New Doula Program Aims to Address Maternal Health Inequities

Having access to a trained, nonclinical advocate during labor and delivery — and for prenatal and postpartum support — can improve equity and outcomes.
doula with a patient

UMass Memorial Health will be launching a doula program at UMass Memorial Medical Center with the goals of positively impacting the patient experience and improving specific birth and postpartum outcomes, especially among pregnant patients of color. The 15 doulas who have been trained as part of program initiation have diverse cultural and linguistic backgrounds, and they strive to help patients feel more empowered during their birthing experience.

Clinicians at UMass Memorial Health are working to improve patient experience and health outcomes for their pregnant patients, while mitigating social determinants and inequities that can adversely affect pregnancies. They believe that doulas — non-clinical professionals trained to advocate for the patient giving birth and to provide prenatal and postpartum support — are an essential addition to the care team.  

"There is a large and growing body of literature around the effectiveness of doulas as support persons to help improve equity and outcomes, especially among pregnant patients marginalized by racism and socioeconomic disadvantage,” said Tiffany Moore Simas, MD, MPH, MEd, Chair, Department of Obstetrics and Gynecology, UMass Memorial Health, and Professor, UMass Chan Medical School.

“Our goal is to provide patients with a more empowered birthing experience, where their voices are heard and their preferences are honored. This will improve the emotional and lived experience of the birth, while promoting equity and improved clinical outcomes.”

Advancing health equity

According to the Centers for Disease Control and Prevention (CDC), about 700 people in the U.S. die annually from pregnancy-related causes during pregnancy or during the year after giving birth, with most of these deaths preventable. Another 50,000 have unexpected outcomes of labor and delivery with serious short- or long-term health consequences. Black birthing patients are three times more likely to die from a pregnancy-related cause than their white counterparts.

As the top provider of health care to the multiracial, multiethnic and multilingual birthing patient population of Central Massachusetts, UMass Memorial Medical Center is uniquely positioned to develop innovative initiatives such as the doula program to address these health inequities.

“Our outcomes are very good,” Moore Simas said. “But like the rest of the country, we have disparities across racial and socioeconomic lines, and we are very committed to advancing equity and continually improving what we do.”

Studies have shown that having a labor support person:

  • Improves the quality of care the patient receives during labor and raises the patient’s perception of that care
  • Helps with communication between the laborer and their team, particularly if there are language barriers
  • Results in better outcomes

“Patients who have the support of a doula feel that they really have a voice in their labor,” said Gina Sullivan, MD, OB/GYN, Assistant Professor, UMass Chan Medical School.

“By pairing patients with culturally competent and skilled providers who can meet their personal needs during labor, we are hoping to enhance our level of care to our laboring patients in minority populations, addressing inequity we see in care for this population,” she said. 

Building a sustainable, meaningful program

In May 2021, supported by philanthropic funding and a CDC Racial and Ethnic Approaches to Community Health grant, UMass Memorial Medical Center partnered with an experienced doula training organization and successfully trained 15 doulas, who represent a diversity of backgrounds, life experiences and languages, including Brazilian Portuguese, Spanish, Yoruba (Nigeria) and Twi (Ghana).

The ultimate goal is to create a sustainable network of doulas who are culturally and linguistically concordant with patients and partner them throughout prenatal and postpartum care. With enough of a team to provide back-up coverage, doulas will assist at one to two births each month to start, with each doula eventually supporting three to four births per month.

“The ideal is for doulas to form a relationship with the patient not just during labor, but also throughout the prenatal, birthing and postpartum process, recognizing that the postpartum period is a very high-risk time for issues,” Sullivan said.   

Integrating doulas into the birthing team

The introduction of a doula requires a culture change to the traditional obstetrics team.

“We are approaching this thoughtfully to ensure that our doulas are fully integrated and embraced as part of the birthing team,” Sullivan said. “When the integration of doulas happens in a holistic way, providers seek them out. Providers recognize the positive impact of having someone at the bedside whose only job is to support the emotional and physical needs of that patient, lending a voice to their concerns and freeing up the clinical team to focus on the progress of labor.”

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