Addressing the Black Maternal Mortality Rate

Introduction: As of 2021, the Black maternal mortality rate in the United States was 69.9 deaths per 100,000 live births as compared to the national average of 32.9 and the White American average of 26.61. It has been demonstrated that this discrepancy is not fully explained by socioeconomic status. Doulas are professionals who provide support and guidance throughout pregnancy, birth, and early parenthood. Encouraging the use of doulas may be an effective approach to improve the birth experience for Black mothers. Methods: A literature review was performed using PubMed and the following search strings: maternal mortality rate (+race, +race +ethnicity, +African Americans, +Doulas) and improving perinatal care (+race, +doulas). In addition to this search strategy, title and abstract searches were used. Systematic and narrative reviews, qualitative and quantitative primary publications were included. Publicly-available data from national organizations were also used. Extracted data were analyzed through IBM SPSS v29.0, GraphPad Prism v12.0 and/or functions in Excel for quantitative analyses. Thematic word searches were used for qualitative analyses. Results: Women supported by doulas are found to experience more respectful care, as opposed to women without doulas. This association is largest for non-Hispanic Black women. Doulas were found to positively impact perinatal outcomes during antepartum, labor and delivery, and postpartum periods. These impacts include: improved self-esteem, increased perceived social and clinical support, decreased cesarean rates, decreased rates of preterm birth and low birthweight, and increased infant safety practices. Conclusions: The support of doulas is associated with both objective and subjective improvements in birth outcomes, particularly for Black mothers. Surveys indicated that Black mothers benefited not only from their experience with doulas, but from the support they gained throughout their pregnancies and deliveries. This suggests that increased use of doulas by Black mothers may help address the racial disparities in maternal mortality and birth outcomes.