Bridging the Gap in Maternal Care: A Doula’s Role in Reducing Disparities and Improving Birth Outcomes

A morning spent at a mother’s side as she gives birth – the afternoon spent in the office running a business focused on maternal health. For Kenda Sutton-EL, it’s all in a day’s work, and her work is vital.

Kenda is co-founder and executive director of Birth in Color RVA, a birth, policy, and advocacy nonprofit in Richmond, Virginia. On top of managing her company, Kenda also serves clients hands-on as a doula.

The mission is critical. Black women in the United States are dying at an alarming rate due to pregnancy-related causes. In fact, the  maternal mortality rate  for Black women is nearly three times that of white women.

“That’s reality right now, that Black women are dying during childbirth and our biggest concern is making sure they don’t die, making sure the baby doesn’t die, and creating a healthy mom and a healthy baby,” Kenda said.

Black women also face a higher risk of serious complications during pregnancy, and racial and ethnic disparities persist no matter the woman’s socioeconomic situation.

“There are many factors that contribute to maternal inequities, including but not limited to: access to care, prenatal co-morbidities, and racial bias in healthcare,” said Dr. Demetria Malloy, regional vice president medical director at Elevance Health. “In addition to helping birthing moms with prenatal care plans, doulas can coach during labor and provide additional health education during the postpartum period. Data has shown favorable links between successful breastfeeding and lowering the rate of sudden infant death syndrome (SIDS) with the use of doulas.”

The Elevance Health Foundation  recently committed  more than $14.5 million in grants to address maternal health. With a potential to impact a collective 100,000 women, each grant will focus on one or more of the following goals: reducing preterm birth rate, reducing maternal morbidity and mortality, and reducing primary cesarean rate. These grants are part of up to $30 million the Foundation plans to invest over the next three years to make significant progress on improving maternal health outcomes.

Birth in Color RVA is one of 17 organizations receiving support in the first round of grants. The Doula program will receive a $150,000 grant over two years to fund the training and development of 18 doulas of color in three underrepresented localities in Virginia. The new doulas will join existing doulas of color to provide prenatal and postpartum care that demonstrates cultural humility. Lactation consultants, birth workers, and community-based doulas are trained to provide emotional, physical, and social support to women and families before, during, and after pregnancy. 

As more attention is brought to maternal health disparities and maternal care, more and more pregnant people are turning to a community-based doula—a person from the same culture, background, and often shared experiences.

The increase might be tied to many Black and Hispanic/Latino expectant women expressing they feel unheard and overlooked by their healthcare providers when asking questions or expressing concerns about their health. Doulas help bridge the gap by putting their priority on serving the interests of the woman, acknowledging their experiences, and helping to communicate their concerns. Studies show that mothers in historically marginalized and underserved communities who use a doula have  better birth outcomes.

“There are multiple ways to implement doula programs, but those that involve community-based organizations that help engage and serve those birthing persons at highest risk often seem to be the most successful and sustainable,” said Dr. Malloy. “They provide a trust factor during a vulnerable time in a mother’s and family’s life that can optimize sustained engagement, wellbeing, and clinical outcomes.”

Kenda, who is a mother of two, used a doula during her pregnancies and had support from family members. She says that village of support is what she’s used to, and what led her to work as a doula for many years giving expectant mothers a platform for more personalized care. She eventually launched Birth in Color RVA in 2018 and elevated her work to advocate for and empower Black mothers.

“People said they couldn’t find doulas that look like them and that’s what they preferred. We collectively said let’s create a space that is a central location where they can find people of color,” Kenda said.

Through support customized for each client, doulas aim to improve health outcomes of all birthing people and babies. They help remove barriers, reduce stress, and encourage new moms to embrace the joy of motherhood.

“They’re always there to support you; any questions you have, they’re going to answer,” Kenda said. “Equipping them with evidence-based information and helping them to find the power within themselves is the key role of the doula. Helping with comfort measures, thinking outside of the box, and equipping them with the knowledge to make their own decisions.”

Her doula duties on this day: welcoming a baby into the world. 

“Everything went well. Healthy mom, healthy baby. Seven pounds, three ounces.”

For Kenda, her work is a labor of love.

“It’s exciting to be a part of birth,” she said. “You helped to have a healthy mom and a healthy baby, you helped participate in that outcome. You helped give the mom the birth that she wanted and that’s the reward. You go away feeling fulfilled.”