Effectiveness of an Enhanced Community Doula Intervention in a Safety Net Setting: A Randomized Controlled Trial

Area of Science:

• Maternal Health
• Health Equity
• Public Health Interventions

Background:

• Racial disparities in maternal health outcomes stem from systemic racism and social determinants.
• Community doula support, offering emotional, educational, and advocacy services, is a potential intervention to reduce these disparities.
• While historically rooted in BIPOC communities, its role as a disparity-reducing clinical intervention is a recent development.

Purpose of the Study:

• To test the effectiveness of enhanced community doula support within a safety net hospital setting.
• To explore the association between community doula support and improved health equity in birth outcomes.
• To analyze the impact on cesarean birth, preterm birth, and breastfeeding rates.

Main Methods:

• A pragmatic randomized trial comparing standard maternity care with standard care plus enhanced community doula support.
• Participants included nulliparous individuals with publicly funded health plans and lower-risk pregnancies.
• Primary outcome was cesarean birth, with secondary outcomes including preterm birth and breastfeeding; subgroup analysis by race-ethnicity was performed.

Main Results:

• Overall outcomes were similar between groups in the primary intent-to-treat analysis.
• A trend toward increased breastfeeding initiation was observed (p=0.08).
• Black non-Hispanic participants showed a nonsignificant 12% absolute reduction in cesarean birth and an 11.5% increase in exclusive breastfeeding.

Conclusions:

• While the overall study sample showed similar outcomes, Black birthing individuals experienced improved cesarean and breastfeeding rates.
• This study highlights the need for larger trials investigating community doula support for Black birthing individuals.
• The findings suggest community doula support may be a valuable tool for advancing maternal health equity.