1

Doula Care to Reduce Negative Maternal Outcomes

Sarah Austin

California State University, Channel Islands

HLTH 499

Professor Winans

July 30, 2023

 2

Doula Care to Reduce Negative Maternal Health Outcomes

The United States is experiencing a maternal health crisis, topping the charts as having

one of the highest maternal mortality rates in the industrialized world. When examining the

reasons for this, we find a major maternal health disparity happening within our healthcare

system, greatly affecting women of color. According to research, here in the United States, Black

women have a maternal mortality rate three times that of White women (Sayyad et al., 2023).

Black women also are more likely to experience mental health conditions related to pregnancy

such as postpartum depression symptoms, double the rate of White women (Falconi et al., 2022).

Addressing these health issues requires a multifaceted approach that acknowledges the systemic

racism that exists within our healthcare system while also developing solutions and interventions

to reduce the disparity. The following articles discuss the research and data that show

improvements in maternal health outcomes when doulas are caring for pregnant women during

perinatal care.

Doulas work as a non-medical birth support person that provides physical and emotional

comfort to birthing people throughout the pregnancy, birth, and postpartum period. They serve as

advocates and mediators between pregnant women and their providers, providing more effective

communication. An article looking at doulas effects on maternal and birth outcomes found that

doulas have been shown to be correlated with positive delivery outcomes such as reduced

cesarean rates, preterm deliveries, length of labor, and postpartum depression and anxiety rates

(Sobczak et al., 2023). A study sampling women receiving Medicaid with doula support across

three states in the U.S. found a 52.9% decrease in cesarean surgery and a 57.5% decrease in rates

of postpartum depression and anxiety (Sobczak et al.,). Another study exploring the impact of
 3

doulas on socially disadvantaged mothers found that those receiving support from a doula had

better birth outcomes, were 4 times less likely to have a low-birth weight baby, two times less

likely to experience a birth complication, and significantly more likely to start breastfeeding

(Sobczak et al., 2023). Sobczak et al. (2023) argues that providing low-income mothers a doula

will both reduce health disparities and costs of labor by reducing the rates of adverse events in

childbirth.

Another study came to similar findings of reduced cesarean sections with doula support,

concluding that these reductions can be linked to lower maternal mortality rates as cesarean

surgeries come with their own set of risks and increase likelihood of complications (Sayyad et

al., 2023). Sayyad et al. (2023) describes an increased benefit from having Black doulas serving

Black expectant mothers, acting as protectors from negative social determinants of health. This

particular study found that this arrangement created dynamics that promoted a good birth

experience such as knowledge, respect, self-efficacy during birth, and connectedness (Sayyad et

al., 2023). In accordance with this is an article that addresses the systemic racism in birth doula

services, and finds that community-based doulas offer additional support by being able to

connect through shared experiences of structural racism between doula and pregnant individuals

(Van Eijk et al., 2022). This understanding creates a strong relationship increasing the pregnant

person’s trust, engagement in their own healthcare, and ability to advocate their needs (Van Eijk

et al., 2022). Both Sayyad et al. (2023) and Van Eijk et al. (2022) recognize the need to address

barriers of access to doula care for Black women as well as diversifying the workforce to better

support the unique needs of diverse populations.

An article examining the role of doulas in respectful care for communities of

color illuminated the high rates of mistreatment during labor and birth in the United States. The
 4

article states that “Mistreatment was more common among women of color, including Black,

Hispanic, Indigenous, and Asian women, and especially low‐income women of color—27% of

whom reported mistreatment—compared with low‐income white women (19%)” (Mallick et al.,

2022). A study conducted in California discovered that the association between doulas and

respectful care was stronger among communities of color and promoted informed decision

making, advocating for oneself, and empowerment (Mallick et al., 2022). This article is in

agreement that utilizing doulas for marginalized groups can help increase respectful care and

reduce disparities in maternal experiences.

According to a research study conducted evaluating doula programs providing

support to women at high-risk for adverse maternal health outcomes found that those receiving

doula care attended their postnatal appointment at a rate of 61.5% vs those not receiving doula

care at 35.9% (Falconi et al., 2022). This study also found increased rates of prenatal doctor's

visits as well. Attending pre and postnatal appointments are critical in promoting the best health

outcomes for both mother and baby. This article concludes that women most at risk for poor

maternal health outcomes can greatly benefit from the support of a doula by mitigating their

health risks (Falconi et al., 2022).

These articles described the benefits of implementing doula services to reduce the

negative maternal health outcomes experienced by marginalized communities. All women

regardless of race deserve the same quality of healthcare, especially during pregnancy. Based on

the outcomes, women of color and other disadvantaged populations should have access to doula

services as the first line in combating systemic racism, reducing costs, and protecting mothers

and babies. From a practical standpoint, studies are showing significant reductions in cesarean

births and other complications which will save money, offsetting additional doula costs. Doula
 5

services should become widely adopted, especially for women of color, as one of the best ways

to equalize maternal healthcare to the benefit of our entire society.

 6

References

Falconi, A. M., Burt, S. B., Tang, T., Malloy, D., Blanco, D., Disciglio, S., & Chi, W. (2022).

Doula care across the maternity care continuum and impact on maternal health: Evaluation of

Doula programs across three states using propensity score matching. SSRN Electronic Journal.

https://doi.org/10.2139/ssrn.4023204

Mallick, L. M., Thoma, M. E., & Shenassa, E. D. (2022). The role of doulas in respectful care

for communities of color and Medicaid recipients. Birth, 49(4), 823-832.

https://doi.org/10.1111/birt.12655

Sayyad, A., Lindsey, A., Narasimhan, S., Turner, D., Shah, P., Lindberg, K., & Mosley, E. A.

(2023). “We really are seeing racism in the hospitals”: Racial identity, racism, and doula care for

diverse populations in Georgia. PLOS ONE, 18(6), e0286663.

https://doi.org/10.1371/journal.pone.0286663

Sobczak, A., Taylor, L., Solomon, S., Ho, J., Kemper, S., Phillips, B., Jacobson, K., Castellano,

C., Ring, A., Castellano, B., & Jacobs, R. J. (2023). The effect of Doulas on maternal and birth

outcomes: A scoping review. Cureus. https://doi.org/10.7759/cureus.39451

Van Eijk, M. S., Guenther, G. A., Kett, P. M., Jopson, A. D., Frogner, B. K., & Skillman, S. M.

(2022). Addressing systemic racism in birth Doula services to reduce health inequities in the

United States. Health Equity, 6(1), 98-105. https://doi.org/10.1089/heq.2021.0033

7