Doula Program Aims to Improve Pregnancy Health Outcomes

In the summer of 2022, Mass General Brigham, as part of its United Against Racism work, launched The Birth Partners Doula pilot project to address maternal mortality rates and help close the racial gaps that exist. Maternal mortality has been on the rise across all ethnic and racial groups for decades, with the rates for Black women the highest of any group regardless of education or income.

This program matches eligible pregnant patients who are most at risk of negative outcomes during pregnancy and birth with doulas. The aim is to connect a patient with a doula who speaks their language and understands the patient’s cultural values and beliefs.

Allison Bryant, MD, MPH, associate chief health equity officer at Mass General Brigham, along with a team of doctors, nurses, and midwives across the health care system, worked together to launch the project. Dr. Bryant is also a maternal-fetal medicine specialist in the Obstetrics and Gynecology Department at Massachusetts General Hospital where she cares for patients.

What is the Birth Partners Doula project?

The Birth Partners Doula project connects eligible pregnant patients, who are identified by their prenatal care providers, with a doula. This program is currently available to patients planning to give birth at Mass General, Brigham and Women’s Hospital, Salem Hospital, or Newton-Wellesley Hospital. 

The doula meets with the patient twice before birth, is present for labor and birth, and visits the new parent and baby twice after they transition home. Since its launch, the program has matched about 140 pregnant patients with doulas.

What is a birth doula?

Birth doulas are trained, non-medical professionals that offer emotional, physical, and informational support to birthing parents before, during, and after birth, and in the early days following childbirth. They are not doctors, obstetricians, midwives, or nurses. 

A birth doula can meet with the pregnant patient in the prenatal period to prepare for labor and birth. They work with the patient to help them draft a birth plan. Once in labor, the birth doula joins the patient at the hospital to provide physical and emotional support, as well as help advocate for the patient. After the baby arrives, a doula can offer chestfeeding support in the early postpartum period or help the birthing parent process their labor and delivery experience. 

Doula care ranges in cost, and some health plans, including Mass Health, cover part of the cost. Patients should ask their prenatal care provider for more information.

What is maternal mortality?

Maternal mortality, or the death of the pregnant person who gave birth, is a death during or up to 1 year after the end of pregnancy. For all ethnic and racial groups, maternal mortality more than doubled between 1999 and 2019. Rates for Black women were the highest of any group. The United Against Racism initiative pushes Mass General Brigham to address the inequities in health outcomes like this.

“One of our jobs under United Against Racism is to understand the assets in our communities that help make people well,” says Dr. Bryant. “Doulas are one example of an asset we can tap into which can help address maternal health outcomes.”

Research shows that the labor support a birth doula can provide benefits the pregnant patient and the baby. These benefits include:

• An increase in spontaneous, non-induced vaginal births. This also contributes to a decrease in Cesarean sections (C-sections), which are considered major surgery.

• Improved 5-minute Apgar scores, which rate a newborn’s health immediately following birth

• An improvement in patients’ ratings of their childbirth experiences

• A decrease in the use of pain medications or anesthesia, like an epidural

“The Birth Partners program fills a crucial need for trained birth support for many of the pregnant people we serve,” says Bryant. “It has been an example of how a team of committed doctors, midwives, nurses, and doulas can work together to strive toward our system goal of excellent and equitable outcomes for the families in our care.“