Doulas Associated With Better Maternal Health Care, Particularly for Patients of Color, Study Finds

University of Maryland researchers have found that a valuable but scarce resource in the field of maternal health is linked to better pregnancy outcomes and more respectful health care from doctors and nurses: a doula.

According to a study led by Lindsay Mallick, doctoral student in the Department of Family Science, and published this month in the journal Birth Issues in Perinatal Care, the ongoing presence of a doula—a trained professional who provides information about pregnancy as well as physical and emotional support during labor and birth—also contributed to broadly positive feelings about pregnancy and labor, especially among Medicaid users and people of color.

Previous research had established that a doula’s presence is connected to reduced preterm and low birth weights, fewer C-sections and shorter labor.

“Doulas are associated with (patients’) voices being heard,” said Mallick. “Especially for people of color, whose voices tend to be dismissed, having a doula can really safeguard against racism.”

Mallick, along with Associate Professor Marie Thoma and Professor Edmond D. Shenassa, also from the School of Public Health, evaluated data from 1,977 respondents to a 2018 survey of California mothers led by the National Partnership for Women and Families. They found that 49.6% of people who used the services of a doula reported respectful health care, in which they felt heard and included in making medical decisions, compared to 43.3% of those without a doula. The odds of Asian and Black people indicating respectful care were two to three times higher if they used the services of a doula than if they did not.

Mallick noted that even though doulas can be a critical resource in improving health care for people of color, the major barriers to equitable health care are structural. “Doulas are being seen as a tool to reduce racism, but I don’t think that they should be left alone to bear this burden in maternity care,” she said. “The change really needs to come from systems and policies.”