Doulas can help reduce disparities in serious postpartum complications

Published June 10, 2024

In East L.A., new mom Deziree* is at home feeding 16-day old son Bennett when her doula Keesha Hernandez pays a visit. You might not think of doulas visiting after the birth of a child, but it’s essential, according to this doula’s employer, Mahmee.

Hernandez checks on mom and baby’s health, but her focus is on Deziree. How is she recovering from childbirth? Is she sleeping well, eating enough, experiencing any physical or mental health problems? Deziree says her partner has gone back to work and the transition leaves less time for her to take care of herself. Hernandez heads into the kitchen to prepare Deziree a healing tea and some nourishing broth.

Heading off serious childbirth complications

It’s recommended new moms see their doctors at least a couple of times in the postpartum period. But what about the weeks between those visits? A postpartum doula’s care can complement, not replace, them. Hernandez is trained to recognize and escalate the early signs of any problems. Those could include serious, unexpected childbirth complications, or severe maternal morbidity (SMM).

SMM events can lead to hospitalizations, long-term consequences or even death. They include sepsis, heart failure, kidney failure and more. Black and Latina women experience far greater rates of these postpartum complications than white patients, according to new data from the Blue Cross Blue Shield Association (BCBSA). A third of these events happen in the first six weeks after birth—after discharge from the hospital. What’s more, Black patients are more than 70% more likely than white patients to be hospitalized for those events.

Blue Shield of California tackles postpartum complications with wraparound care from Mahmee

Blue Shield of California decided to launch an initiative focused on counties with the highest rates of postpartum complications. The approach: wraparound care for moms to fill the gaps between visits to the obstetrician (OBGYN), a diverse workforce of doulas to match patients’ lived experiences and a robust set of metrics to track progress.

A doula can function as that bridge in between delivery, discharge home and the six-week postpartum appointment,” says Jacqueline Ejuwa, Blue Shield of California vice president of health transformation.

Deziree and Bennett will continue to receive check-ins from a doula and wraparound care team from Mahmee for the next 12 months. New parents may continue to deal with postpartum complications up to a year after birth.

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A partner in a mother-daughter duo

Mahmee, founded by a mother-daughter duo, offers wraparound care from pregnancy through the first year after birth through in-person and virtual doula visits and an app that helps moms and providers track their health. Wraparound care considers a patient’s social, physical and emotional needs. It’s the kind of care CEO Melissa Hanna says can start to close those disparities in SMM between patients of color and white patients.

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“Mahmee’s mission is to make the United States the best place in the world to give birth,” says Hanna. “That mission is not achievable unless you find a way to care for everyone equitably and to meet them where they're at and provide the chance for a safe, joyous, empowering childbirth experience.”

Building equity and diversity into the model

“When we're hiring, when we're looking at how we're training and who we're bringing into our company, we're looking for doulas of color, for example Black women who will be caring for women who not only look like them, but have similar lived experiences,” says Linda Hanna, RNC, MSN/Ed., IBCLC, Mahmee’s co-founder and director of care.

Catching signs of dangerous events early

A woman may not know she’s in danger or might wait for a doctor’s appointment to raise a concern. Doctors say a doula can identify issues and help a woman advocate for care with doctor.

Melissa Hanna says listening is one of the first steps to reducing disparate rates of maternal mortality and morbidity. She hears from patients whose previous childbirth experiences didn’t go the way they’d hoped. “When patients come to Mahmee with a subsequent pregnancy, with a subsequent postpartum experience, they get a chance to try things differently and to experience what it's like to be absolutely heard and cared for.”

Blue Cross Blue Shield Association advocates for policy changes to reduce disparities in SMM. Read our recommendations.

A promising future

Blue Shield of California’s Jacqueline Ejuwa says the early data is promising for patients like Deziree when it comes to avoiding serious postpartum complications and preventing maternal morbidity and mortality. That’s thanks to regular visits with doulas and close attention to the mother’s needs.

Her aspiration for the program? “My aspiration for this program is that we don't have to talk about this anymore. It'll be a good day when we're not sharing statistics that show that the rate of maternal deaths in the United States is increasing.”

*We’re not using Deziree’s last name to protect her privacy.

Blue Shield of California is an independent licensee of Blue Cross Blue Shield Association, an association of independently owned and operated Blue Cross and Blue Shield companies.