The effects of a community doula program on perinatal outcomes and respectful care
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Citation
Abstract
The United States maternal mortality ratio has been increasing for several decades with persistent disparities negatively impacting birthing people of color. Health inequity in perinatal care is often attributed to obstetric racism and a lack of access to continuous birthing support. While research on the specific impacts of community-based doulas on perinatal outcomes and respectful care is lacking, a growing body of evidence supports the positive impacts of doula support on perinatal outcomes and patient experiences during pregnancy care. Numerous studies have also demonstrated that doula support can mitigate the effects of systemic racism on birthing people of color. Despite the evidence of positive outcomes associated with doula services, marginalized communities, such as Black and low-income birthing people, often lack access to this essential care. The proposed study aims to measure the impacts of a community doula program on improving perinatal outcomes, including rates of cesarean sections, preterm births, breastfeeding, and experiences of respectful care among birthing individuals. This project will be conducted as a parallel-group, pragmatic single-center trial with 1:1 randomization at Boston Medical Center. The intervention group will receive services from the Birth Sisters Program, which includes prenatal home visits, continuous labor and birthing support, and postpartum home visits. The usual care control group will receive standard interdisciplinary maternity care.
Data collection will involve extracting outcomes from electronic medical records and conducting postpartum interviews. The analysis will include intent-to-treat and post hoc per-protocol analyses to assess the intervention's practical effectiveness and potential efficacy. The primary outcome will be the proportion of cesarean births, while secondary outcomes will include preterm birth, low birth weight, breastfeeding initiation and exclusivity, and respectful care. Exploratory subgroup analyses will focus on the intervention's impact on Black non-Hispanic participants compared to other races/ethnicities.
This project aims to contribute to future research on the benefits of doula care and fill a gap in the existing literature by focusing on community doula programs and their impact on health equity and respectful care. This study has the potential to inform clinical practice and public health policy, advocating for expanded access to doula services and addressing perinatal health disparities.
Description
2024