Hospital-Based Doula Program Aims to Address Maternal Health Equity

March 20, 2024
Stock image of pregnant person and doula

Detroit-- To help address the alarming rate of maternal and infant mortality, particularly within the Black birthing population, Detroit-based Henry Ford Health has established a program that makes the services of a doula available to pregnant patients with Medicaid Health Plans (MHP). The program is believed to be the first of its kind in the country. 

A doula is a trained professional who gives emotional, physical, and educational support before, during and after pregnancy and childbirth. Studies suggest that doula care can make labor and delivery safer for pregnant people and babies.

Patients with Medicaid who will deliver their babies at Henry Ford Hospital in Detroit or Henry Ford West Bloomfield Hospital are eligible for the program. The goal is to eventually expand the program across the health system. Eligible patients can request a doula or be referred to the program by a Henry Ford provider at any time during pregnancy, including during labor.  

“The majority of pregnant Medicaid patients are Black and Hispanic and have historically experienced disproportionate maternal and infant mortality and morbidity,” said Dr. Richard Leach, Chair of Henry Ford’s Department of Women’s Health.  “Providing this unique service to women who might otherwise not have access is an effective way to begin to address inequities in maternal and infant health outcomes.” 

The State of Michigan began reimbursing doula services provided to individuals covered by or eligible for Medicaid in 2023. Doulas must submit claims for services to MHP members and wait to be reimbursed.

Dr. D’Angela Pitts, Director of Maternal Infant Health Equity for Henry Ford, says the health system’s program is unique in that doulas trained outside Henry Ford are employed and paid directly by the system on a bi-weekly payroll schedule. The health system assumes the burden of billing Medicaid and waiting for reimbursement, rather than the doula.

Having the doulas on staff also makes it easier to integrate them into all stages or a willing patient’s care and promotes cooperative relationship between doulas and the healthcare team Dr. Pitts said.  

“Far too often individuals arrive at the hospital to give birth having had no prenatal care. These patients are most at-risk for complications during and after birth,” Dr. Pitts added. “That’s why we took the extra step of having doulas on call in the hospitals.” 

Emergency department and labor and delivery staff may offer pregnant patients the services of an on-call doula who can provide additional support during the birthing process and to follow up with them in the weeks following birth, when the likelihood of complications that lead to pregnancy-related death is high.

Ideally, a patient’s relationship with a doula begins early in their pregnancy.  Many people don’t know what a doula is or understand how they can help; that’s where referrals can help.

During new patient intake appointments, OB staff identify eligible patients. In addition to being MHP members, patients should benefit from additional emotional, physical, and educational support before, during and after pregnancy; they may also need help addressing two or more social needs such as housing, financial or food insecurity.  

“When a pregnant person chooses to work with a doula the relationship tends to be very successful,” said doula supervisor Alexis Grantham. “We’re working to share information about the new services in our clinics and educate patients about the benefits of doula care, then help them choose which of our doulas they want to work with.”

The United States has the highest infant and maternal mortality rates among developed countries, with Black women three times more likely to die from pregnancy-related causes than white women.

In 2021, across Henry Ford’s five acute-care hospitals, there were 8,281 births; almost 26% to Black mothers, and 48% to mothers on Medicaid. At Henry Ford Hospital, where 26% of all Henry Ford births occurred, almost 46% of births were to Black mothers, and 71% were to mothers on Medicaid.

Benefits of doula care include fewer c-sections; less anxiety and depression for pregnant people; less pain-relief medication during labor; shorter time in labor; fewer negative childbirth experiences; and lower healthcare costs.

Particularly for women of color, like Amari Nichols and Octavia Solomon, the most invaluable benefit of working with a doula may be peace of mind. Both paid out-of-pocket for doula services. 

“I’d heard the statistics about Black women and pregnancy, but it didn’t really hit me until the last month of my pregnancy,” said Nichols, who gave birth to a baby girl in 2023. “I already had the doula, and I knew if anything did go wrong, she would do anything in her power to advocate for me and the baby.”

Causes of maternal death vary widely. Death from hemorrhage is most likely during pregnancy and at the time of birth, and deaths from heart conditions and mental health–related conditions are most common in the postpartum period.

Among the most common causes of infant mortality are maternal pregnancy complications, such as preterm birth and preeclampsia.

“All the things we know and think about go out the window when we turn into a patient,” said Solomon, a healthcare professional from Detroit, who gave birth to her daughter in 2022. “In my vulnerable state I knew my doula was there to play that critical role of spotting something potentially problematic.” 

In addition to providing reassurance, Solomon says her doula created a peaceful environment with candles, music, aromatherapy and more. She says the birthing experience went so smoothly, she’s afraid she may be in for a rude awakening in a future pregnancy.

“Everyone deserves to give birth in a positive environment,” said Dr. Pitts. “Most importantly, they deserve to have a positive outcome. By increasing access to doulas for more patients, we can make that possible and we can save lives.”

Patients who believe they qualify for Henry Ford’s doula program, are interested in doula services, or have questions, can talk to their Henry Ford doctor or midwife. A referral list of doulas is available for patients who have private insurance or wish to pay out of pocket.





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