Detroit  has one of the highest maternal mortality and infant mortality rates in the nation. Black women and birthing people are too often not listened to nor taken seriously by health providers when addressing health-related concerns. They are also more likely to die from pregnancy-related conditions such as blood pressure disorders, heart diseases, blood clots, and hemorrhages [1].  Addressing these disparities will require systemic changes such as embracing a holistic model of care. Doulas can provide that holistic, non-clinical support and advocacy Black families need.

A doula is a trained professional who provides physical, emotional, and educational support to their client before, during, and shortly after childbirth [2]. Doulas take care of moms’ non-clinical needs. There have been many studies that show the benefits of having a doula during pregnancy. Studies suggest that doula support can reduce the need for c-sections and reduce serious complications such as hysterectomies and uterine ruptures [3]. Other studies have shown that having a doula as a member of the birth team decreases the overall c-section rate by 50%, the length of labor by 25% [4]. Doulas also provide services after the baby is born. Doulas provide breastfeeding support, monitoring for mental health and postpartum recovery, and encourage the parents to attend postpartum visits.

Doula support is critical for Black families because Black women and birthing people have significantly higher rates of pregnancy and childbirth complications. Black women and birthing people are four times more likely than their white counterparts to die during childbirth or due to childbirth-related causes. Having the support of a doula can prepare a family for some of the challenges they may experience as people of color. Financial barriers often make it hard for Black families to access doulas. Michigan Medicaid now reimburses for doula services [6]. With the recent expansion of Medicaid postpartum coverage to 12 months, Black women and birthing people can get the appropriate care needed for a healthy pregnancy.

Henry Ford Health (HFH) has taken great strides to make sure doulas have fewer hoops to jump through when entering a facility for labor and birth. At Henry Ford Hospitals, doulas are not considered a visitor when entering labor and delivery, so the patient can have two support persons and one doula. Dr. D’Angela Pitts, Maternal Fetal Medicine Physician and Director of Maternal Health Equity at HFH, leads the Maternal Infant Health Equity Strategic Taskforce (MI-HEST) which includes a doula subcommittee. MI-HEST is in the process of creating a hospital-based doula program utilizing community-based doulas across all the HFH five hospital sites. In addition to welcoming doulas, HFH has taken steps to decrease unconscious bias for maternal and child health. The Reducing Unconscious Bias, an Imperative or “RUBI” Trainings have been conducted throughout women’s health services with a focus on Black maternal mortality prevention. So far, Henry Ford Detroit Hospital campus has completed the training and it is currently being conducted at Henry Ford West Bloomfield Hospital.

WIN Network: Detroit’s Community Health Workers are trained as both Community Health Workers and doulas. This dual training allows them to fully support mothers, birthing people and families’ needs during pregnancy and postpartum. The community health workers co-lead the group prenatal care with a Certified Nurse Midwife. CHWs also meet with moms outside the group sessions to make sure they are getting the information and resources they need for a healthy pregnancy.

Detroit has numerous organizations taking steps to decrease maternal mortality. Black Mothers’ Breastfeeding Association (BMBFA) provides a free community-based doula training program using the HealthConnect One model in addition to providing free doula services to pregnant persons in the Metro Detroit area. Visit bmbfa.org/doulatraining for more information.

[1] Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths | CDC Online Newsroom | CDC

[2] What is a Doula – DONA International

[3] Greiner, K.S., Hersh, A.R., Hersh, S.R., Remer, J.M., Gallagher, A.C., Caughey, A.B. and Tilden, E.L. (2019), The Cost-Effectiveness of Professional Doula Care for a Woman’s First Two Births: A Decision Analysis Model. Journal of Midwifery & Women’s Health, 64: 410-420. https://doi.org/10.1111/jmwh.12972

[4] Hodnett ED. Gates S Hofmeyr GJ. Sakala C. Continuous Support for Women During Childbirth. Cochrane Database of Systematic Reviews. CD003766, (2003)

[5] Do Black Women Need Doulas More Than Anyone? (parents.com)

[6] Doula Initiative (michigan.gov)

[7] BMBFA | Black Mothers’ Breastfeeding Association (blackmothersbreastfeeding.org)