Influence of Doula and Midwifery Services on Pregnancy Outcomes for Black Women in the United States: A Structured Literature Review Public
Ellis, Chariesse (Spring 2021)
Published
Abstract
Background Black women in the United States face tremendous racial/ethnic disparities in accessing effective high-quality pregnancy care and experience high rates of poor birth outcomes, including but not limited to, cesarean section, pain medication use, postpartum depression, preterm birth, low birthweight, and maternal and infant mortality. Continued labor support (CLS) doula and midwifery services have been associated with improved maternal and infant birth outcomes. The utilization of doulas and midwives has become increasingly more common as a pathway to mitigate the impact of racial and socioeconomic disparities within the healthcare system on a Black women’s birthing experience and her pregnancy outcomes.
Methods A structured literature review of peer reviewed articles was conducted using electronic databases PubMed, JSTOR, MEDLINE and PsychINFO published between the years 1990-2021. Articles were screened for the exposure of interest: pregnant Black/African American women who utilize doula and midwifery services and the outcome: maternal and infant pregnancy outcomes.
Results 9 total articles were included for review and synthesis. Interventional and observational studies were included for analysis. Articles identified various birth and infant outcomes where doula and midwifery services improved outcomes: reduced cesarean sections, reduced use of pain medication during labor, increased initiation of breastfeeding, improved feelings of agency, knowledge, connectedness, and personal security, reduced preterm birth and low birthweight.
Conclusion Available literature indicates the importance of doula and midwifery services in reducing the impact of racial/ethnic disparities in obstetric care and improve birth outcomes for Black women in the United States. Future studies must investigate the impact of CLS services on high-risk women, non-binary self-identified Black women and women delivering twins.
Table of Contents
Introduction………………………………………………………………………………...1
The Black Women’s Burden…………………………………………………..….1
Patient-Provider Power Dynamics………………………………………………3
Influence of Doula/Midwifery Services on Pregnancy Outcomes…..……4
Methods…………………………………………………………………………………..….6
Article Selection Criteria……………………………………………………...…6
Database searches……………………………………………………………....…7
Results……………………………………………………………………………….……....9
Literature Review Selection…………………………………………………...…9
Maternal Outcomes…………………………………………………….….…..…14
Infant Outcomes……………………………………………………………....….19
Barriers to Access……………………………………………………………….…20
Limitations……………………………………………………………………..........…..23
Discussion…………………………………………………….………………………...….26
Impact of CLS on Maternal and Infant Birth Outcomes……..………..….26
Implications for Education and Practice………………………..……..…….27
Suggestions for Future Research……………………………………..…….....28
Conclusion…………………………………………………………………………....…...29
References…………………………………………………….………………..……........31
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