Advancing Equity in Maternal Health With Virtual Doula Care

Despite advancements in medical care, maternal morbidity rates are rising in the US, and Black birthing people disproportionately experience adverse outcomes, including maternal mortality. Policymakers have highlighted the importance of addressing the maternal health crisis and stark racial disparities. One potential strategy highlighted in the White House Blueprint for Addressing the Maternal Health Crisis is to increase access to doula care. Doulas are nonclinical professionals who offer physical, emotional, and informational support during pregnancy, delivery, and post partum. They also help parents navigate the health care system and mitigate the effects of racism by encouraging parents to self-advocate in interactions with health care professionals. Several systematic reviews have shown that doula support can reduce cesarean birth rates and premature deliveries and improve breastfeeding initiation and birth experiences. Recognizing these benefits, 12 states now provide coverage for doula services in their Medicaid programs. Although doulas have historically used telephone calls and text messaging to enhance communication, they generally worked with clients in person. However, many fully virtual and hybrid (in-person and virtual) doula services that use synchronous video visits have emerged in recent years. While virtual doula services were initially delivered out of necessity in response to the COVID-19 pandemic, the care model remains common. In this Viewpoint, we review the advantages and limitations of virtual doula services and discuss their potential to address the maternal health crisis.

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