Many mothers suffer serious complications, and doulas could help

With America’s maternal health crisis gaining more attention, healthcare leaders say that mothers clearly need more help.

Some healthcare leaders say that increasing access to doulas could help patients avoid complications and have healthier babies. Doulas aren’t clinicians but they offer support to patients during pregnancy, childbirth and after delivery.

Elizabeth Cherot, CEO of the March of Dimes, has repeatedly said doulas could help reduce maternal mortality and serious complications. In a September interview with Chief Healthcare Executive®, Cherot said doulas could make a difference in improving outcomes. She said she’s hoping that she would like to see hospitals partner with the March of Dimes to integrate doulas into their services.

“That would be a place that I think that hospital systems could really partner with us,” Cherot said.

Any remedies to help improve maternal health appear to be worth trying. Maternal deaths rose 40% in 2021 compared to the previous year, according to figures from the Centers for Disease Control and Prevention. Black women are 2.6 times more likely to die of maternal causes than white women, according to federal data. As many as 60,000 U.S. women suffer severe childbirth-related health complications annually, according to the Commonwealth Fund.

Most women don’t use doulas during pregnancy. Only 6% of patients who had given birth received assistance from a doula, according to a 2013 study.

The March of Dimes has teamed with the CVS Health Foundation to raise awareness and improve access to doula services. The foundation donated $4 million over five years to the March of Dimes to expand doula care and recruit more doulas from diverse groups.

In addition, the March of Dimes has financed a research center at the University of Pennsylvania, the Penn Research Center for Advancing Maternal Health Equity, to explore the integration of doula in maternal care. The organization has called for more training and development of doulas.

Cherot noted that many patients don’t have access to doulas because they can’t get reimbursed for coverage. Many private insurers don’t cover doula services, so patients must pay for services out of their own pocket. Depending on the region, doulas can cost anywhere from $500 to $2,000, according to Parents.

Across the nation, only 11 states, along with Washington, D.C., offer Medicaid reimbursement for services from doulas, according to the Georgetown University McCourt School of Public Policy. But most states are seeing legislative efforts to expand Medicaid coverage for doulas.

Cherot has said expanded access to doulas, and other services such as mobile units offering maternal care, are vital to deal with the number of maternity care deserts in America. More than one-third of U.S. counties don’t offer obstetric services, the March of Dimes says.

Kisha Davis, MD, a board member of the American Academy of Family Physicians, noted that expanded access to doulas could reduce disparities in maternal health among Black patients.

“We've seen some really great outcomes,” Davis said in a recent interview with Chief Healthcare Executive®. “The doula programs are still pretty small, and the funding is difficult.”

Doulas can serve as an additional voice for pregnant patients, including raising concerns about potential complications. Davis said a family member worked with a doula, who provided valuable help during a difficult pregnancy.

“Having somebody there who could help advocate for her, and help navigate through that process really made a difference,” Davis said.

The March of Dimes also points out that patients working with doulas are more likely to breastfeed their babies and avoid postpartum depression.

Researchers who examined more than 15,000 patients in 17 countries found doulas helped mothers and babies, according to findings published by Cochrane Library. Working with care teams, doulas helped patients have shorter periods of labor, and they were more likely to avoid C-sections. The support of doulas “may improve outcomes for women and infants, including increased spontaneous vaginal birth,” the study found.

A 2013 study in The Journal of Perinatal Education also points to doulas helping patients.

“Doulas can empower women to achieve the best birth outcomes possible, and all outcomes—for births, infants, and mothers—seem to be affected more positively if support is provided by a doula in addition to the medical personnel,” researchers wrote.