A Boston-area healthcare system reported a successful first year of a pilot program aiming to reduce maternal mortality by providing free doula services to women most likely to need, but often unable to afford them.
A Boston Globe article spotlighted Massachusetts General Brigham’s (MGB) Birth Partners Doula project, which formed in October of 2021 as one initiative among many in BMG’s United Against Racism program. In its first year, the program served 58 Black or Indigenous first-time mothers who were low-income and homeless, incarcerated, lacking support, or otherwise at-risk. Participants were selected from a lottery that they entered during their third trimester of pregnancy. Each mother received doula accompaniment at two prenatal visits, throughout the labor and birth process, and for two postpartum home visits.
While other doula programs in the country — including another Boston area hospital — have relied on private donations, grant money, or, in rare cases, Medicaid funding, to operate, the MGB program is the first nationwide to be funded by a healthcare system itself.
The Birth Partners Doula program funds four hospitals within the MGB system, which then contract with local doula agencies, with an emphasis on matching clients with doulas who have similar “cultural and linguistic backgrounds.” The out-of-pocket cost of doula services, which are typically not covered by insurance, would otherwise be $2,000.
Black women are disproportionately impacted by maternal mortality, and rates are worsening over time
While maternal mortality rates are significantly higher amongst U.S. women of every ethnicity compared to those in other developed nations, Black women are the hardest hit by maternal mortality. A Centers for Disease Control and Prevention (CDC) report on the 2020 maternal mortality rate showed an abysmal rate of 55.3 deaths per 100,000 live births amongst Black women, while the rate amongst white women was 19.1 deaths per 100,000 live births. These numbers were significantly worse than just one year prior, when the rate was 44 deaths per 100,000 live births. The group most at risk of dying during pregnancy, birth, or the postpartum period is Black women over age 40.
The CDC found that the maternal mortality rate in aggregate (all races) was a staggering 107.9 per 100,000 live births for women aged 40 and over.
Massachusetts General Hospital is one of the four participating in the MGB Birth Partners Doula program. Senior medical director of health equity, quality, and patient experience Dr. Allison Bryant commented, “In particular, our Black and Indigenous birthing people are much more likely to have maternal morbidities, or to be sick in the context of their pregnancies, or to die in the context of their pregnancies or in the year following.”
Doula services help drive down the maternal mortality rate
In a joint statement, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine recognized that “Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.” The statement notes that research shows “that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery [a major abdominal surgery with possible risks of hemorrhage, infection, and even death]. Given that there are no associated measurable harms, this resource is probably underutilized.”
Pregnant women in Massachusetts have much to gain from doula services. A 2022 report by the state’s Special Commission on Racial Inequities in Maternal Health estimated that the provision of doula services translates to a 39% decrease in Cesarean sections plus decreased pain medication use and greater rates of breastfeeding, which has numerous benefits for both mothers and babies.
According to a Massachusetts General press release, doula services are associated with an “increase in spontaneous vaginal births and shorter labors, and a decrease in the use of pain medications, regional anesthesia, instrumental vaginal delivery, Cesarean sections, and most importantly, a negative birth experience.”
How do doulas do it?
How can doulas, who are nonmedical personnel, tackle steep maternal morbidity (short or long-term medical conditions that develop during pregnancy or birth) and mortality rates? They provide emotional, physical, and informational support to pregnant women and their partners or families, teaching them what to expect and what their options are, and then advocating for them, particularly during labor and birth.
Mari-Elena Leckel, the founder of one of the doula agencies partnering with the Birth Partners Doula program, told the Globe, “For someone who’s never done this [given birth] before and doesn’t really understand the process, we can break it down and help make decisions so that they can feel like part of the process instead of the process being done to them.”
Phelicia Cadet, one of the Birth Partners Doula program clients attested, “The program helps you to understand how the process works and how to prepare yourself.”
The pro-life movement has long recognized that when women lack support, they may be pressured into abortion. But conversely, when pregnant mothers are supported, their babies thrive. The expansion of doula services nationwide recognizes the vital importance of caring for both mothers and children, throughout pregnancy, labor, birth, and beyond. Prioritizing both, not focusing on one at the expense of the other, as the abortion lobby does, is a fundamental pillar of a truly just, pro-life society.
Abortion advocates have long falsely insisted that legalizing or expanding abortion would drive down the maternal mortality rate, a claim that Live Action News previously addressed here. In reality, we decrease maternal mortality by fixing what’s actually wrong with the system, not by killing the preborn. The philosophy behind doula care reflects this understanding: that it’s possible to care well for both mothers and their babies.
