Understanding Patient Needs and Perceptions of Doula Care in South Florida

Racial and ethnic disparities continue to affect maternal mortality, morbidity, and birth outcomes. Historically marginalized communities currently face higher rates of cesarean surgery, preterm birth, low birth weight, and infant mortality. Increased accessibility to culturally congruent doula services can help bridge disparities in maternal mortality, morbidity, and birth outcomes. This feasibility study aimed to characterize the need for doula care among patients of two large academic hospitals to inform the creation of a hospital-based doula program. In partnership with community-based midwives and doulas, we created an institutional review board-approved, anonymous, cross-sectional survey of consenting patients from two large academic health-care centers, one of which is a large safety-net hospital. Inclusion criteria included patients between the ages of 18 and 49 years who have had previous pregnancies, are currently pregnant, are thinking about becoming pregnant, or are not currently considering pregnancy. Surveys were offered in English, Spanish, and Haitian Kreyol. A total of 176 patients participated in and completed our survey study. Patients with an annual household income between $25,000 and $50,000 (Odds Ratio = 4.87, 95% confidence interval [1.02, 23.36]) were almost five times more likely than those with an annual household income below $25,000 to express interest in doula care. Among patients who expressed interest in doula care, there was a statistically significant association between the ability to pay for doula care and race (X ² [8, N = 148] = 19.25, p = .01). Results illustrated an increased need for doula care, especially among patients from low-income and historically marginalized groups. More research is needed to understand why differences among demographic groups exist in our patient population. At the same time, other health-care systems nationwide are further encouraged to evaluate doula support needs within their community.