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It is well known that Black women are overrepresented in maternal and infant mortality rates. We must learn more about Black women’s experiences–from the women themselves–and outcomes to develop tailored interventions that meet their unique needs. Although research finds continuous support during labor is associated with more positive birth outcomes, including less use of interventions, most research on doulas has mainly focused on White women’s experiences. Interventions are increasingly being developed and modified to recognize the importance of culturally matched services for Black women, specifically, addressing race-specific stressors. Birthing Beautiful Communities (BBC) fills this need in the greater Cleveland/Akron area, using Black perinatal support doulas (PSDs) to provide intensive perinatal support to pregnant Black women. This study examined the pregnancy and birth experiences of Black women enrolled in BBC during COVID-19 as contrasted to before COVID. We asked the following questions: What were Black women’s pregnancy and birth experiences before and during COVID-19 and how did these relate to their birth outcomes?
Methods
We employed a transformative concurrent mixed methods design. For the qualitative strand, we interviewed 41 Black women (29 BBC clients individually and 12 doulas in focus groups) in 2020 and 2021. For the quantitative strand, we analyzed client administrative data (N=387) on birth outcomes such as birth weight, gestation, interventions, and breastfeeding initiation. A total of 276 clients delivered their babies before stay-at-home orders (March 15, 2020); 111 delivered after. Qualitative data were coded inductively and analyzed using a phenomenological lens. For the quantitative data, t-tests were conducted to compare pre-and post-COVID birth outcomes.
Results
Birth outcomes were less positive after the pandemic began as compared to before it. Compared to before COVID, BBC clients delivering during COVID were significantly more likely to: deliver via cesarean section, deliver their babies preterm, and for their baby to be born with a low birth weight. More women breastfed during COVID, but this change was not statistically significant. In qualitative interviews, we identified three key themes: (1) COVID increased women’s social isolation but also had advantages for some; (2) PSDs and clients both “felt” the doulas’ absence, particularly in health provider interactions, but doulas provided support in other ways, working around limitations COVID imposed and reducing stress.
Conclusions and Implications
In contrast to our pre-COVID study in which women emphasized how important their doulas were at their prenatal medical appointments and births, we found that COVID regulations meant almost all women attended appointments alone. Without their PSDs, women missed out on important support including transportation to appointments, childcare during the appointments, and importantly, translating of medical terms, interpretation of health concerns, and advocacy for their births, all roles doulas fill. Given strong evidence of doulas’ association with positive birth outcomes, doulas should be essential workers, valued members of birth teams, particularly for Black women if we are ever to achieve equitable maternal health outcomes.