Color Skins

The Underutilized Gem in the Quest for Health Equity: Doula Care

During the course of a pregnancy, it's not uncommon to encounter a myriad of professionals including physicians, midwives, nurses, sonographers and others each playing their part in the tapestry of maternal care. But during my time as a practicing OB/GYN, I rarely encountered a doula. Just once or twice in over a decade of helping mothers deliver their babies. Many years later, as I served as the Physician General of Pennsylvania,  I began to unearth the enormous, yet frequently overlooked potential of doulas in enhancing maternal care outcomes.

During a memorable visit to Magee-Womens Hospital Of UPMC , I witnessed firsthand the transformative power of incorporating doulas into the medical team. They were not just any doulas, but those recruited from the very communities they serve, resonating with an authentic, localized understanding of care.

And my awe didn't stop there. Touring the Pettaway Pursuit Foundation, Inc., stories poured in of birth experiences elevated, of fears alleviated, all thanks to the unwavering support of a doula.

Yet, despite these stories of transformation, our maternal health outcomes remain a cause for concern. As a global superpower, it's not just distressing but downright alarming that our maternal outcomes are the worst among developed nations. The widening disparity in outcomes for African Americans only adds salt to this open wound, especially when we pride ourselves on our vast resources and cutting-edge technology.

In times past, we lived in communities with our mothers, mothers-in-law, aunties, and others who could support us and guide us through pregnancy and beyond.  Most of us now don’t live that way. Enter doula care. For those unfamiliar, a doula provides emotional, physical, and educational support to mothers before, during, and shortly after childbirth. This low-cost enhancement to maternal care has shown marked improvements in outcomes. But the lingering question remains: Why isn’t it more ubiquitous?

Is it policy? Many states, unfortunately, do not recognize the essential role of doulas.

Is it finance? The lack of universal reimbursement by health insurers is indeed a roadblock.

Is it awareness? For many, the term 'doula' remains enigmatic. Those who could most benefit do not even know the concept.

Or is it a territorial mindset? A reluctance to step out of traditional roles and truly embrace a team approach to maternal care?

Our quest for health equity demands that we open our eyes, minds, and hearts to the possibilities that lie before us. Organizations like The National Black Doulas Association are leading the charge, but it's on each of us to advocate, educate, and actively incorporate doulas into the fold of maternal care.

In a world desperately yearning for health equity, let's not sideline one of our most potent allies. Doulas might just be a critical missing piece in our grand puzzle. Educate yourself, advocate for their integration, and let's march forward in our collective journey towards true health equity.

Denise Johnson, M. D. is an OB/GYN Physician, Health Equity Consultant, Former Physician General of Pennsylvania and a passionate advocate for Health as a Human Right.