Grounded in Community: Development of a Birth Justice‐Focused Volunteer Birth Companion Program

Abstract

Continuous labor support is an evidence‐based practice demonstrated to improve birth outcomes, particularly when provided by a trained doula or birth companion. Access to doula services designed to meet the needs of historically underserved and diverse communities can mitigate the negative effects of structural racism and health disparities in perinatal care. Unfortunately, continuous labor support by a companion of choice is not universally supported. This leaves individuals with limited resources unable to access services from a trained doula. Volunteer birth companion programs are one model for increasing access to continuous labor support by bringing the community into the hospital. This article describes a birth justice‐focused volunteer birth companion program that evolved out of a multistakeholder collaboration between community birth workers, local reproductive justice organizations, and hospital‐based providers, staff, and administrators in direct response to community needs. This program is unique in its collaborative development, grounding in core values, and design of a reproductive justice‐focused curriculum that includes training in diversity, inclusion, and care for clients with a history of trauma or perinatal substance use. Key takeaways include recommendations to center client needs, consider sustainability, and embrace flexibility and change. Discussion includes recognition of the strengths and limitations of a volunteer‐based model, including acknowledgment that volunteer birth work, while filling an important gap, necessitates the privilege of having sufficient time, economic freedom, and social support. Ensuring universal insurance coverage for doula services has the potential to increase access to continuous labor support, improve birth outcomes, and diversify the birth workforce.

Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy

“…A systematic review examining multi-modal group parenting programs found no significant improvement in maternal stress, anxiety or depression ( Waldrop et al, 2021 ). At UNM, the organization home to the present study, several institution-based initiatives have been implemented, including a volunteer-doula birth companion program as well as a specialized, multidisciplinary perinatal psychiatric clinic ( Del Fabbro, 2016 ; Kivlighan et al, 2022 ). The ACOG recommends pharmacotherapy as the first-line method of treatment for depression, anxiety and PTSD in pregnant and postpartum patients.…”

A Qualitative Study of Hospitals and Payers Implementing Community Doula Support

“…9 However, Medicaid funding for doula care is being implemented or considered in several US states, 10 with the intent to increase access to doulas by overcoming cost barriers. 11,12 Despite increased access, the challenging task of implementation remains. Identifying both ✦ Published research, supplemented by internal programmatic data and narratives of positive experiences, are critical for obtaining stakeholder buy-in of doula programs.…”

“…14 Midwifery-led hospitalbased models of doula care that focus on workflows and integration help to increase access to doula care, reduce health disparities, and contribute to doula care sustainability. 15 Midwives remain uniquely positioned to facilitate multistakeholder collaboration, while upholding the values of reproductive justice, 12 which is essential for non-Hispanic Black women's outcomes. 16 Given these policy implications and potential impact on racial inequities, the study of implementing communitybased doula care holds value.…”

Innovations in Midwifery Practice and Care

“…Univer-sal coverage for doula services would enhance the sustainability of this program. 5 Enhancements to community birth care is shared in 3 articles. Smooth Transitions seeks to improve the quality of client transfer from home to the hospital setting for birth when needed.…”

“…Their aim was to provide inclusive continuous labor support for individuals who may not otherwise have access to such a service. Universal coverage for doula services would enhance the sustainability of this program 5 …”