When Phelicia Cadet’s water broke on May 22, one of the first things she did was call her doula, Ieshia Lee. Cadet remembers battling contractions while crying over the phone, “Help me through this pain!”
Lee, who had been working with Cadet through her pregnancy, rushed to the hospital to support her through labor.
Cadet is one of 58 women who have been paired with free doula services through Mass General Brigham’s Birth Partners Program for first-time Black and Indigenous mothers. It connects them with doulas to help reduce the obstetric complications they disproportionately face.
Launched in October 2021, the program is funded by the health system’s United Against Racism initiative, which seeks to address issues related to medical racism. Four Mass General Brigham hospitals — Massachusetts General, Brigham and Women’s, Salem, and Newton-Wellesley — use the funding to contract with doulas from local agencies, with a focus on those who share the cultural and linguistic backgrounds of their patients.
“The program helps you to understand how the process works and how to prepare yourself,” said Cadet, 27, who lives in Randolph. “You have somebody there who will speak for you when you can’t even speak.”
According to the Centers for Disease Control, Black women are about three times more likely to die of pregnancy-related causes than white women and have higher odds of undergoing a caesarean section. In Massachusetts, Black non-Hispanic women are almost two times more likely to die during pregnancy or within a year postpartum than white non-Hispanic women, according to the Massachusetts Department of Public Health.
Studies have also shown gaps in the rates of breastfeeding. Black, Latino, and Indigenous mothers leave hospitals exclusively breastfeeding at less than half the rate of white women, which can have serious health effects for both mother and child.
Doulas, who provide nonclinical physical, emotional, and informational support to families during and after pregnancy, can play a role in addressing these health disparities. Trained in the anatomy and physiology of labor and birth, they can help women navigate medical decisions and serve as a bridge between patients and their medical team.
“For someone who’s never done this before and doesn’t really understand the process, we can break it down and help make decisions so that they can feel like part of the process instead of the process being done to them,” said Mari-Elena Leckel, founder of Boston Birth Associates, which provides doula support and childbirth education classes.
Working with doulas has been linked to better health outcomes for mothers as well as infants. According to a 2022 report from the Massachusetts Special Commission on Racial Inequities in Maternal Health, the use of doulas leads to a 39 percent reduction in cesarean births, reduced use of pain medication, and increased breastfeeding rates.
However, doula care, which can cost $2,000 or more per birth in the Boston area, typically isn’t covered by health insurance, often making it inaccessible for those who may benefit from it the most. This may soon change as MassHealth, the state’s Medicaid program, is exploring coverage of doula support services.
Despite evidence that doula care leads to better health outcomes, hospital initiatives offering doula services are still pretty rare, according Dr. Ashanda Saint Jean, associate professor of obstetrics and gynecology at New York Medical College and chair of the obstetrics and gynecology department at Health Alliance Hospitals in New York.
“What’s happening in Boston is really revolutionary and should be applauded and replicated throughout the country,” said Saint Jean.
Another barrier to doula care for women of color is that the workforce is overwhelmingly white. That can make finding doulas of similar racial or linguistic backgrounds hard, according to Dr. Allison Bryant, senior medical director for Health Equity at Mass General Brigham.
To address this, the Birth Partners program is funding a doula training scholarship to diversify the workforce in Massachusetts.
“Once we turn on that faucet, we need to make sure that we have a pipeline of folks who are ready, willing, and able to serve in that capacity,” said Bryant, who is also a maternal-fetal medicine specialist in the Obstetrics and Gynecology Department at Massachusetts General.
Brigham and Women’s patients who qualify for the doula program enter a lottery in their third trimester. If selected, they are paired with a doula who can attend two prenatal visits, the birth, and two home visits afterward.
Cadet first heard about the program seven months into her pregnancy from her doctor, who was concerned that her lupus may put her at risk for complications. The autoimmune disease, which is three times more likely to affect Black women than white women in the United States, can increase the risk for birth complications, such as preeclampsia and premature delivery, according to the CDC.
Cadet said working with Lee eased a lot of her anxiety, especially during labor. After Cadet gave birth to her son, Kashden, Lee also supported the young mom as she worked through difficulties with breastfeeding.
Lee, 48, became a doula 28 years ago to help advocate for mothers in a way she felt no one did for her during her pregnancy. She said her main job is to “help them feel like they have a voice” both at the hospital and within their families.
While the program aims to increase the overall maternal health of participating patients, its two main goals are to lower the rates of C-sections and increase exclusive breastfeeding.
Dr. Nicole Smith, Cadet’s doctor and a maternal fetal medicine expert at the Brigham, hopes to see a reduction in C-sections that matches the national goal of 23.6 percent set by Healthy People 2030, a US Department of Health and Human Services women’s and children’s health initiative. Massachusetts ranks 19th in the nation for the highest percentage of C-section births, at nearly one-third, according to CDC data.
This is not the first hospital program in the area to offer free doula services. Boston Medical Center developed its Birth Sisters program in 1999 in response to high rates of infant mortality and increased disparities between Black and white births. The program, now focused on addressing maternal morbidity and mortality, offers multicultural doula services to expectant mothers who need it the most, including women with no or low social support.
“BMC decided to go for a grant to decrease the discrepancies that were going on at the time to provide a program that was bringing in doulas that were actually from the communities where the pregnant people were coming from,” said Dona Rodrigues, a certified nurse midwife, director of the Birth Sisters program, and clinical assistant professor of Obstetrics and Gynecology at the Boston University Chobanian & Avedisian School of Medicine. Unlike doulas, midwives are medically trained to provide care during the prenatal, birth, and postpartum periods.
While doula support is helpful in mitigating maternal disparities, it should not be used as a Band-Aid solution for larger issues of systemic racism, which is at the root of these disparities, according to the BMC program’s coordinator, Ebere Oparaeke.
“Change is not going to come from putting more tools into the system,” she said. “It’s really going to come from challenging, dismantling, uprooting the things that have been embedded for so long.”