The Role of Doulas and Midwives in Pregnancy

The United States, according to the CDC and the Department of Health and Human Services, has an official maternal mortality rate of 17.4 deaths per 100,000 births in 2018. Maternal mortality is used as an international indicator of the health of a population overall. While developed countries have seen a decline of 3.1% annually over the last decade, the U.S. has seen an annual increase of about 1.7%. This information showed that the maternal mortality rate among Black women was 37.1, which is 2.5 times higher than white women (14.7). With this alarming statistic, many Black women are rightfully concerned about their postpartum outcomes. This brings into question how can they navigate a system that may be stacked against them and their unborn child?

Studies done by medical institutions and published in notable medical journals demonstrate that the use of doulas has been shown to have positive results on birth-specific and postpartum-specific outcomes. Before we get into the ways a doula can help, we need to define who they are and where they fall regarding prenatal, delivery, and postpartum care. A doula is a non-clinical support paraprofessional who provides physical, informational, and emotional support to pregnant women. A doula is not a physician or a midwife. 

In previous articles, I have discussed the role of a good OB/GYN in the pregnancy journey but not so much the role of a doula and midwife. In the 1910s, midwifery came under public scrutiny by reformers of that time, focusing on maternal-fetal mortality rates. By the 1920’s most of the northern states had displaced midwives with physicians; however, in the South, the midwife practice was still present, especially within the African American communities. Most African American women preferred home births to avoid discrimination in hospitals. During that time, midwives trained as educators to expectant mothers and community residents in African American communities throughout the South. They were health educators for their communities, who encouraged women to seek prenatal and postnatal care, accompanied them to their medical visits, and explained these visits to these women.

Most OB/GYN practices have midwives working alongside physicians; however, some midwives are trained to practice in birthing centers and home births without physicians. They tend to work with low-risk patients; however, they cannot perform c-sections or do any emergency surgical procedures that a physician can do. If you are doing a birthing center or home delivery, it is recommended to have a plan for getting to the hospital for emergent situations to ensure both the mother and infant’s safety.

The use of doulas has been associated with decreased cesarean section rates, higher Apgar scores, shorter labors, and positive breastfeeding outcomes. They can help pregnant patients navigate the health care system, which would place them in the role of an advocate for my Black patients. The traditional doula mostly works with the patient during the birthing process; however, there are community doula programs that involve prenatal and postpartum care. They are also doulas that help with bereavement for patients who have gone through a pregnancy loss. Doula services have been significantly underused because people are unaware of what services they offer and the cost. 

Statistics show that Black women comprising up to two-thirds of all maternal deaths, regardless of socioeconomic status and education, demonstrate the disparities in healthcare. It is necessary to be proactive in our care. Utilizing all the resources available to us can lead to better outcomes. Consider having a team for your healthcare; explore insurance coverage and community programs that may help with utilizing these services. 

Bridgette Provost, MD
Anti-aging and wellness focused Doc.

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