Doulas as care coordinators: Connecting women to postpartum care

Background: Current recommendations are that all women receive at least one postpartum visit within 8 weeks after delivery, yet up to 45% of women in some economic and racial/ethnic high risk groups do not have a visit after delivery. In this study we examine whether having a doula through the Birth Sisters program at Boston Medical Center (BMC) can better help connect women to the healthcare system post-delivery.

Methods: We performed a retrospective chart review of women who received prenatal care at BMC, a large urban tertiary care hospital, and delivered a live infant between 7/1/06 and 2/1/08; we identified a subset of these women who received Birth Sister services. We compared the proportion of women with a postpartum visit between those with and without a Birth Sister.

Results: 1527 women received prenatal care at BMC during our study period; 86 women had a Birth Sister and 1441 did not. Women with a Birth Sister were less likely to speak English (65.1% versus 77.7%). Initial unadjusted analyses showed that 80.2% of women with a Birth Sister had a postpartum visit, and 74.6% of women who did not have a Birth Sister had a postpartum visit (p=0.2419). Multivariate analysis is underway.

Conclusion: Postpartum care can be critical in improving women's health after delivery, however many women still miss their postpartum visit. Our data show a trend towards improved connection with postpartum care for women who received doula care. The role of community based programs in improving postpartum care requires continued research.