Community-based doulas are changing the experiences of Black pregnant women, mothers and their children in traditionally marginalized neighborhoods in Sacramento, Los Angeles and Fresno, California.
Evidence supports the use of culturally congruent doulas
While the idea of using a doula isn’t new, this doula pilot program, launched by Blue Shield of California (Blue Shield), is. The idea is that supporting Black mothers with doulas hired by community-based organizations can do more to improve health outcomes and reduce racial health disparities than programs that don’t use workers with intimate knowledge of the communities they serve.
Doulas are trained, non-clinical professionals who can give a mother emotional, physical and educational support. There’s strong evidence that working with a doula can reduce childbirth complications and improve care coordination.
Focusing on ZIP codes with the greatest needs
The pilot began in ZIP codes selected because of their high rates of infant mortality and childbirth complications. Doulas were hired by the community organizations that focus on Black mothers: Her Health First and Diversity Uplifts-Frontline Doulas. Their services are free, paid for by Blue Shield, and open to anyone.
Shannon Cosgrove, Blue Shield's director of community health, says it was critical to partner with organizations that have been leaders in culturally appropriate pregnancy care. “We knew we couldn’t erase disparities or provide services on our own,” says Cosgrove.
New data show the test is succeeding.
How doulas have begun to improve outcomes for Black mothers and babies
Blue Shield analyst Courtney Paulson says participants have had a higher percentage of full-term births, fewer Cesarean sections and lower rates of postpartum depression compared to state and national averages. Based on this early success, Blue Shield hopes to increase the doula workforce and access to other culturally competent providers statewide.
Leigh Purry, senior manager of Blue Shield's community health team, says doulas begin by meeting with moms who decide to enroll in the program. “They work to understand their history, their needs, their birthing preferences,” says Purry. “This is when the doula dives into establishing that relationship as a foundation.”
The relationship, says Purry, is critical to decreasing a mom’s stress during pre- and postnatal periods.That stress may be the result of previous experiences in hospitals and doctor’s offices. “At a patient intake,” says Purry, “many moms report their treatment in health care settings has been unfair because of their race or ethnicity.”
Purry notes that doulas can:
- Empower families to develop their own birth plans
- Ensure mothers receive the care needed to manage risks, such as chronic disease, a prior low-weight birth, or depression
- Attend a delivery and advocate for a mother’s wishes
- Link families to resources that help address social needs, such as housing
The program also gives moms access to an online tool called Mahmee that houses health records for the mother and child, enables messaging with their doula and provides access to group classes and other resources.
Listening to Black mothers' experiences
Cosgrove says this pilot is part of a larger effort at the health plan to reimagine Black maternal health care. A key part of that effort is listening to the community. Her team and the Black Wellness & Prosperity Center have been convening a series of Black Maternal Health Circles. Participants share experiences about their interactions with health care providers, health plans and BSC’s maternal health resources. The outcomes of those conversations might include implementing a survey for OB patients called the “Patient Reported Experience Measure of Obstetric Racism,” providing cultural humility training to providers or tailoring benefits to better support Black women.
Cosgrove says Blue Shield is evaluating new maternal health benefits, based on the findings from the pilot and community feedback.
Cosgrove, Paulsen and Purry agree there’s much work to be done. But as Purry puts it, “This is a total passion. We want to make sure we’re closing the gaps on the disparities that our community faces statewide.”
Blue Shield of California is a licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.