Massachusetts’ second largest insurer has partnered with Boston Medical Center to grow an initiative aimed at closing racial disparities in maternal health.
Boston Medical Center’s Birth Sisters program, which has provided doula services to the hospital’s expectant mothers since 1999, will soon double the number of pregnant patients who can receive doula care at the hospital to 300 per year. The expansion will be funded by Point32Health, which announced a three-year partnership with BMC to reduce severe birth complications, especially among Black and Hispanic women who disproportionately experience them.
“Our goal is that every patient with a high risk [pregnancy] can have a doula,” said Elena Mendez-Escobar, executive director of BMC’s Health Equity Accelerator. “High risk, not just from a clinical point of view, but also from a social point of view, including people who maybe don’t have as much support during their birth or pregnancy.”
Although Massachusetts’ maternal mortality rates are some of the lowest in the country, complications from giving birth have been on the rise for over a decade. A 2022 report found that, between 2009 and 2018, the state saw rising rates of severe labor and delivery complications, including hemorrhage, blood clots, strokes, and heart attacks. Such severe complications were 70 percent more common among Black women than white women, according to the report.
The rate of these complications continued to increase during the pandemic, rising by nearly 31 percent between 2019 and 2022, according to data from the Betsy Lehman Center for Patient Safety, a state agency researching safer health care practices.
Expanding BMC’s doula program is an important step in closing those racial disparities, because one in seven Black babies and one in 13 Hispanic babies in Massachusetts is born at BMC, according to Mendez-Escobar. “So we really have a responsibility to create great outcomes,” she said.
The funding will also allow the program to recruit more doulas from diverse backgrounds, ensuring that more mothers get paired with doulas who share their culture and language, said Dona Rodrigues, a certified nurse midwife and director of the Birth Sisters Program.
“Our mission has always been to recruit from people that live and work in the communities we serve,” Rodriguez said. “It helps our birthing clients build deeper relationships with ‘sisters’” who are better able to meet their needs.
A Massachusetts commission tasked with finding ways to reduce racial disparities in maternal health found that community-based doulas “play a vital role in combating the discrimination, racism, and loss of autonomy” that often lead to negative experiences, especially for women of color and low-income women.
Doulas are nonmedical professionals who offer emotional, physical and educational support to families during and after pregnancy. Over the past few years, there has been a growing movement to expand access to doula care, particularly for vulnerable mothers. Mass General Brigham launched its own free doula program in 2021 for first-time Black and Indigenous mothers.
Working with doulas has been linked to better health outcomes for mothers as well as infants, including 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.
In addition to expanding the Birth Sisters program, the partnership will also allow BMC to create other solutions to reduce maternal complications. One approach, based on feedback from patients, is to provide expectant parents with better information on common conditions like preeclampsia that can strike during pregnancy.
“Most of [our patients] told us the first time they heard that word was when they were being diagnosed with it and they all said we wish we had known more before,” said Mendez-Escobar. “So, we’re revamping all of our patient education, really giving patients more information around these and other other conditions.”
Including the voices of patients in improving health care is key, especially when it comes to maternal care, said Claire Levesque, chief medical officer for Commercial Products at Point32Health.
“We know women are not well listened to in health care no matter what and [for] women of color, there’s even more of an issue,” she said. “So empowering women to help care for themselves is really important.”