doula birth outcomes
childbirth

Birthing People of Color in America are Dying. Here's 1 Solution to the Problem

Providing underserved communities with low-cost and easy access to doulas helps improve birth outcomes for these groups.

Being pregnant is hard, especially if it's the first time. Add in the stress of a pandemic, climate change and the U.S.'s high maternal mortality rates, and almost anybody would need some additional help. That's where a doula comes in.

A doula is a nonclinical, trained professional who provides physical, emotional and informational support to a birthing person.

"Traditionally, when we were living communally, you had people to provide the support, especially for Black communities, so that doula was your sister, that doula was your aunt, because when it came time for you to have a baby, somebody needed to feed you," Nicole Miles, doula and certified lactation counselor, told NBCLX. "Somebody needs to make sure your house was clean. ... They're coming to you with information and providing that social, emotional, physiological, psychological support."

Doulas have been around for centuries, but it wasn't until a couple of decades ago when people started documenting their impact on birth outcomes. Spoiler alert, it improves them.

Dozens of studies have concluded that people with doula support deliver their babies faster, have lower C-section rates and are less likely to have preterm or low birth-weight baby.

But despite being one of the most advanced countries in the world, maternal mortality rates in the U.S. are incredibly high, especially in communities of color.

The maternal mortality rate for 2018 was 17.4 deaths per 100,000 live births. The mortality rate for Black women (37.3) was 2.5 times the rate for white women (14.9).

Those are the kinds of statistics that people like Twylla Dillion, Ph.D, at Health Connect One, a national birth equity organization, are working to change.

"The term health disparity is one that I'm not a huge fan of. It's an inequity. This shouldn't be. This is something that has happened because of what we've experienced historically, so doulas and midwives getting increased attention has a lot to do with the way that they can help improve our outcomes," Dillion said. 

During birth, doulas can serve as an extra set of eyes and ears in the hospital room. They also help birthing people stick to their birth plans as much as possible.

"I just wanted to make sure that I was protected, that my voice was heard," new mom Jessica Dixon said. "Because when you're having a baby, you're just in pain. So having a doula in the room or someone who's prepping you to ask questions, I wouldn't have thought to say that stuff or to know that I could tell them that."

Doulas are different from midwives, who are medically trained and help with giving birth, often outside of hospitals or in birthing centers. 

"It's an ancestral, sacred art," said Alexis Robles-Fradet, health policy analyst at the National Law Health Program. "It was regulated of existence for a while until it was kind of a feminist movement to be more engaged in birth. And I think with that increase in desire for autonomy, it's something that has made doula care and midwife care more popular."

Miles added: "We treat pregnancy as a condition that requires medical management. That's where we fall short. But if we make this a very normal thing, we may see a home birth as very normal or we may see ... our bodies, in and of themselves, as something normal that sets the stage for true empowerment education."

It also sets the stage for new way of thinking when it comes to childbirth in America, specifically with legislation.

Dillion believes it's critical that Medicaid cover doulas. Why? Medicaid covers over half the births in the country — more than any other U.S. insurance provider. Many of these birthing people are under-resourced and Black, brown or Indigenous, so they stand to benefit even more from easy and low-cost access to doulas.

Only four states currently reimburse doulas. Oregon, New Jersey and Minnesota went the legislative route; Florida didn't. Instead, Florida provides doula care as an enhanced benefit for insurance plans to pick up, and all of the major plans decided to add it. So there's a statewide rollout, without any new laws.

"It's important to see what have those states done so other states don't replicate the same mistakes or challenges that these states have already gone through," Robles-Fradet said.

Currently 28 other states have ongoing legislative efforts to include doula care into Medicaid coverage. Proposed federal legislation includes things like the Black Maternal Health Momnibus Act and portions of President Biden's Build Back Better campaign. Both of these initiatives would dedicate millions of dollars to community-based services already working with doulas and midwives.

But these two policies aren't the magical answer to solving maternal health inequity in the U.S.

"Right now we're in a state where we're trying to retrofit things. We're trying to add these things onto [the current health care system] ... to make it better. You need to knock it all down and redo it," Miles said. "A doula is providing care for a person who's going into the hospital system. That hospital system has not changed. I'm not trying to be a conflict to what your medical provider is saying. I want to be in collaboration with that provider."