New York City public hospitals expand community-based doula programs

More pregnant people who are incarcerated or experiencing housing insecurity and homelessness will have free access to a doula under a new expansion project in New York City.

The Helping Promote Birth Equity Through Community-Based Doula Care Program (HOPE) will increase the number of doulas from the 12 currently working with NYC Health + Hospitals (H+H), and provide additional training based on the needs of pregnant patients who are incarcerated or experiencing housing insecurity through a three-year, $2 million grant.

“With the support from [the grant], we can better assist our community members who have historically faced disproportionately high adverse childhood experiences, chronic health challenges, limited support during the critical perinatal period, and poor maternal and child health outcomes,” Sheela Maru, HOPE faculty lead and H+H/Elmhurst attending physician, said in a statement.

The program, which launched in 2022 at two H+H facilities in Queens, aims to address maternal health disparities, especially for Black patients and other patients of color.

In 2018, Black women in New York were 2.3x more likely to experience potentially life-threatening childbirth complications compared to white women in the state, according to a 2020 report from the New York Health Foundation.

Community-based doulas provide nonclinical physical, emotional, and educational support throughout the pregnancy and postpartum period. They can help educate patients on topics such as pregnancy risk factors or breastfeeding, and provide both prenatal and postpartum home visits, according to a 2022 report from the federal Office of Health Policy. Doulas also function as patient advocates and help communicate patients’ needs and concerns to their medical team.

“Doulas are often trusted members of the community they serve and are well-suited to address issues related to discrimination and other drivers of disparities by bridging language and cultural gaps and serving as health navigators,” according to the report.

The cost of doula services ranges anywhere from $500 to more than $3,500, which includes support throughout pregnancy and labor with additional postpartum visits, the New York Times reported.

Community-based doula services may also be a cost-effective way to decrease birth complications.

Medicaid recipients who received doula support during pregnancy had a 22% lower risk of preterm birth compared to those without, a 2016 study analyzing more than 65,000 Medicaid births found. Premature births cost health systems more than $100 billion each year from neonatal care and frequent hospitalizations.

Doula services, which are rarely covered by insurance, are often out of reach for pregnant patients who are at higher risk of birth complications.

Infants born to “severely housing insecure mothers,” namely mothers who faced eviction or homelessness during pregnancy, were much more likely to need costly neonatal intensive care, compared to those born to mothers with no reported housing insecurity, according to a 2020 study from researchers at Johns Hopkins and other universities.

Incarcerated pregnant people are also at higher risk for factors—such as poor nutrition, poor dental health, or opioid use—that lead to birth complications like low birth weight, a 2019 study published in the Journal of Correctional Healthcare found.

In 2013, the incarceration rate for Black women was twice that of white women, the Department of Justice found. Across the country, Black people are overrepresented among people experiencing homelessness, according to a 2022 Department of Housing and Urban Development report.

The HOPE program plans to use community input, especially from those who gave birth while incarcerated, to tailor the program to their needs and provide additional training for doulas, Maru told Healthcare Brew. The program is collecting feedback and will start offering services later this year, according to the statement.

In addition to providing doula services, H+H employs nearly 100 midwives to help care for patients during all stages of pregnancy and the postpartum period. Midwives, unlike doulas, are medical professionals who can help deliver babies and perform gynecological exams. The two can work together to provide emotional and medical support to the patient during childbirth.