How doulas close care gaps for NC families

Doulas help their clients in many ways, providing physical, informational, and emotional support over the course of a pregnancy and in the immediate postpartum period. Encouraging better communication between patients and providers is a linchpin of that work. That’s 1 reason why more and more public health strategies identify them as an important, underutilized resource, according to a report from the NC Department of Health and Human Services (PDF).  

As a father of 6, my investment in seeing doulas take on a more significant role to advance maternal health equity (PDF) is both personal and professional. 

As more programs aimed at elevating doula support roll out, as reported in a case study by the Medicaid and CHIP Payment and Access Commission, it’s important to remember that communications challenges run both ways. Just as expecting parents may have trouble expressing their questions and concerns when they talk with a provider, doulas face a communication challenge of their own: How to promote more understanding and awareness of their services in ways that connect with the families and communities who need them.  

Earlier this spring, the Brody School of Medicine at East Carolina University launched a new doula training program to address lagging perinatal health throughout North Carolina’s Coastal Plains region. SEEDS ENC (Supporting, Educating, and Engaging Doulas to Serve Eastern North Carolina) does important work on many different levels, but here's what’s particularly interesting to me: The program’s design doesn’t just aim to increase the number of certified doulas throughout the area – it also takes steps to help them improve outreach and engagement with the communities they serve. 

SEEDS ENC welcomed the first cohort in March, with 8 people completing the DONA International-based curriculum. Up next, they’ll participate in seminars focused on perinatal mental health and support for people who use drugs and those in recovery. The program also features a mentorship component, which nurtures a more collaborative peer network across the region’s existing doula community. 

That’s a big deal in a state that earned a D+ on the 2023 March of Dimes Report Card, which tracks indicators of overall maternal and infant health. To put that grade in perspective: Between 2019 and 2021, North Carolina’s perinatal mortality rate doubled from 22 to 44 per 100,000 births, according to a report from the Samuel DuBois Cook Center on Social Equity at Duke University. That’s a dramatic sweep in the wrong direction. Perinatal mental health is a known driver of perinatal mortality and the reason for the specific design of the SEEDS ENC program. 

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) helped fund the program, recognizing the important role it will play in improving access to resources and support. Most of the 29 counties served by the program are among the state’s 40 most economically distressed (classified as Tier 1), where affordability is a significant barrier to care for many expecting parents. The region is mostly rural, and its remoteness magnifies the challenges of finding care: Providers are few and far in between, making it difficult for anyone with unreliable access to transportation or tight work schedules to get the care they need.  

Not surprisingly under these circumstances, growing families in the region face real challenges. The Brody School of Medicine hopes that the program can help turn things around. More and more evidence shows doulas can improve care with better outcomes for babies and their parents, especially in under-resourced communities, according to a study published in The Lancet. These outcomes include fewer cesarean sections, less anxiety and depression, more positive birth experiences, lower costs, and more.  

I’ve been deeply engaged in the Medicaid space over the years, and I’ve had plenty of opportunities to visit OB-GYN facilities in person and witness how providers need support with patient communication; often, they can’t focus on all aspects of care in the limited time they have during a visit. 

By building expecting parents’ knowledge base and serving as supportive patient advocates, doulas ultimately can help foster the open and productive dialogue that is so important to a healthy pregnancy and delivery. 

Doulas can be central figures building the bridge between the provider community and expecting parents. But the widespread lack of comprehension around what doulas do or how their function differs from midwives illustrates how this work depends on improved connections between doulas and the families they want to help.  

The comprehensive vision guiding SEEDS ENC establishes a foothold for that all-important bridgebuilding to begin. The Brody School of Medicine recognizes that growing the numbers of certified professionals is only part of the challenge. It’s just as important to extend and deepen their reach into communities.  

Participants commit to providing free full-spectrum doula care to at least 1 new high-risk client per month. Referrals into the program come from community partners and may include individuals facing social isolation, trauma, teen pregnancy, or barriers in navigating the health care system. To address these complex needs, staff will match clients with doulas who share a similar language and cultural background, when possible.  

Sustaining that kind of community outreach requires doulas to beef up their own communication efforts. To promote this, SEEDS ENC doesn’t just deliver primary skills – it also helps trainees and experienced doulas develop business platforms and marketing strategies. Improved community outreach and engagement will help them connect with new clients from diverse backgrounds.  

These skills aren’t just essential to anyone trying to establish, grow, and sustain a viable practice – they’ll also ensure that the region’s growing doula network actually reaches the community members who stand to gain the most from their services.  

In addition to SEEDS ENC, Blue Cross NC has invested in a variety of other programs to support doulas across the state. Our Healthy Blue Medicaid program includes, as an important value-added service, free support by a certified doula for expecting parents in certain areas who have completed at least 1 prenatal visit.  

For our part, we recognize that we too have an important role to play raising awareness among our members, provider partners, and stakeholder organizations. 

Just recently 2 members of the Healthy Blue team joined a public health social work conference to deliver a presentation on the impact doulas can have at the local level and how health department staff can connect their clients with doula-related services. Their presentation reached roughly 75 local health department care managers and other staff, and it led to an impromptu problem-solving dialogue at the end of the session. 

That’s a lot of reach with just 1 modest engagement. More than that, something interesting happened during the presentation: 1 attendee shared that she’d participated in SEEDS ENC. That’s real-world evidence of the power of cross-pollination, suggesting how education and outreach across all spheres is already driving progress toward a stronger, more responsive doula network in North Carolina.