Birth doulas working in underserved communities: - PowerPoint Presentation

1. Birth doulas working in underserved communities: Addressing systemic racism in services to improve perinatal health inequitiesPaula M. Kett, PhD, MPH, RN, IBCLCGrace A. Guenther, MPAMay 5, 2022AAMC Health Workforce Conference

2. What is a birth doula?2A birth doula is a trained professional who provides physical, emotional and informational support to a pregnant or birthing person before, during and shortly after childbirth.(source: https://www.dona.org/what-is-a-doula/)

3. Background3Significant disparities in birth outcomes in the U.S.Structural racism is a major underlying factorCommunity-based doulas:Shown to have a positive impact on birth outcomes Can provide support to specifically address effects of structural racism on pregnant individuals

4. Background4Interest in expanding access to doula servicesThe system currently struggles to provide the needed training, compensation, and support for doulas working in underserved communitiesLack understanding of the work conditions and experiences of doulas providing services underserved communities

5. Study Aim5To explore the work experiences, stressors, and strategies to mitigate these stressors of doulas who work primarily or solely in underserved and historically excluded communities across the United States. 

6. Methods6

7. Results7

8. Fostering a deep connection8Engaging in specific work to advance perinatal equity“…when you work with people and have a connection with them and know what their families are like, know what their personality is, know if they have high anxiety, or they don't like to be touched or whatever these things are, you're in a more valuable position to be able to support people.”  "As a people, we have a lot of ..., taboos, that we would abide by before pregnancy, during pregnancy, and after pregnancy. We have ceremonies that we do during those times. We are limited to certain interactions during that time, certain foods, and certain activities. [In our community] pregnancy and birth is really sacred. [And so, there are] protocols that we as doulas and the families typically uphold as we’re providing our services.""...there's often a huge issue with Black birthing people and other birthing people of color, we can go unseen and unheard in that space. It’s making sure, and we try to do this ahead of time in the prenatal visits, they're armed with the language to remind the providers like ‘I do know some things.’" Facilitating culturally specific birthing practicesEmpowering clientsAddressing additional needs

9. 9Witnessing DiscriminationExperiencing Discrimination Witnessing and Experiencing Discrimination...You get to delivery and it's like this there's a lot of expectations of failure, I think, coming from the ... medical providers […]. People that talk about the disparities and higher maternal and infant death rates, the frequency that like something bad will happen is really exaggerated in a lot of cases to scare patients into being compliant. There's ... a lot of focus on patient compliance and not as much on informed consent." “it’s almost something that I can expect to be met with…when I say that, it's just the way that I’m treated versus how people who are more White-passing or are White doulas are treated. I know this because of comparing experiences."

10. 10Concern that raising rates would increase barriers in accessing servicesExpectation to provide free services due to who they serve – reinforcing privilege and racism in the health systemStruggling to stay financially afloat“Do I think I should be paid a lot more for my work? Yes, absolutely. However, the women who need me can't afford to pay me what I really should be paid. So, do I just leave them, or do I take the time to help them?”  "I'm not gonna ever ask a Black woman to work for free. Our ancestors already did it, I already did it."

11. 11Peer support – “doulas for doulas”Reconnecting with their motivation for the workReminding themselves that their job is not to take on the full responsibility of fixing broken systems.   Mitigating the effects of stress

12. Conclusions & Implications12Findings affirm current research about the positive role of doulas and the services they provide which address perinatal inequities and improve outcomes. Doulas are motivated to continue this equity work amidst strenuous work conditions and without systematic financial and political support.Better compensation is needed, but also has inherent complexities

13. Next Steps13Policy focused on reimbursement for doula services needs to consider the complexities of doulas’ workGreater incorporation of CBOs in training and employment and in decision- and policy-making processes focused on expanding access to servicesInterventions to facilitate better collaboration and sharing of responsibilities among the entire workforce providing care to these communities.Systems-level changes which promote birth doula services as essential and create a foundation to advance equity in perinatal health outcomes

14. Acknowledgements14Co-Authors: Marieke van Eijk, PhDSusan Skillman, MSBianca Frogner, PhDThank you to our participants for their time and sharing their perspectives. Funding: This study was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $536,449 with zero percentage financed with non-governmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. https://www.hrsa.gov/grants/manage/acknowledge-hrsa-funding.

15. References15Adams C and Thomas SP, Alternative prenatal care interventions to alleviate Black-white maternal/infant health disparities, Sociology Compass, 2018, 12(1):e12549, https://doi.org/10.1111/soc4.12549.Combellick JL et al., Birth during the Covid‐19 pandemic: What childbearing people in the United States needed to achieve a positive birth experience, Birth,  2022, https://doi.org/10.1111/birt.12616.Crear-Perry J et al., Social and structural determinants of health inequities in maternal health., Journal of Women's Health, 2021, 30(2):230-235, https://doi.org/10.1089/jwh.2020.8882.Lucas L and Wright E, Attitudes of physicians, midwives, and nurses about doulas: A scoping review, MCN: The American Journal of Maternal/Child Nursing, 2019, 44(1):33-39, https://doi.org/10.1097/nmc.0000000000000488.Van Eijk MS et al., Addressing systemic racism in birth doula services to reduce health inequities in the United States, Health Equity, 2022, 6(1):98-105, https://doi.org/10.1089/heq.2021.0033.

16. Thank you!Questions? Paula Kett: pmk@uw.eduGrace Guenther: gguent@uw.eduLearn more at:Website: https://familymedicine.uw.edu/chws/Facebook: https://www.facebook.com/uwchwsTwitter: @uwchws