Underserved women of color typically live with high levels of chronic stress. During pregnancy and childbirth, they commonly face disrespect, poor communication, and other biased treatment by the health care system that can lead to delays in treatment, poorer quality treatment, and poorer health outcomes for their babies and for themselves. They also face greater challenges in the postpartum period to manage their babies’ needs while not neglecting their own, with the elevated stress levels of this time having a greater negative impact on their health because of their higher baseline levels of stress and overburdened social support systems.
The effectiveness of doula services in improving pregnancy outcomes through client education and guidance, expert health care advocacy, and perinatal support is well-established. This effectiveness has been demonstrated primarily in relation to medically “low-risk” pregnancies, which is particularly relevant to efforts to reduce racial disparities in maternal health in that racial disparities in outcomes are the greatest for medically “low-risk” pregnancies. Expanding doula services to underserved women of color holds tremendous potential in reducing racial disparities in maternal mortality and other maternal health outcomes, and in a very cost-effective manner.
In coordination with project partners Nzuri Malkia Birth Cooperative (NMBC) and Birth Supporters United (BSU), Baltimore Healthy Start (BHS) will recruit 6-7 doula trainees in order to ensure at least 4 will complete training, be certified, and be available to provide doula services to BHS clients. By the end of the project period, at least 80 BHS clients will receive doula services from the doulas trained under the project.
The training program, featuring the NMBC curriculum and mentoring by BSU doula practitioners, combined with the embedding of doula practice within the comprehensive case management, social support, and health education service structure of Baltimore Healthy Start, will offer the trained doulas the resources necessary to offer services and referrals for individuals who need more comprehensive support than most doula training programs prepare them to provide.
The project will act as a demonstration to inform the policies that the State of Maryland could develop to offer Medicaid reimbursement to extend doula services to Medicaid beneficiaries. In this way, the impact of the project has the potential to extend far beyond the doulas trained and the doula services delivered to Baltimore Healthy Start clients funded under the grant.
The project was developed by Andrea Williams-Muhammad of NMBC, Patricia Liggins of BSU, and Lashelle Stewart of BHS, and the grant proposal was written by Peter Schafer.