Maternal health
Published March 3, 2021

How doulas can improve the safety of childbirth for women of color

Kristin Gourlay

For every mother who dies a pregnancy-related death in the U.S., 70 experience a life threatening event. These are unexpected cases of what doctors call severe maternal morbidity (SMM) events such as cardiac arrest, hemorrhage or sepsis, events that could have been fatal or can affect a woman long after childbirth. The overall rate of these events has increased by over 200% in the past two decades. And the statistics are worse for Black, Indigenous and other women of color. Researchers at the University of Illinois Chicago found that Black women face a 70% higher risk of SMM than any other racial group. Doulas might provide the prenatal support women at risk need to have a healthy pregnancy and childbirth.

The role of doulas in reducing SMM

Doulas provide emotional, physical, and informational support to women before, during and after childbirth. They’re trained but non-clinical partners to women, often supplementing care from doctors and midwives. There’s evidence to suggest that working with a doula can reduce serious complications among BIPOC women. Research finds that doula care can help reduce C-sections, decrease maternal anxiety and depression and help coordinate care and communication between women of color and their other healthcare providers. According to March of Dimes, “The role of doula care in reducing C-sections is important, because C-sections contribute to the risk of maternal morbidity and mortality in initial and subsequent pregnancies.”

The role of doula care in reducing C-sections is important, because C-sections contribute to the risk of maternal morbidity and mortality in initial and subsequent pregnancies.

Blue Cross and Blue Shield companies are increasing support for doulas

Many BCBS companies are including doula coverage in their members’ plans, making philanthropic contributions to doula organizations that focus on underserved communities and funding training programs to increase the number of doulas of color.

  • Training

    The Blue Cross Blue Shield of Michigan Foundation funded a program at Western Michigan University Homer Stryker Medical School to create and train a network of eight community doulas to assist women at risk of poor birth outcomes. Blue Cross and Blue Shield of Minnesota is providing scholarships to increase the number of doulas in areas with the least access.

  • Doula coverage

    CareFirst BlueCross BlueShield, through their grant making efforts, covers doula services for Medicaid patients, including for those who visit the innovative Mamatoto Village, an organization focused on empowering Black mothers with services and education. Blue Cross and Blue Shield of Minnesota is exploring ways to let members know that doula care is covered. Analyzing claims data, the health plan found that moms who used doulas had healthier outcomes.

  • Supporting doula organizations

    Blue Cross and Blue Shield of Illinois, a division of Health Care Service Corporation (HCSC), has provided funding to Chicago Volunteer Doulas, who care for pregnant and new mothers in vulnerable communities. Excellus BlueCross BlueShield supports Syracuse Community Connections, an organization that provides culturally competent doula care with a focus on Black women and women of color.

Doulas and culturally competent care

Doulas may also be able to play another role in eliminating racial disparities in maternal health. A Tufts University School of Medicine researcher notes that doulas may be more trusted members of the community and able to spend time listening to a mother's needs and concerns. Within the traditional healthcare system, Black women face unconscious bias, which can cause doctors to dismiss a Black mother's concerns or create a lack of trust between patient and doctor.

Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Michigan Foundation, Blue Cross and Blue Shield of Minnesota, CareFirst BlueCross BlueShield, Health Care Service Corporation and Excellus BlueCross BlueShield are licensees of the Blue Cross Blue Shield Association, an association of independent, locally owned Blue Cross and Blue Shield companies.

All company names and brands are the property of their respective owners, used for identification purposes only, and are in no way associated or affiliated with the Blue Cross and Blue Shield Association. Use of these names and brands does not imply endorsement.

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