Black Maternal Health and The Role of Doulas

A doula is an individual that provides professional emotional and physical support to new and expecting parents before, during, and after birth. Many types of doulas are available for support during each stage of the pregnancy journey. Below we will discuss the black maternal experience, the different types of doulas and their roles, and the impacts of doulas on black maternal health and birthing outcomes!

The Black Maternal Experience

It's evident that women of color, especially black women, face adverse perinatal and health outcomes compared to other races. A recent Ontario population-based retrospective cohort study found differences in perinatal outcomes between White and Black people in which Black pregnant people had higher rates of stillbirths, preterm births, and cesarean sections (Miao et al., 2022). Black individuals also have higher risks of gestational diabetes, preeclampsia, placental abruption, low birth weight, and infants who are small for gestational age. These adverse pregnancy and health outcomes may be attributed to obstetric racism, which is the form of violence and abuse that medical personnel or any personnel within medical institutions routinely perpetrate against Black women (Scott & Davis, 2021,p. 682). Black women also experience gendered racism in which both marginalized identities, women and black, lead to further discrimination. There is increasing recognition that the racism, discrimination, and mistreatment experienced by many black women have a distinct relationship to health outcomes. Experiences of racism and the fact that racism exists and is inherently present in our healthcare system can cause stress leading to poor health and perinatal outcomes among black women. We must have conversations about these differences in health and birthing outcomes among black women so we can begin to address this issue and push for change. 

Fertility Doula 

A fertility doula is an individual who supports people on their journey to becoming pregnant, regardless of the route that they decide to take, whether it includes the fertility clinic, IVF, at-home monitoring, insemination, or a combination of these methods. A fertility doula can provide support in the form of emotional, physical, or education-based support to best suit your needs. 

Labor and Delivery Doula

A labor and delivery doula is probably the most well-known doula. These individuals meet with clients for prenatal appointments to get to know the client and their preferences. They support individuals by offering a space for the client, and their partner(s), if relevant, to share their needs, fears, hopes, and questions about labor, birth, and the beginning of parenting. Doulas then provide continuous physical and emotional support during labor, delivery, and the initial few hours of postpartum. This support can look like verbal and nonverbal reminders to breathe, affirmations, comforting touch, invitations to change positions, and communication support between the client, care providers, and/or partner(s). 

Postpartum Doula 

The postpartum period begins immediately after birth and is typically considered to end six weeks after birth as hormone levels and the uterus returns to a pre-pregnancy state. Postpartum doula support can be offered in-home or online. Since the covid-19 pandemic, there has been an increase in options for virtual support. Postpartum doula support can look like cooking or coordinating meals/nutrition, offering information about postpartum healing, sharing newborn care tips and tricks, and helping the birthing person connect to mental health professionals, among many other ways.

Impacts of a Doula on Black Maternal Health 

Although a doula's primary role is to emotionally support clients, this can considerably impact physical health and perinatal outcomes. Research shows that doulas can be beneficial for physical pain, reduce the risk of cesarean sections, decrease labor times, and contribute to maternal satisfaction with the birthing process. This study published by (Bohren et al., 2017) also showed evidence that doula support in labor can lower postpartum depression in mothers. There is no evidence of negative consequences to continuous labor support. This study demonstrated improved perinatal outcomes for women with both a birth partner and a doula compared to having a birth partner alone. The Cesarean rate for first-time mothers was 25% for people with a partner only and 13.4% for those with a partner and a doula. The increase in spontaneous vaginal birth was most significant in the group, with a doula present at a 15% increase. There was also a 10% decrease in the use of any medications for pain relief, shorter labors by 41 minutes on average, and a 38% decrease in the baby's risk of a low five-minute Apgar score. However, there is no data on if the type of person (family, friend, or doula providing continuous support makes a difference.

Thank you!

After reading this post, I hope your knowledge of the role of doulas and the black maternal experience has expanded.

References 

Scott, K. A., & Davis, D. (2021). Obstetric racism: Naming and identifying a way out of black women's adverse medical experiences. American Anthropologist, 123(3), 681-684. https://doi.org/10.1111/aman.13559

Miao Q, Guo Y, Erwin E, Sharif F, Berhe M, Wen SW, et al. (2022) Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada. PLoS ONE 17(6): e0269158. https://doi.org/ 10.1371/journal.pone.0269158

Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. The Cochrane database of systematic reviews, 7(7), CD003766. https://doi.org/10.1002/14651858.CD003766.pub6