One of the first things Phelicia Cadet did when her water broke on May 22 was to call her doula, Ieshia Lee. While sobbing over the phone between contractions, the cadet said, “Help me get through this pain!”
To encourage Cadet during delivery, Lee, who had been working with her throughout her pregnancy, hurried to the hospital.
The Mass General Brigham Birth Partners Program provides free doula services to 58 first-time Black and Indigenous mothers, including Cadets. To lessen the obstetric difficulties they disproportionately experience, it connects women with doulas.
The health system’s United Against Racism initiative, which aims to address issues related to medical racism, provided funding for the program, which was introduced in October 2021. Four Mass Brigham hospitals—Massachusetts General, Brigham and Women’s, Salem, and Newton-Wellesley—use the financing to hire doulas from neighborhood organizations focusing on those familiar with their patients’ respective cultures and linguistic heritages.
According to Cadet, a 27-year-old Randolph resident, “the training helps you learn how the process works and how to prepare yourself.” You have a representative there who will speak for you if you cannot do so.
Black women had higher odds of having a cesarean section and are roughly three times more likely than white women to die from pregnancy-related reasons, according to the Centers for Disease Control. According to the Massachusetts Department of Public Health, Black non-Hispanic women in Massachusetts have a nearly two-fold increased risk of dying during pregnancy or within a year of giving birth compared to white non-Hispanic women.
Studies have also revealed disparities in breastfeeding rates. Black, Latina, and Indigenous mothers are less likely than white mothers to leave hospitals exclusively breastfeeding, which can have major health consequences for both mother and child.
Doulas can help close these health gaps by offering non-clinical physical, emotional, and educational support to families throughout and after pregnancy. They can assist women in making medical decisions and act as a liaison between patients and their medical team because they are trained in the anatomy and physiology of labor and birth.
According to Mari-Elena Leckel, founder of Boston Birth Associates, which offers doula support and childbirth education classes, “for someone who’s never done this before and doesn’t understand the process, we can break it down and help make decisions so that they can feel like part of the process instead of the process being done to them.”
Doula use has been associated with improved maternal and newborn health outcomes. A Massachusetts Special Commission on Racial Inequities in Maternal Health report from 2022 claims that using doulas results in a 39 percent decrease in cesarean births, a decrease in the need for painkillers, and an increase in breastfeeding rates.
However, doula care is often not covered by health insurance, making it frequently unavailable for those who may benefit from it the most. In the Boston region, a doula can cost $2,000 or more per birth. As MassHealth, the state’s Medicaid program looks into including coverage for doula support services, this could soon change.
According to Dr. Ashanda Saint Jean, associate professor of obstetrics and gynecology at New York Medical College and head of the obstetrics and gynecology department at Health Alliance Hospitals in New York, hospital programs offering doula services are still very uncommon.
Saint Jean declared that what is taking place in Boston is truly revolutionary and should be praised and adopted nationwide.
The workforce’s predominant whiteness is another obstacle for women of color seeking doula care. According to Dr. Allison Bryant, senior medical director for Health Equity at Mass General Brigham, this can make it difficult to find doulas with similar racial or linguistic backgrounds.
The Birth Partners program supports a doula training scholarship to diversify the Massachusetts workforce to solve this.
Bryant, who is also a maternal-fetal medicine specialist in the Obstetrics and Gynecology Department at Massachusetts General, said, “Once we turn on that faucet, we need to make sure that we have a pipeline of people who are ready, willing, and able to serve in that capacity.”
Patients at Brigham and Women’s who meet the requirements for the doula program participate in a lottery in the third trimester. If chosen, they are matched with a doula who can attend the birth, two postpartum home visits, and two prenatal visits.
Seven months into her pregnancy, Cadet learned about the program from her doctor, who worried her lupus might increase the chance of complications. According to the CDC, the autoimmune condition can raise the risk for birth issues like preeclampsia and early delivery, which affect Black women in the United States three times more frequently than white women do.
Working with Lee, according to Cadet, significantly reduced her anxiety, particularly during labor. After Cadet gave birth to her baby Kashden, Lee helped the new mother as she struggled through breastfeeding challenges.
Lee, 48, started working as a doula 28 years ago to support expectant women in a way that she felt was lacking during her pregnancy. She stated that both at the hospital and among their families, her primary responsibility is to “make them feel like they have a voice.”
The program’s two main objectives are to decrease the rate of C-sections and boost exclusive breastfeeding, even though it also seeks to improve the participants’ general maternal health.
Cadet’s physician, Dr. Nicole Smith, a specialist in maternal-fetal medicine at Brigham, hopes to see a decline in C-sections that meets the national target of 23.6 percent established by Healthy People 2030, a women’s and children’s health project of the US Department of Health and Human Services. According to CDC data, Massachusetts has the highest percentage of C-section births in the country—nearly one-third—ranking 19th overall.
This hospital program in the area is not the first to provide free doula services. In 1999, the Boston Medical Center created the Birth Sisters program in response to high infant mortality rates and widening birth inequities between Black and White women. The initiative, which is now concentrating on tackling maternal morbidity and mortality, provides multicultural doula services to pregnant moms who are in the greatest need, such as those who have little or no social support.
Dona Rodrigues is a certified nurse midwife, director of the Birth Sisters program, and clinical assistant professor of Obstetrics and Gynecology at the Boston University Chobanian & Avedisian School of Medicine.
“BMC decided to go for a grant to decrease the discrepancies that were going on at the time to provide a program that was bringing in doulas that were actually from the communities where the pregnant people were coming from,” she said. Midwives, as opposed to doulas, are medical professionals training in pregnancy, delivery, and postpartum care.
Ebere Oparaeke, the coordinator of the BMC program, says that while doula assistance is beneficial in reducing mother disparities, it shouldn’t be exploited as a Band-Aid solution for more significant problems of systemic racism, which are the cause of these disparities.
Adding more tools to the system won’t bring about change, she declared. It will primarily result from confronting, deconstructing, and uprooting the long-entrenched issues.