New research eyes closer integration of doulas and hospital maternity care

Projects from Penn’s new Research Center for Advancing Maternal Health Equity help determine how non-medical birth support workers can be more a part of maternal care teams.

Long outliers in the modern world of hospital maternity care units, doulas have been making increasing inroads into those clinical spaces as the U.S. struggles to address its maternal mortality crisis. Those advances are likely to be further broadened by the March of Dimes’ funding of a new Penn Research Center for Advancing Maternal Health Equity and its research project aimed at determining how doulas can be more closely integrated into maternal care teams.

Liz Howell at her desk.
Elizabeth Howell, chair of the Perelman School of Medicine Department of Obstetrics and Gynecology and LDI senior fellow, heads up Penn’s new Research Center for Advancing Maternal Health Equity. (Image: Hoag Levins)

Originally established in 1938 to address polio, in 2005 the March of Dimes made premature births the primary focus of its funding and has continued to expand programs for mothers and babies ever since. Its latest report notes that an average of two women die every day from pregnancy-related causes in the U.S. and two babies die every hour. The organization characterizes the situation as a “crisis fueled by many factors, including structural racism, poor maternal health, and socio-economic status.”

Elizabeth Howell, chair of the Department of Obstetrics and Gynecology in the Perelman School of Medicine and Leonard Davis Institute (LDI) senior fellow, is the chair of the Scientific Advisory Committee and principal investigator of the new center.

“Disparities research has traditionally shown that Black women are three to four times more likely to die of pregnancy-related causes than white women,” says Howell. “So, we have a lot of data on disparities but what we haven’t been hearing as much about is: ‘What can we do to change this? How are we going to intervene? What are the action steps that we can take?’ That’s what this new March of Dimes center at Penn is about. It’s focused on action-oriented solutions and thinking about new models of care.”

And, in that spirit, one of the center’s first two research projects is focused on expanding the evidence base related to the positive effect of doulas in maternal care. These non-medical support people provide guidance and comfort measures to help women cope with the physical and emotional demands and stresses of labor and childbirth. They can also provide education and advocacy, helping women make informed decisions about their care.

The doula research project is headed by LDI senior fellow Sindhu Srinivas, a professor of obstetrics and gynecology at the School of Medicine, vice-chair for quality and safety, and associate chief medical officer for the Hospital of the University of Pennsylvania.

“The first goal of the project is to understand various stakeholder perspectives in working toward creating more integrated obstetric care delivery models in which doulas are part of the care team,” says Srinivas. “The stakeholders we’re talking about are birthing patients, trusted community partners including community-based doulas, and clinical providers, including physicians, midwives, and nurses.”

Read more at Penn LDI.