Diversifying the Perinatal Workforce Leads to Improved Maternal Health Outcomes in Birthing People of Color

Authors: Sharee Livingston, Cherise Hamblin, Kayla Bolden

Affiliations: 1University of Pittsburgh Medical Center, Lancaster, PA, United States; 2University of Pennsylvania Lancaster General Hospital, Lancaster, PA, United States; 3CDC, Atlanta, GA, United States.

Introduction: Models of interventions to address disparities in outcomes for paitents of color frequently focus on a patient centered approach, positioning patients as the drivers of poor outcomes. This project positions the care team as an important driver of disparate outcomes. Doula care is associated with decreased preterm birth and cesarean section rates. Our team hypothesizes that diversifying the perinatal workforce, in this case with Doulas, is the critical step currently lacking from proposed solutions to the Black maternal health crisis.

Methods: Women of color were recruited and trained as Doulas through a customized training program. Black and Latinx birthing people were recruited for fully subsidized Doula care through an online intake form. Outcomes of route of delivery and gestational age at delivery were assessed.

Results: 47 Doula trainees were recruited over 6 months. Of the 47 Doula trainees, self-reported ethnicities included Black 23 (62.16%), Latinx 19 (51.35%), Arab 1 (2.7%), other 2 (5.4%) and not reported 7 (14.9%). Trainees reported speaking 7 languages including English, Spanish, Amharic, Arabic, Portuguese, Kiswahili and Urdu. Trainees reported learning of the program through word of mouth (54%), nonprofit website (10.8%), at their doctor’s office or at the hospital (10.8%), from a flier posted at a community location (8%), at work (5.4%) or at a community organization (5.4%).

DDI trained 28 Doulas of color. This represents a 2700% increase in Doulas providing full scope Doula care. Regarding race and ethnicity data, 8 of the 28 (28.5%) Doulas identified as Black. 20 out of 28 (71.4%) Doulas identified as Latina(o)(x). Doula trainees underwent birth, postpartum, mental health first aid, and lactation education.
Of the 105 clients receiving care in DDI during the evaluation period, 29 underwent a cesarean delivery (27.6%) and 11 delivered at less than 37 weeks (10.4%).

Conclusion: The DDI model of care resulted in lower cesarean section rates compared to the national average of 31%. The DDI preterm birth rate was comparable to the national average of 10.1%. Doulas of color can play an important role in addressing racial health disparities in OB care. Diversifying the perinatal workforce is imperative for addressing racial health disparities.