Improving birth satisfaction and outcomes among disadvantaged women through community-based doulas: A starting point for social justice

Objectives: Despite modern maternity care, poorer, younger, and minority mothers and their infants continue to experience poor birth outcomes that reflect social disparity. We examine health care use, health outcomes and birth satisfaction among women participating in a community-based doula program called the Birth Circle.

Methods: Since 2006, the Birth Circle has worked with a medical assistance insurance program to provide doula services to low income pregnant women. Doulas are trained lay women from the community who provide several services, including childbirth education, nutrition education, and breastfeeding support. The doulas accompany women to medical visits, perform pre-natal and post-partum home visits, provide continuous labor support, and connect women to needed behavioral health and social services. Data on home visits, medical services and birth outcomes were collected. Birth Circle participants also completed a satisfaction survey.

Results: The Birth Circle program has served more than 300 women, who report high birth satisfaction and demonstrate increased breastfeeding initiation (as an indicator of attachment) compared to area breastfeeding rates. Preliminary examination of birth outcomes is encouraging: women receiving at least 3 pre-natal and one post-partum doula visit had fewer low birth weight babies, compared to women who received no doula services. However, further work is warranted to standardize the intervention and to clarify connections to health outcomes.

Conclusions: The use of community-based doulas to engage disadvantaged mothers in prenatal care and delivery choices improves birth satisfaction and infant attachment. This intervention offers promise for improved health outcomes and warrants policy and funding consideration.