Integrating Community-Based Doulas into the Maternity Health Care System in an Urban Hospital

Background:Maternal morbidity and mortality in the United States are higher than peer countries. These adverse events disproportionally affect Black women.Local problem:Rates of maternal morbidity and mortality among Black childbearing women in West Louisville, Kentucky are higher than rates in Kentucky and the United States.Methods:We conducted a quality improvement project to evaluate the effectiveness of adding doulas to the health care teams at the Norton downtown hospital to address health disparities and other challenges identified by Black childbearing women related to communication and health care system barriers.Intervention:Three culturally congruent doulas were hired and integrated into the health care teams in one large health care organization.Results:Participants in the doula program had lower no-show rates for postpartum visits compared with non-participants. No-show rates for prenatal visits were the same for both groups. Rates of diagnosed preeclampsia, hypertension, and chronic hypertension were similar among doula program participants and those who did not participate. Narrative data indicated that program participants and health professionals were generally pleased with the doula program and there was positive feedback from the community.Conclusions:Integrating culturally congruent doulas into the health care system maximized their impact to address health and other challenges experienced by Black childbearing women. In this quality improvement project, doulas were added to the health care teams at an urban hospital in Louisville, KY to address health disparities, barriers in access to the health system, and other issues identified by Black childbearing women in the surrounding area. Integrating culturally congruent doulas into the health care system at no cost to patients offered an opportunity for program participants to have an advocate with them through pregnancy, birth, and postpartum to help navigate the maternity health care system.