Deconstructing Maternal Burdens: Doulas and the Community Unite for Health

Women in the United States (US) have not reaped the benefits of the decline in worldwide maternal mortality rates as maternal deaths have increased steadily in the US for the past three decades. Disparities exist in both maternal morbidity and mortality in the US. Low-income women or those covered by Medicaid are more likely to experience increased maternal morbidity when compared to those in higher socioeconomic classes. Effective, sustainable interventions are urgently needed to improve outcomes for all women and to close gaps in maternal health. Doulas have been associated with improved maternal outcomes; however, there are challenges in access to doula services due to cost or lack of third-party reimbursement; rendering these services sometimes inaccessible for low-income communities. This proposal will leverage existing community partnerships and infrastructure to refine and test the Perinatal Wellness Doula Home (PWDH). A unique model of comprehensive doula support for low-income women throughout the prenatal, birth, and postpartum period. Our overarching goal is to demonstrate the utility of PWDH in reducing perinatal mood and anxiety symptoms, maternal morbidity, and close gaps in perinatal health outcomes. This project will be executed utilizing three aims: Aim 1: collection of qualitative data from pregnant/postpartum women, support persons, doulas, medical providers, community partners, and various stakeholders to refine our previously developed intervention prior to testing (n=48). Aim 2: conduct of a pragmatic two-armed Effectiveness-Implementation Hybrid Randomized Controlled Trial of PWDH and standard Medicaid doula care in a socially high-risk population (n=516). Aim 3: integration of qualitative and quantitative data to contextualize findings, develop community-informed messaging for dissemination, and promotion of systems change by informing Medicaid doula policies. This innovative implementation-effectiveness approach will allow us to not only determine effectiveness of PWDH, but also to understand context for implementation. We hypothesize that PWDH will provide multilevel support and address non-medical needs, thereby improving maternal mental wellbeing, and reducing adverse perinatal outcomes. We strive for a comprehensive approach that gathers necessary information from all stakeholders and decision makers to facilitate implementation of PWDH if observed to be effective. Study activities will be guided by two Community Advisory Boards comprised of 1) Service Recipients – low-income pregnant and postpartum women, partners/ support persons, and 2) Service Providers – doulas, medical staff, community representatives, and policy makers. This proposal is critical to developing the community-informed interventions needed to help low-income communities thrive.