Addressing Systemic Racism in Birth Doula Services to Reduce Health Inequities in the United States

Eijk, Marieke S. Van; Guenther, Grace A.; Kett, Paula M; Jopson, Andrew D.; Frogner, Bianca K.; Skillman, Susan M.

doi:10.1089/heq.2021.0033

Cited by 22 publications

(19 citation statements)

References 27 publications

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“…The use of doulas is expanding as a cost-effective way of reducing health disparities by providing support to women before, during, and after labor and delivery, including through community-based organizations. 6 Doula support is associated with fewer cesarean and interventional vaginal births, as well as lower rates of postpartum depression and anxiety. This movement is growing, including through Healthy Start funding of community-based doula initiatives.…”

Section: Workforce Challengesmentioning

confidence: 99%

Maternity Care Deserts in the US

Sonenberg

Mason

2023

JAMA Health Forum

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Section: Workforce Challengesmentioning

confidence: 99%

Maternity Care Deserts in the US

Sonenberg

Mason

2023

JAMA Health Forum

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“…7,8 Doula-supported births have received increasing attention as a potential, yet underutilized, strategy to ameliorate racial disparities in birth outcomes. 9 Doulas are trained, nonmedical childbirth professionals providing continuous physical, emotional, and informational support for birthing people throughout pregnancy and postpartum. 9 They aid in navigating birthing clients through the health care system, building skills in their self-advocacy, providing comfort measures, and developing birth plans.…”

Section: Objectivementioning

confidence: 99%

“…9 Doulas are trained, nonmedical childbirth professionals providing continuous physical, emotional, and informational support for birthing people throughout pregnancy and postpartum. 9 They aid in navigating birthing clients through the health care system, building skills in their self-advocacy, providing comfort measures, and developing birth plans. 10 Doulasupported births are associated with improved clinical outcomes, including lower rates of cesarean birth, and more effective communication with medical professionals, [11][12][13][14][15][16][17] especially among historically marginalized communities.…”

Section: Objectivementioning

confidence: 99%

“…10,17,18 Doulas can offer additional support that address the effects of structural racism, which may increase trust and engagement in prenatal care, and bolster birthing persons' agency in medical decision making. 9 Despite these benefits, doula services are not covered by most insurance plans and are not integrated with routine prenatal care. 19,20 Digital health platforms are a potential solution to increase access to doulas and overcome roadblocks in coordinating care.…”

Section: Objectivementioning

confidence: 99%

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Association Between Doula Use on a Digital Health Platform and Birth Outcomes

Karwa,

Jahnke,

Brinson

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To examine the association between the use of virtual doula appointments on a comprehensive digital health platform and users' mode of birth and their birth experiences, among all platform users and Black platform users. METHODS: Data for this retrospective cohort study were extracted from individuals who enrolled in a comprehensive digital health platform, between January 1, 2020, and April 22, 2023. Multivariable logistic regression models were used to estimate the association between number of virtual doula appointments completed on the digital health platform and odds of cesarean birth and user-reported birth experience outcomes, which included help deciding a birth preference, receiving a high level of support during pregnancy, learning medically accurate information about pregnancy complications and warning signs, and managing mental health during pregnancy, stratified by parity. The interaction of doula utilization by race for each outcome was also tested. RESULTS: Overall 8,989 platform users were included. The completion of at least two appointments with a virtual doula on the digital health platform was associated with a reduction in odds of cesarean birth among all users (adjusted odds ratio [aOR] 0.80, 95% CI, 0.65–0.99) and among Black users (aOR 0.32, 95% CI, 0.14–0.72). Among platform users with a history of cesarean birth, completion of any number of doula visits was associated with a reduction in odds of repeat cesarean birth (one visit: aOR 0.35, 95% CI, 0.17–0.72; two or more visits: aOR 0.37, 95% CI, 0.17–0.83). Analyses among all users indicated dose–response associations between increased virtual doula use and greater odds of users reporting support in deciding a birth preference (one visit: aOR 2.35, 95% CI, 2.02–2.74; two or more visits: aOR 3.67, 95% CI, 3.03–4.44), receiving a high level of emotional support during pregnancy (one visit: aOR 1.99, 95% CI, 1.74–2.28; two or more visits: aOR 3.26, 95% CI, 2.70–3.94), learning medically accurate information about pregnancy complications and warning signs (one visit: aOR 1.26, 95% CI, 1.10–1.44; two or more visits: aOR 1.55, 95% CI, 1.29–1.88), and help managing mental health during pregnancy (one visit: aOR 1.28, 95% CI, 1.05–1.56; two or more visits: aOR 1.78, 95% CI, 1.40–2.26). CONCLUSION: This analysis demonstrates that virtual doula support on a digital health platform is associated with lower odds of cesarean birth and an improved birth experience. Positive findings among Black users and users with vaginal birth after cesarean suggest that doula support is critical for patient advocacy, and that digital health may play a meaningful role in increasing health equity in birth outcomes.

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“…Studies have found that people of color and individuals from underserved communities are more likely to work in underserved areas, providing increased access to health care in medically underserved communities 58 . Birth doulas are an example of an occupation in which practitioners often originate from the communities they serve (with short training pathways) and positively affect pregnancy and birth outcomes among underserved populations 63 . Recent studies of orientation to, and preparation for, rural practice by nurse practitioner education programs have identified a variety of factors facilitating, and limiting, interest in rural practice 64 .…”

Section: Recruiting and Retaining The Workforce That Reflects The Pop...mentioning

confidence: 99%

The Workforce Needed to Address Population Health

2023

Self Cite

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On-the-job training programs and employer support are needed for the current health workforce to gain skills and competencies to address population health.r Funding and leadership combined are critical for developing the population health workforce with the goal of supporting a broad set of workers beyond health and social care to include, for example, those in urban planning, law enforcement, or transportation professions to address population health.

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Addressing Systemic Racism in Birth Doula Services to Reduce Health Inequities in the United States

Cited by 22 publications

References 27 publications

Maternity Care Deserts in the US

Maternity Care Deserts in the US

Association Between Doula Use on a Digital Health Platform and Birth Outcomes

The Workforce Needed to Address Population Health

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