Compassion & advocacy: How doulas provide more equitable pregnancy & postpartum care

The U.S. faces a severe maternal health crisis with devastating impacts on the health and well-being of birthing parents across the country. Compared to other high-income countries, women in the United States are more likely to die from complications related to pregnancy or childbirth. A driving factor behind the high mortality rate is the disproportionate number of Black and Indigenous women who experience pregnancy-related complications and death. What’s more, the CDC estimates that 84% of maternal deaths in the U.S. are preventable.

Doula care is gaining prominence in the mainstream as an effective way to combat some of the inequities experienced by birthing parents in the United States—and globally. Doulas have been a source of birthing care for pregnant people for centuries, but only in the past few decades have doulas seen broader recognition among the healthcare industry and government. 

“When families are supported by doulas from their home communities, they are able to receive culturally humble care within a medical system that largely doesn’t enable that type of care,” says Maven Doula CE Durfee, MSN, CNM, ARNP, CLC, CD(DONA). 

As employers and health plans look for avenues to reduce the insidious effects that inequities have on the health of parents-to-be and new parents, increasing access to doula care should be a key component of any strategy. Here’s what HR and health plan leaders need to know about doulas and health equity. 

Understanding the role doulas play in pregnancy, birth, and postpartum

A doula is a trained professional who provides emotional and physical support to birthing parents during childbirth and the postpartum period. Doulas are not medical professionals and do not provide medical care; rather, they offer information and advocacy to help pregnant people navigate the healthcare system, make informed decisions about their care, and understand their options throughout pregnancy. While third-party certifications for doula care exist, many doulas working today do not seek certification. 

“Doulas are so important because we help educate birthing parents,” says Blue Andrew, Maven Care Advocate and Doula at Brooklyn Birth. “We normalize advocating for yourself and having ownership and autonomy over one’s body, which many people don’t experience as part of their birthing process. Doulas are there to carry and support parents through one of the most vulnerable times of their lives.”

Doulas are there to carry and support parents through one of the most vulnerable times of their lives.

Through their emotional support and advocacy, doulas help drive better outcomes for birthing parents in clinical settings. A study by the University of Washington found that birthing parents supported by doulas are less likely to have a C-section, have a low birth weight infant, and give birth to a newborn that requires medical attention immediately after birth. Birthing parents who receive doula care also report increased engagement in their health and higher satisfaction with care. 

“Doula care gives families confidence and support,” says Qef Johnson, Maven Birth & Postpartum Doula. “We help parents make an informed decision and encourage them to become an engaged part of their care team instead of being completely reliant on their medical professional to lead their care. And this advocacy can be incredibly important because providers may make decisions that are unconsciously driven by racism, classism, or sexism that don’t result in the best care.” 

How doulas drive more equitable care for birthing parents

Advocacy for historically marginalized communities

While doulas drive improved outcomes for all birthing parents, their support can be particularly powerful for parents who are part of historically marginalized communities. Black and AAPI women report higher rates of unfair treatment, harsh language, and rough handling during their hospital stay compared to white women. Similarly, members of the LGBTQIA+ community often struggle to find gender-affirming pregnancy care, and gender-variant patients describe pregnancy as a deeply lonely experience. 

“In my role as a doula working with Black families, migrant families, non-English speaking families, and queer families, I have seen staff start speaking more respectfully to the birthing parent and their families because a doula is present,” says Durfee. “Medical staff take their questions more seriously and answer them more thoughtfully, resulting in more empathetic and impactful care.”

Providing culturally humble care

Many members of historically marginalized communities are not able to receive care from providers who share their same cultural background and lived experiences. Black and Hispanic physicians only account for 18% of all OB-GYNs, and only 7% of certified midwives are Black. While fewer statistics exist on the number of maternal healthcare providers who identify as LGBTQIA+, one AMA survey found that approximately 4% of medical students say they’re LGBTQIA+. 

However, historically marginalized communities are represented at higher rates among doulas. Close to 40% of doulas are Black, Latine, Asian, or AIAN, and 6% identify as LGBTQIA+. What this means for birthing parents from these communities is that they can have a birth care provider who understands their lived experiences and can help provide culturally-humble care through their birth and postpartum period. Care matching is shown to lead to more engaged patients, greater willingness to pursue preventative treatments, and better patient understanding of health risks and complications. 

“When I’m supporting a Black birthing parent and see them at home with their baby, it’s one of the most rewarding moments for me as a doula,” says Andrew. “I know they made it, they’re happy and healthy, and I helped make sure that another Black person and baby didn’t become part of the horrifying maternal mortality statistics in our country.” 

Increasing virtual access to birth and postpartum care 

More than 6.9 million women live in maternity care deserts, where they have limited to no local access to obstetric providers or a hospital or birth center providing obstetric care. As a result, many birthing parents are forced to travel long distances to receive the essential pre- and postpartum care they need, often giving birth far from their community. 

Virtual care emerged during the pandemic as an essential supplement to in-person care, filling in gaps in care between scheduled appointments, especially for birthing parents living in maternity care deserts. Doula care is no exception—many pregnant people and new parents seek doulas virtually, looking for education, advocacy, lactation help, and more services that don't require in-person support. Virtual care enables women who may not have a doula in their local community to receive quality, compassionate doula care without leaving the comfort of their own homes. 

“Because I meet most families virtually through Maven, I love growing our relationship and seeing how my birthing parents progress each week,” says Johnson. “Virtual doula care enables me to see the family dynamics, help partners understand the process and their role, and watch them move to the postpartum stage as a family. It’s incredibly rewarding.”

Virtual doula care enables me to see the family dynamics, help partners understand the process and their role, and watch them move to the postpartum stage as a family.

How Maven increases access to doula care

As employers and health plans look to provide more equitable support to all employees and members, increasing access to doula care should be a top priority. As the leading women’s and family healthcare company, our 24/7 platform provides clinical, emotional, and financial support all in one place. 

Maven members can meet with doulas and other reproductive health specialists virtually, with appointments available same-day. Doulas are the highest booked provider in the maternity track . And Black Maven members seek doula support at higher rates than white members: about 20% of Black members had an appointment with a doula during their pregnancy.

As your organization looks to provide more equitable care for employees, Maven is here to help. Schedule a demo with our team today to see how Maven supports working families, retains talent, and reduces costs.