CAPPA), an international certification organization for doulas, childbirth and lactation educators.
The work is demanding, but Acuña knows it’s crucial to increasing healthy births. “Labor is very unpredictable regardless of how well we prepare,” warns Acuña. According to the Iowa Department of Health and Human Services, three out of five pregnancy-related deaths are preventable. This drives Acuña to ensure people of the African diaspora, whether they come from Latin America like her or other parts of the world, have the physical, emotional and educational support during one of the most transformative times in their lives.
Part of a doula’s role is mitigating childbirth stress factors as much as possible so her client can have a less traumatic experience. Acuña advocates for medical professionals to explain the risks and benefits of medical interventions, allowing patients to decide what is best for them. “I ask, ‘Can they have more time? Does this really need to be decided right now?” She insists that most decisions, unless in an emergency, allow time to choose and discuss alternatives.
When her clients are Spanish-speakers, hospital staff often expect Acuña to be an interpreter, a role that requires a different skill set and training. “I cannot serve as an interpreter in hospitals; that’s not within my scope of work. I face that every time I go to the hospital and there is a Latina mom who doesn’t speak English,” she laments. “They think because I speak both languages, I can interpret all the medical stuff. I immediately say no.” In those moments she requests a medical interpreter so she can focus on her client’s needs.
Regarding pre- and post-birth, Acuña says, “We’re going to educate you about all the procedures and everything that happens with your body. Nutrition, resources, where to go if you have certain medical conditions and the doctor is only prescribing you medicines, I can give you references for second opinions.” Aside from movements and foods that enhance the body before, during, and after birth, she ensures the family and other supports know how to help during those times. “I prepare you emotionally, mentally, and spiritually so you are confident about what your body does, so you can trust your intuition,” she says.
Acuña recommends researching options through the Iowa Black Doula Association, the Black Doula Collective, the Young Women’s Resource Center, Molina Health Care, and EveryStep. “There are a lot of Black doulas who work privately as well,” she says. “There’s also doulamatch.com. There are so many different places to find a doula in Iowa.”
Acuña’s passion grows with her aspirations. In January 2025 she announced some exciting news through her business, Rising Doula, LLC that she received a scholarship to become a childbirth educator and become certified with Lamaze International, the only organization teaching this course in Spanish. Upon completion in the spring Acuña will be the only Spanish-speaking certified childbirth educator in the state. “This is a game-changer for Spanish-speaking families as I will be looking into partnering with non-profit organizations to offer these classes for free to the expecting community,” she shared.
Acuña aims to reduce preventable pregnancy-related deaths through holistic care focused on communities that haven’t had many resources in the past. Her work is creating pathways to healthier births and empowered families for generations to come.
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