Birth equity on the front lines: Impact of a community-based doula program in Brooklyn, NY

Effects of Doula Care on Mother and Infant Health Outcomes in Al-Ahsa Region, Saudi Arabia: A Retrospective Cohort Study

Introduction Continued supportive care during childbirth may be the key to preventing unfavorable outcomes for both mother and child. It is important to assess and comprehend the sources of assistance available during pregnancy in order to enhance the birthing process and promote favorable outcomes. Objectives The current study aimed to assess the impact of ongoing doula support on mother and infant health outcomes compared to standard care. Methods A retrospective cohort study using both medical records and direct interviews based on information in the data collection form was carried out in the Eastern Province of Saudi Arabia, Al-Ahsa Region. The data that were collected included demographic information, obstetric history, delivery data, and postpartum outcome. Results A total of 50 pregnant women receiving doula care and 100 pregnant women receiving standard care were included. Regarding the mode of delivery, 43 (86%) of the doula group had vaginal deliveries compared to 73 (73%) of the standard care group, while CSs were needed for seven (14%) and 27 (27%), respectively (P = 0.78). Only seven (14%) neonates in the doula group required neonatal intensive care unit admission, versus 22 (22%) in the standard care group (P = 0.246). Additionally, initial breastfeeding within the golden hour occurred in 27 (54%) of the doula group compared to 16 (16%) of the standard care group, while exclusive breastfeeding was reported in 32 (64%) of the doula group compared to 26 (26%) of the standard care group (P < 0.001). Conclusion The current study showed more advantageous delivery and postpartum outcomes among doula care women and their infants compared to standard care, mainly for increasing the rate of initiated breastfeeding within the golden hour, exclusive breastfeeding, and reducing postpartum depression.

Readiness to Implement a Doula-Hospital Partnership Program

OBJECTIVE

To assess obstetric clinicians' and leaders' baseline knowledge, attitudes, and experience with doulas and their readiness to implement a novel doula-hospital partnership program.

DESIGN

Survey of obstetric clinicians and leaders before implementation of the doula program.

SETTING/LOCAL PROBLEM

Academic medical center in Western Massachusetts that was preparing to pilot a doula-hospital partnership program with Black doulas for Black women to address racial disparities in maternal morbidity and mortality.

PARTICIPANTS

Obstetric clinicians and leaders (N = 48).

INTERVENTION/MEASUREMENTS

We used established questions from the Organizational Readiness for Implementing Change (ORIC) scale and original questions to assess participants' knowledge, attitudes, and experiences with doulas and their readiness to implement the planned doula program. We distributed the questionnaire to 103 potential respondents. We conducted descriptive and bivariate analyses and analyzed open-ended responses using content analysis.

RESULTS

Forty-eight participants responded to the survey. Of those who provided intrapartum care (n = 45), all were familiar with doula roles. Respondents who reported having experience working with a doula, 47.3% (n = 18/38) had at least one prior negative experience with a doula and 76.3% (n = 29/38) reported positive experiences with doulas. However, there was a mean score of 12.62 on the attitude toward doulas (scale range: 3-15). The mean score on the ORIC change commitment subscale was 20.65 (range: 15-25) and on the ORIC change efficacy subscale, mean score was 29.31 (range: 19-35). Results did not differ by participants characteristics.

CONCLUSION

Our findings suggested strong support for and readiness to implement the doula-hospital partnership program.

Why Causation Matters: Rethinking "Race" as a Risk Factor

Although it is tempting to construe the correlation between Black "race" and higher rates of preterm birth as causal, this logic is flawed. Worse, the continued use of Black "race" as a risk factor for preterm birth is actively harmful. Using Black "race" as a risk factor suggests a causal relationship that does not exist and, critically, obscures what actually causes Black patients to be more vulnerable to poorer maternal and infant outcomes: anti-Black racism. Failing to name anti-Black racism as the root cause of Black patients' vulnerability conceals key pathways and tempts us to construe Black "race" as immutably related to higher rates of preterm birth. The result is that we overlook two highly treatable pathways-chronic stress and implicit bias-through which anti-Black racism negatively contributes to birth. Thus, clinicians may underuse important tools to reduce stress from racism and discrimination while missing opportunities to address implicit bias within their practices and institutions. Fortunately, researchers, physicians, clinicians, and medical staff can positively affect Black maternal and infant health by shifting our causal paradigm. By eliminating the use of Black "race" as a risk factor and naming anti-Black racism as the root cause of Black patients' vulnerability, we can practice anti-racist maternity care and take a critical step toward achieving birth equity.