The Integration of Doulas into the Pregnancy Care Teams of Women of Color in the United States

Abstract

The United States has one of the highest maternal mortality ratios of any country in the Organization for Economic Cooperation and Development (OECD) at 17.4 per 100,000 live births as of 2017, far more than Canada, Sweden, Australia, or Germany (OECD.Stat, 2021). A primary reason for this considerable difference between the U.S. and other OECD countries is the racial disparity in maternal mortality. One intervention aimed at addressing this racial disparity is the integration of a doula, a professionally trained companion who provides birth support, into a woman’s biomedical care team (Gilliland, 2002). The doula works with their client throughout pregnancy, through delivery, and in the postnatal period, providing guidance and encouragement to the mother while also working within the healthcare system to advocate for, and in some cases to protect, her. This paper will provide a general background on maternal death in the United States, highlighting the historical and modern instances of racism and its impact on maternal health; examining the use of doulas as an intervention for reducing maternal death, using New York City as a case study; and discussing the potential implications of a national expansion of Medicaid reimbursed doula programs aimed at improving maternal outcomes countrywide.