Perinatal Sites Discuss Maternal Health Disparities and Racial Equity with Doulas Across Pennsylvania

Ngozi Tibbs, MPH, LCCE, IBCLC of Healthy Start shared how doulas are bringing a human element to what can be an alienating experience for birthing families during the pandemic.

On June 11, the Pennsylvania Perinatal Quality Collaborative (PA PQC), managed by the Jewish Healthcare Foundation and WHAMglobal, hosted its latest virtual statewide learning session with over 220 attendees. One of the key sessions focused on doulas' efforts to address perinatal mortality disparities, particularly for Black women and babies. This session continued the conversation about bringing racial and reproductive justice to perinatal health care, as Black mothers and babies in Pittsburgh experience higher mortality rates than in most similar cities. With 65 member birth sites and NICUs covering 87% of live births in Pennsylvania, the PA PQC is primed to address this disparity.

The spotlight on doulas emphasized a trauma-based, harm reduction approach to providing care, bridging the gap between birthing families and healthcare teams. In Allegheny County, Healthy Start's doula program offers postpartum care for Black birthing persons, reducing risks while also supporting breastfeeding. As challenges continue to unfold from the COVID-19 pandemic, Healthy Start leveraged technology to virtually support birthing persons from the prenatal through postpartum stages, with a special focus on the Black community and persons already experiencing discrimination. In the first week of the program, doulas received 21 referrals and attended three births across 11 zip codes.

The Philadelphia-based Maternity Care Coalition's Community Doula and Breastfeeding Program has trained over 160 community birth workers who provide culturally, ethnically, and linguistically informed care at no cost to childbearing families. At the Philadelphia Department of Public Health, doulas are taking a similar approach, drawing on lived experiences to support birthing persons and families with a history of substance use disorders.

To continue promotion of racial equity in childbirth, the PA PQC worked with AccessMatters to offer three virtual training sessions for birth sites on "Cultivating Awareness of Racial Microaggressions." In these July trainings from AccessMatters, participants will learn about implicit bias and its impact on patient and staff health. By the end of the training, participants will have increased insight into the prevalence of racial microaggressions, understanding of how to reduce their frequency, and skills for implementing a reparative response.

PA PQC participants also highlighted the continued work of PA PQC hospital teams during the COVID-19 pandemic, while experts presented on Motivational Interviewing and the Eat, Sleep, Console care tool for opioid-exposed newborns. PA PQC teams shared projects funded by SUD/NAS Sub-Awards, in addition to their experience in the PA PQC Long-Acting Reversible Contraception (LARC) Pilot. Sixteen PA PQC hospitals received sub-awards to build the infrastructure to collect and submit data for the PA PQC Neonatal Abstinence Syndrome (NAS) or Opioid Use Disorder (OUD) quality measures. The hospitals will then implement a quality improvement project for NAS or maternal OUD. Three PA PQC sites are participating in the LARC pilot and will work from April 2020 to September 2020 to develop the supporting infrastructure, processes, and team roles to provide comprehensive contraceptive counseling and care, including immediate postpartum LARC. The PA PQC's work to improve care for pregnant/postpartum women and newborns exposed to opioids is funded by the Pennsylvania Department of Drug and Alcohol Programs.