Integrated bi-directional partnerships between birthing facilities, health care providers
and community leaders and community birth support persons, such as doulas, is critical to
improving health equity and maternal outcomes. This study is partnering with a birth
worker/community support organization, with a mission to celebrate Black motherhood and
influence favorable outcomes in Black Maternal Health by promoting a community-empowered
model of care.
The United States has one of the largest racial and ethnic disparities in
pregnancy-related morbidity and mortality of industrialized nations. Black, Indigenous
and other people of color (BIPOC) patients have a 2-3 times higher risk of
pregnancy-related mortality compared to white patients. For every maternal death, over
100 patients experience a severe maternal morbidity, which is a life-threatening
complication during their delivery hospitalization, resulting in over 50,000 women and
birthing people experiencing one of these events every year in the U.S. (with the
majority occurring in BIPOC patients). These disparities are even more pronounced in the
city of Philadelphia, the poorest of the nation's top ten largest cities. A recent report
from the Philadelphia Maternal Mortality Review Committee identified 80% of mortalities
were among BIPOC patients and 80% of those mortalities had identified social and
structural barriers, including, but not limited to, mental health issues, substance use
disorders and lack of prenatal care. Integrated bi-directional partnerships between
birthing facilities, health care providers and community leaders and community birth
support persons, such as doulas, is critical to improving health equity and maternal
outcomes. While doulas and other community organizations partner with some birthing
providers, the way in which this occurs is variable and the most effective model for
integration through the pregnancy continuum has not been determined. Results from
previous studies show the importance of implementing community models of care throughout
the pregnancy continuum that will mitigate bias, mistrust, and mistreatment thereby
improving both the experience and outcomes specifically and especially for Black birthing
people.
The study will test the hypothesis that an integrated partnership between a birth
worker/community support organization and the Hospital of the University of Pennsylvania
(HUP) will mitigate bias and mistrust thereby improving both the experience and outcomes
for Black birthing people at HUP. Within this study, the investigators will determine the
effectiveness of this integrated partnership in reducing maternal depression score at 6
weeks postpartum. Self-efficacy, perceived trust of care providers, stress, birth
satisfaction, and obstetric outcomes will also be assessed. Patients will be randomized
(n=230) to Doula care (receive 2 prenatal visits, continuous intrapartum support, and 2
postpartum visits with a certified doula) or standard of care (receive prenatal care,
labor and delivery, and postpartum care as they normally would if not in the study) and
followed through 6 weeks postpartum.