Thread by @DrChelleMD

1/ A thread on our recently published perspective @PSRHjournal "Community‐Based Doulas & COVID‐19: Addressing Structural & Institutional Barriers to Maternal Health Equity" onlinelibrary.wiley.com/doi/full/10.13…

cc: co-authors @uhkti_ayomida @Wendy_LBennett @KellyBowerRN

#CiteBlackWomenSunday

2/ Community-based doulas are birth workers closely tied to the communities they serve. They offer support of birthing people throughout pregnancy, labor, & postpartum AND provide additional services/ resources aimed at addressing social and structural health inequities.

3/ I work w/ co-author & community-based doula @uhkti_ayomida & other birth workers on policy reform to advance maternal health equity. This past year we have focused on policy reform for the doula workforce (e.g reimbursement reform, anti-racism focused training requirement)

4/ What I have learned in the process is that despite evidence supporting doula care as a strategy to⬇️ birth disparities & improve maternal and infant health outcomes. Few federal, state or hospital level policies support doulas in building sustainable models of care.

5/ The #COVID19 pandemic has magnified this valuation by the US healthcare system, as doulas have been deemed non-essential in labor and delivery settings & in some cases relegated to *visitor* status.

6/ As hospitals began (& continue) to impose strict visitation policies limiting the # of visitors in the room of pregnant people. See: "Labor & Delivery Visitor Policies During the COVID-19 Pandemic..." jamanetwork.com/journals/jama/…
These designations limited doula access to birthers

7/ While best practices for disease mitigation remain a priority; doulas are not visitors. They are frontline workers and members of the healthcare team and play an important role.

8/ Most especially for historically marginalized populations for which there is accumulating evidence of disproportionate representation among COVID-19 cases and disparities in COVID-19 related birth outcomes:
cdc.gov/mmwr/volumes/6…

ncbi.nlm.nih.gov/pmc/articles/P…

9/ Despite barriers to access, many community-based doulas adapted their roles and found new ways to support birthing people. Dropping off supplies, continuing to connect people to social services, and offering virtual visits.

10/ But all these adaptations are more challenging when you are not connected or integrated into a health care system/ have to fight for sustainable funding.

11/ In our perspective, we discuss how programs like @HRSA funded Maternal Telehealth access projects, led by organizations like @Support_ROSE @NBEC can help bridge the immediate gap.

12/ But beyond these programs, and the obvious step of making sure doulas are acknowledged as members of the healthcare team-- we also need to address broader policy issues related to recruiting and retaining a diverse doula workforce ( more to come on that!)

13/ Next steps? @MySMFM graphic shows ways to provide equitable care to birthing people during #COVID19 pandemic. It's complex, but focusing on #SDOH, community resource & acknowledging the role of racism, seems most promising ROI.

14/ Community-based doulas can help. Let's not miss out on an opportunity to 1) engage a capable public health workforce and 2) identify weaknesses in our current approaches & start to dream of sustainable structural & policy-level solutions.
Check our paper for more deets! END

@JH_WomensHealth @JHhealthequity
@BlkMamasMatter @AncientSong7 @TheDoulaProject @BirthEquity @MOTHERLAB20 @JHhealthequity @JHUrbanHealth @doccrearperry @mclemoremr @RRHDr @RJEpiOBWarrior @doccrearperry @PhDiva0618 @DrSlaughter99 @katybcoz @KavitaShahArora @citeblackwomen