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Maternity & Family Benefits

The importance of doulas and culturally congruent care:
what health plans and employers can do today to close the birth equity gap

August 10, 2020

Dr. Joia Crear-Perry, Founder and President of The National Birth Equity Collaborative, recently joined Ovia Health for a critical conversation on the current state of birth equity, how changes in our healthcare system due to COVID-19 threaten to impact communities of color, and what health plans and employers can do to mitigate and prevent adverse outcomes. You can download the complete webinar here.

Health justice advocate, Dr. Joia Crear-Perry, spoke with Ovia Health recently about the importance of social support and personalized care for birthing parents, particularly for Black mothers and families.

Black families experience disproportionately worse maternal and infant health outcomes for a number of reasons including dismissal of pain (Black mothers, who are twice as likely as white mothers to report that they were ignored by the health system), limited access to care, and higher rates of underlying health conditions, among others. Many of these barriers to care have been exacerbated by COVID-19, like the building fear of hospital delivery. The combined impact of these factors and others creates a misguided feedback loop that centers the blame for health disparities on individuals rather than the systems that created and continue to perpetuate them.

One of the factors that perpetuates health disparities is incongruent care, which results from discrepancies between those who make the decisions about healthcare priorities and norms and the recipients of care. Incongruent care can lead to communities feeling disregarded by and uncomfortable with the healthcare system. For example, there are marked inconsistencies between how individuals envision their delivery experiences and how hospitals restrict delivery rooms, even before COVID-19.

Dr. Joia Crear-Perry notes that for many communities the delivery experience is one of celebration and includes extended family in the delivery room. This preference is typically incongruous with hospital protocols that limit the number of the people permitted in a delivery room. These restrictions — often grounded in assumptions of norms rather than safety precautions — have rippling effects. “Norms” stretch beyond hospital walls and are encoded in policy, fortifying a set of standards that disregards individual and community needs and preferences.

When it comes to delivery decisions, many Black families are left to weigh the advantages and disadvantages of delivering at a hospital, where they may be required to sacrifice their comfort level, personal preferences, and needs. The result is a dramatic overrepresentation of Black families who opt for a more personalized delivery experience at home. (With the onset of COVID-19, for the first time, many white families are experiencing restrictions to their birthing preferences, shining a light on existing restrictive practices.) Note: Ovia Health’s Clinical team is monitoring the impact of the pandemic, and has found that while 40-50% of birthing parents had someone beyond a partner with them during delivery pre-COVID-19, that number has now gone down to 14%.

The healthcare system’s failure to equitably support, include, or prioritize Black families calls attention to the need for new solutions, grounded in social support, that center community perspectives and values.

Dr. Joia Crear-Perry emphasizes the importance of advocating for and investing in resources that prioritize congruent and personalized care — and organizations like Mamatoto Village, in Washington D.C. that works with local Community Birth Workers or doulas to offer emotional, educational, and physical support.

The reason for Community Birth Worker or doula success in many communities, particularly those overlooked by the healthcare system, often lies in that they provide personalized social support before, during, and after delivery. This extended social support from conception through postpartum creates a stronger relationship with the patient and facilitates a deeper understanding of a birthing parent’s unique needs and wishes, while also ensuring their health and safety. This heightened opportunity for connection with patients throughout the pregnancy journey not only broadens access to care, the personalized experience dramatically improves clinical outcomes.

According to a study in the Journal of Perinatal Education, “doula-assisted mothers were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.” Despite the evidence, lack of certification tends to act as a barrier for many health plans and employers to cover doulas; but certification itself limits access to these roles and is not always a useful check on the quality of services a doula can provide.

The prioritization of personalized care and social support services — whether it comes from a digital platform, doula, or both — is one area with a proven impact that health plans and employers can implement today to improve outcomes for their members and employees.

What health plans and employers can do:

Increase access to doulas and community care networks

Whether it’s covering the cost of doulas and birth centers, or at minimum, making sure your members can easily tap into a network of trusted doulas, employers and health plans need to incorporate these critical support services into their offerings if they want to improve health outcomes for their entire population.

If covering the cost of doulas is too large a hurdle, providing access to peer care providers who have shared experiences with patients is an impactful first step for health plans and employers. For example, in addition to being registered nurses, many Ovia Health coaches are mothers and peers and often share their personal experiences with patients to create deeper connections with members and facilitate the best possible care.

Prioritize digital social support services

Social support can exist in the delivery room, in the form of extended families or birthing teams, but it is equally important in the months leading up to and following delivery. These months are critical to helping moms, babies, and families thrive.

During the pandemic, online communities and virtual support have played a particularly important role. Health plans and employers should prioritize solutions that emphasize community, enabling people to connect with each other and increase access to care.

Address diverse, personalized needs

Implement an offering that prioritizes personalized care and is informed by diverse needs, preferences, and experiences. Health plans and employers that offer a solution with personalized care are also empowering members to identify helpful resources, encouraging them to advocate for themselves, and providing them with essential social support to ensure more inclusive, equitable, and healthy outcomes.

For more information on what health plans and employers can do, download the webinar with Dr. Joia Perry here

To learn more about Ovia Health's social support services and access to community care networks for employers, click here

To learn more about Ovia Health's social support services and access to community care networks for health plans, click here