How doulas can help improve birth outcomes in the Black community in the U.S.

In the U.S., doulas first emerged to support birthing people and their families in the 1960s, but this type of birthing companionship dates back centuries and across many cultures. Today, Black communities in particular, who face disproportionate disparities in maternal health outcomes, have turned to doulas in hopes of addressing and improving Black infant and maternal mortality rates, as well as other healthcare disparities.

From the emotional and physical support they can provide, to their impact on health outcomes, here’s what you need to know about how doulas can have a positive impact on Black parents.

Doulas support mental, emotional, and physical needs

A doula is an individual who provides non-medical support and care through education, guidance, emotional support, and counseling for people during any part of a pregnancy journey. Doulas work with people attempting pregnancy, those who have become pregnant, those who have given birth, and those experiencing pregnancy loss.

Trained in prenatal, pregnancy, and postpartum care, doulas take a holistic approach to delivering medical, emotional, and social care to clients, which includes:

• Supportive services: Doulas typically cover a range of services from lactation and nutrition support, to stress management, to prenatal and childbirth education, as well as hands-on, everyday assistance to the birthing person and their partner or family.
• Certified care: Doulas don’t replace doctors or midwives, and they don’t deliver babies in the U.S. They can be certified, which they can complete through accredited organizations such as BirthWorks International, Doulas of North America (DONA) International, or the Childbirth and Postpartum Professional Association. A doula’s training certification will typically consist of training hours that include workshops, readings, and in-person classes on labor, antepartum (before childbirth), and postpartum (after childbirth) doula training.

Research suggests that receiving labor support from doulas can reduce physical and psychological trauma during birthing, including shorter labor times, potentially fewer Cesarean sections, and increased parental satisfaction after labor.

Black people and other people of color often receive poorer quality care, are victims of racial bias in hospitals, and benefit from extra support during their birthing journeys. Studies suggest that Black women in the U.S. experience more stress and anxiety during pregnancy than other groups and breast/chestfeed at lower rates. The introduction of community-based doulas can help Black families understand these disparities, and what they can do about them.

Doulas empower their clients

Many factors can explain the Black maternal health crisis in the United States. A history of racism and discrimination that many Black women face throughout their lives creates cycles of chronic stress and other illnesses that stem from it. In return, pregnancy is made even riskier. And other socioeconomic factors, like a lack of access to jobs or affordable housing, also expose pregnant people of color to more stress and more barriers to high-quality fertility care and treatment. Even when controlling for education and economic status, Black women still face a gap. For example, U.S. college-educated Black women die at higher rates of pregnancy-related causes than white women who didn’t finish high school.

Today, many doctors still believe that Black people experience less pain, which leads to their health concerns being more likely to be dismissed. Doulas can’t fix deep-rooted racial biases in the medical system, but they can use their knowledge to guide people through the risks and empower them to speak up for their needs to make sure their voices are being heard. From helping clients create a birth plan and sticking to it, to communicating with medical staff when necessary, doulas make sure their clients’ needs come first. Black doulas can also bridge cultural gaps between clients and healthcare providers, which is a commonly overlooked aspect of the Black birthing experience.

Expanding research and support for doulas

While a few U.S. states, like Minnesota, New Jersey, Oregon, and Indiana, have implemented Medicaid coverage for doula services, coverage for doula services from traditional insurance is limited. Still, more states are introducing programs and legislation to expand support. New York City is launching a pilot program to provide free support from doulas for Black families, and at least 17 states have proposed legislation or other state action to cover doula services through Medicaid.

Discussions around Black maternal health and what can be done to solve disparities are just beginning. And as research continues, it points to doulas being powerful supporters who can save and improve the lives of Black birthing people and infants. One study found that doulas promote healthy labor through their companionship, which “buffers” the stressful conditions of a hospital. The same study also found that doulas are a form of pain relief themselves, and with their continuous support, laboring people are less likely to request epidurals or pain medication.

The use of doulas can serve populations of all backgrounds. For Black people specifically, who have a unique history and experience with medical care, support from doulas can be a powerful way to help give families the safety, support, and agency they need to have healthy and happy births.

Carrot resources for BIPOC members in the U.S.

Inclusive, supportive fertility care, including access to benefits, can help people on all paths of parenthood. For Black, Indigenous, and other people of color (BIPOC) especially, it’s important to offer care that considers their needs. At Carrot, we believe in culturally competent care for all people, which includes:

• Access to BIPOC providers: While culturally competent care can come from providers of any race, research shows that outcomes are often better when Black people in the U.S. will receive care from Black providers. At Carrot, we’ve created a feature for BIPOC members to request a BIPOC provider if they desire one.
• Telehealth options: Through Carrot Pregnancy, members have unlimited access to Carrot experts, including doulas, who can help with many of the things mentioned above as well as other specific needs one may have.

If you’re a Carrot member, sign in to your account to learn more about resources available to you through your benefit.