Doulas Transform Maternal Outcomes
Maternal mortality, a statistic representing racial inequities and healthcare failures, refers to “the death of a woman while pregnant or within 42 days of termination of pregnancy.” Within the U.S., death from pregnancy or pregnancy-related issues was 22.3 deaths per 100,000 live births in 2022. When disaggregated for race, data shows that Black women faced a higher rate of maternal death, with 49.5 deaths per 100,000 live births.
Maternal mortality disparities are further exacerbated in Georgia, where Black women are 3.3 times more likely to die from pregnancy-related complications than white women. Perhaps the greatest tragedy is that with maternal mortality, more than 80% of pregnancy-related deaths are preventable. To mitigate some of the avoidable deaths from maternal mortality, Georgia should expand its Medicaid reimbursement pilot model for doula services.
Factors influencing maternal mortality are widespread, with cardiovascular conditions, hemorrhage and mental health challenges ranking as the top contributors. Georgia’s inability to address these issues stems from a lack of access and support. Long distances to birthing centers and lack of access to any form of obstetrics care play a large role in mothers failing to receive care.
Furthermore, support also serves a critical function in mitigating pregnancy health risks. Many women need more information about medical procedures to make informed decisions about their health and seek comfort from the emotional stress of the pregnancy process.
Expecting mothers in Georgia face limited access to care and support. Thirty-five percent of counties are categorized as maternity care deserts and lack almost any obstetric care. In rural Georgia, women have to travel around 63 miles to reach a birthing hospital.
Additionally, a research survey by Emory University found that many Georgians believe the healthcare system “treats people unfairly” based on insurance, their racial or ethnic background and how well they speak English. These perceptions of bias and discrimination make women feel even less supported, undermining their birthing experiences and affecting their health.
Athens has concentrations of OB-GYNs and midwives similar to those in the metro Atlanta region, but a lack of insurance further complicates accessibility. According to the Athens Wellbeing Project, 22% of Athenians lack insurance coverage, and “even with health insurance, 23% of Athenians said they had been turned away by a provider.” Many minorities in Athens may similarly have worse birthing experiences due to their insurance status or how healthcare providers perceive them.
Given the severity of maternal mortality within Georgia, it’s important to understand what the state has done to combat the issue. The Perinatal Quality Collaborative (PQC) provides technical assistance, education and training on managing obstetric issues for hospitals. Georgia also administers a Maternal Mortality Review Committee (MMRC), which engages in data collection, analysis of maternal mortality rates and publishes findings within Georgia’s Department of Health website.
Georgia also extends Medicaid to allow more women to access care for one year postpartum. While the state has implemented some policies to address maternal mortality, it must take legislative action to provide pregnant women with access to quality care. One solution is to provide doula home visits.
A doula is a “trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth.” Unlike a midwife, a doula cannot deliver a baby nor perform medical tasks. However, doulas still play a crucial role as an intermediary between “pregnant women and healthcare staff.”
Access to doula care provides clinical, emotional and physical benefits for women, including fewer requests for pain medication, reduction of c-sections, decreased anxiety, improved mental health and lactation support. Because of the benefits doulas can provide, states such as California and Florida created Medicaid Reimbursement models for doula services.
One study done through the Healthy Mothers, Healthy Babies Coalition of Georgia implemented and evaluated a doula reimbursement plan for over 175 individuals across Georgia. The study focused mainly on Black women who were insured through Medicaid. The infants born through the program had good health post-delivery, high birth weights and a high rate of breastmilk intake.
In semi-structured interviews conducted by the Coalition, women spoke about the physical comfort, emotional support and advocacy they felt through their doula. The results provide promising implications: increasing access to doulas is a feasible option to improve care for mothers in Georgia.
While doulas cannot replace obstetric care providers, they can reduce certain complications that affect maternal mortality. By visiting women and teaching them about birth plans, comfort measures and the delivery process, doulas relieve some stress that the birthing process places on expecting mothers.
Addressing maternal mortality in Georgia is not impossible. By taking low-cost alternative measures that increase the use of doula services, Georgia can reduce discrepancies in maternal mortality and ensure that women are better informed and have greater access to healthcare resources.
Sara Anis Ali is a third-year student at the University of Georgia studying Political Science and International Affairs. She is a member of the healthcare group.