As of 2017, the pregnancy-related mortality rate in the United States was 17.3%. The rates were even more shocking when looking at specific populations by race. Between 2014 and 2017, the pregnancy-related mortality rate was 41.7% for Black communities, 28.3% for indigenous communities, 13.8% for AAPI communities, and 11.6% for Latinx communities (CDC, 2020). According to the Commonwealth Fund, the United States with a maternal mortality rate of ~17% has the highest rate among 11 industrialized countries. New Zealand ranks the lowest with a maternal mortality rate of 1.7% and Switzerland falls in the middle with a rate of 4.6% (Tikkanen et al., 2020). While the United States has a high maternal mortality rate compared to other industrialized countries, it spends more on healthcare than any other country. Research shows that providing individuals with additional support during pregnancy and at the time of labor contributes to healthier, safer, and happier outcomes (Howard et al., 2020).
Healthcare, especially when coupled with life changing moments, requires additional support apart from meeting medical needs. Individuals and families require emotional and physical guidance to ensure that in situations such as birth, they are safe and comfortable. While medical staff can and do provide valuable support, research shows that additional services are needed to keep women and their families safe, informed, and satisfied. This is where doulas come in.
Doulas, also referred to as birth workers depending on their role, provide support and resources to individuals and their families experiencing birth, postpartum, death, and life transitions. Doulas use their vast knowledge and valuable skills to provide intentional physical and emotional support during some of life's most meaningful yet challenging moments (DONA International, 2018). MSW student Libby Nuss describes the role of doulas as a reminder "of our timeless need for support."
"Traditionally, all major life transitions were surrounded by ritual. These practices helped individuals prepare, be present, and process events, often leading to more fulfilling and meaningful experiences. I believe the re-emerging importance of doulas highlights that we are moving towards more sound systems of community support and resource sharing," says Nuss.
According to Daylisha Reid, a labor, birth, and postpartum educator from Austin, TX, "Doulas typically receive training which outlines their scope of practice, offers various support techniques such as pain management for labor but most importantly educates them on how to best support their client in creating a birth plan, and empowering them to advocate for themselves and their birth wishes within their birth setting." One of the largest and most notable standard-setting and doula certifying organizations in the United States is DONA International which provides those interested in becoming doulas information, certification courses, and resources, so they are best equipped to provide the safest and most effective support.
"A doula does not replace a partner or medical professional...having a doula is proven to decrease unnecessary medical interventions, postpartum depression, maternal health risks and more, and I believe that birthing folks should always consider bringing one onto their birth team" explains Reid.
Recent studies show that doulas who are rooted in their communities can build solid and trustworthy relationships with community members by using "culturally concordant care grounded in principles of social and reproductive justice" (Ogunwole et al., 2020). A 2019 study on community-based doula care showed that Black and Hispanic mothers were more likely to be breastfeeding at six weeks, three months, and six months than those without support from community-based doulas (Ogunwole et al., 2020).
Doulas are trained professionals who provide support and advocate on behalf of individuals and families in times that are often overwhelming and confusing. Doulas are multifaceted professionals who not only assist in providing support during pregnancies and labor but also, according to Nuss, "provide support through . . . postpartum, child loss, abortion, career changes, and death." According to Reid, these doulas are often called full-spectrum doula providers.
Research is clear on this matter. It's time to reevaluate what the United States healthcare system can do to ensure community satisfaction and safety, especially for those marginalized by the same system that should be helping them. Potentially, hospitals can begin by establishing community-based doula programs in communities experiencing high pregnancy-related mortality rates and in communities that have been overlooked due to financial restraints. Doulas, as advocates and supporters, can bridge the gap between communities and service providers.
*Special thanks to Daylisha Reid and MSW student Libby Nuss. You can learn more about Reid’s work through her Instagram account @Womban_Wellness.
References
CDC. (2020). Pregnancy Mortality Surveillance System.
DONA International. (2018). What is a Doula. https://www.dona.org/what-is-a-doula/
Howard, E. D., & Low, L. K. (2020). It’s Time to Dial Up Doula Care. The Journal of Perinatal
& Neonatal Nursing, 34(1), 4–7. https://doi.org/10.1097/JPN.0000000000000456
Ogunwole, S. M., Bennett, W. L., Williams, A. N., & Bower, K. M. Community‐Based Doulas
and COVID‐19: Addressing Structural and Institutional Barriers to Maternal Health Equity. Perspectives on Sexual and Reproductive Health.
Tikkanen, R., Gunja, M., FitzGerald, M., & Zephyrin, L. (2020). Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries
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