Doulas are part of the solution for improving labor and birth outcomes


Yesterday we explained how virtually everyone giving birth can benefit from the support of a doula. Let’s talk about how doulas may help to improve labor and birth outcomes in our community.

We have significant disparities in maternal mortality and birth outcomes.

The United States is in the midst of a maternal mortality crisis. Wisconsin sees significant disparities by race/ethnicity relative to white moms and birthing people, as well as substantial increases in maternal mortality in our state for Hispanic, American Indian/Alaskan Native, and Asian/Native Hawaiian/Pacific Islander people in particular. In Dane County, we see significant disparities in birth outcomes, including higher rates of infant mortality among Black, American Indian and Alaska Native, and Hispanic and Latino babies compared to Dane County babies overall. 

Systemic issues, including discrimination in traditional healthcare settings, underlie these disparities. Experiences such as poverty, inadequate housing, and food insecurity often lead to negative health outcomes for parents and their children too. These challenges do not happen by chance. They are the result of the way systems were designed throughout history. 

Doulas alone cannot solve these problems, but they may help lessen the impact of these unjust systems on birth experiences, especially for parents and babies of color. 

Portrait of doula Nurse Uno
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Nurse Uno

As a black woman I am committed to working with all women, especially women of color receive the best reproductive healthcare possible. I have had the joy and honor of supporting so many wonderful mothers, birthing people from various ethnicities and backgrounds. Advocating and empowering the expectant birthing person is what I love to do!

Nurse Uno, full-spectrum doula and owner of A Doula Just for You

Research shows having continuous support, like the support a doula provides, may improve labor and birth outcomes.

Benefits for Parent

There have been many studies on the benefits of using a continuous support person during labor, including doulas. In a Cochrane Review, researchers reviewed 26 randomized studies that included more than 15,000 people. Researchers found births with continuous support may improve outcomes for both the person giving birth and their baby. 

Specifically, people with continuous support are more likely to have vaginal births without being induced and less likely to have vacuum or forceps-assisted birth, caesarean sections, and negative feelings about childbirth. Labors were shorter by about 40 minutes and babies were less likely to have low Apgar scores at birth. They are also less likely to use pain medication and epidurals. (Keep in mind that doulas are there to support your needs and can help you make a birth plan designed for your ideal birthing experience; if you want a medicated birth, your doula is there to support your wants and needs and not push you to give birth a certain way.) Notably, researchers found no evidence of negative effects from continuous support during labor. 

Benefits for Babies

In births with doulas or another continuous support person, babies are more likely to have healthy, normal vital signs at birth, like crying vigorously. In addition, studies of community-based doula programs have shown “doula support increases attendance at medical appointments and education classes, encourages responsive parenting behaviors, and enhances child health and developmental outcomes such as breastfeeding initiation rates and safe sleep practices.” More research is needed to better understand the relationship between using a community-based doula and birth outcomes.

Benefits of Community-Based Doulas

A community-based doula not only provides the support we discussed in the first blog in our series, but also uses a reproductive justice and birth justice framework to counteract oppressive systemic issues, including racism, discrimination, intergenerational trauma, and implicit bias. 

The Prenatal-to-3 Policy Clearinghouse adds that community-based doulas are unique in their ability to empower and support moms and birthing people. This type of care is especially vital for moms and birthing people of color who are more likely to experience discrimination in traditional health care settings. The Foundation for Black Women’s Wellness, Harambee Village Doulas, and Roots4Change are examples of community-based doula programs in Dane County. 

Moms and birthing people who use community-based doulas report feeling more respected by their medical care team, especially people of color and people with lower incomes

“I actively engage with the local community, fostering connections and building a network of support. By collaborating with healthcare providers, community organizations, and other doulas, I contribute to a holistic approach to perinatal care within the community,” says Chandra Lewis, Certified Full-Spectrum Doula and Childbirth Educator.

Bottom Line

Many things need to change to save moms and birthing people and babies in our community. The relationships surrounding infant and maternal deaths in our community are very complicated – but doulas may be one part of the solution. 

How we work with and support doulas 

Public Health Madison & Dane County partners with community-based doulas in several ways. Through a Wisconsin Partnership Program grant, we are working with Roots4Change to collaborate on community initiatives focused on Latinx/e, immigrant, and Indigenous birthing people and families. 

Portrait of Aída Inuca
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Working together in this partnership gives R4C the opportunity to think more structurally about ways that families not only from Dane County can benefit from doula services. Some of these are communities  where little or no information on maternal and child health can be found, particularly because the information the  medical provider  gives to the family could be great, but receiving continued doula support during the pregnancy, birth, and postpartum, provides a different experience not just to the families, but also providers.

A portrait of the Roots4Change team
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Aída Inuca, doula and co-president of Roots4Change

Our Fetal and Infant Mortality Review (FIMR) program partners with individuals who have experienced a fetal or infant loss, and compensating them for their participation through a state Title V grant. Many of these individuals are also doulas, which allows them to speak to their own experiences as a parent, but also as a birth worker. 

As part of the Dane County Health Council, Public Health supports the Foundation for Black Women’s Wellness in a joint effort called Connect Rx Wisconsin, which links pregnant Black women with doulas and other services such as support for food, housing, employment, economic stability, transportation, and mental health counseling all to improve the patient experience and strengthen the environments babies are born into.

Public Health has two perinatal home visiting programs: Nurse-Family Partnership (NFP) and Prenatal Care Coordination (PNCC). In these programs, Public Health nurses support families throughout their pregnancy and connect families with additional services. In 2022, our nurses started contracting with doulas in the community to provide services to families enrolled in either NFP or PNCC. The nurses have a trusted relationship with the birthing person and help assure that the connection happens with the doula. We are able to use grant funds to pay doulas for their work. This partnership continues to grow, and we contracted with more doulas in 2023.

We also acknowledge and honor the physical, mental, and emotional labor it takes to serve as a doula. We love how our partner Mariela, of Roots4Change, put it:

Portrait of Mariela Quesada Centeno
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Mariela Quesada Centeno

A doula is as strong as the networks that support her role. In the case of Roots4Change, as a cooperative, we support each other and provide spaces for healing and regeneration. 

A portrait of the Roots4Change team
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However, we are continuously fighting the system to recognize our the value proposition of our work, we deal with the never-ending duty of showing our impact and data, because the systems keep failing in producing targeted data to reveal the inequities in maternal and child health in our immigrant communities, and lastly, we have to jumps higher hurdles to finance our work.

Mariela Quesada Centeno, manager of Roots4Change

On Friday, we’ll post the final installment of our doula series: If you’re ready to hire a doula, where do you find one? How do you pay for their services? Subscribe to our blog and you’ll get an email as soon as it posts. 

We’d like to thank doulas Chandra Lewis of Reimagining Full-Spectrum Doula Services, Jasmine M. Jones of Amir’s Angels, Ms. Tracey Russell of Russell Family Doula Services, Uchenna “Uno” Jones of A Doula Just for You, Aída Inuca of Roots4Change, Roots4Change manager Mariela Quesada Centeno, and the Foundation for Black Women's Wellness for their review and contributions to this blog.

This content is free for use with credit to Public Health Madison & Dane County .

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