Enhancing Perinatal Care Support to Improve Maternal Mortality Disparities

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ABSTRACT Persistent and worsening racial and ethnic disparities in severe maternal morbidity and mortality in the US are urgent public health concerns requiring innovative, sustainable solutions. The perinatal period, the time before and after birth, has important implications for a woman’s health and that of her child. Unfortunately, standard perinatal care fails to meet the needs of women from Black, Indigenous and People of Color (BIPOC) communities, especially with consideration to the Social Determinants of Health (SDoH) and the systemic racism that drive health disparities. Doula care is increasingly recommended to support high-risk BIPOC women during labor and the immediate postpartum period and is posited to mitigate the effects of racism and SDoH in underserved populations. However, a key limitation to doula care is that doulas are largely relegated to working in parallel with the healthcare team and the potential consequences of this include disjointed care coordination and missed opportunities to improve healthcare quality for BIPOC women. Building on our team’s prior and current work optimizing perinatal care for medically underserved women, we will develop and evaluate a Well- Mama intervention in 3 participating medical centers in Chicago IL, Baton Rouge LA, and Newark NJ which have some of the highest US rates of maternal morbidity and mortality. The Well-Mama intervention is centered on uninsured and publicly insured pregnant and postpartum BIPOC women supported by Community Doula Navigators (CDNs) who will conduct in-person and telehealth wellness check-ins using the Well-Mama safety checklist; make referrals to resources following the check-ins, with feedback provided to the perinatal care team; lead virtual pregnancy and postpartum support groups; attend select patient visits; and provide labor support. The Well-Mama checklist includes 5 priority topic areas representing leading factors in maternal morbidity and mortality in which to attune doulas and their patients: (a) mental health/depression; (b) cardiovascular symptoms; (c) safety (e.g., guns at home and intimate partner violence); (d) opioid/substance abuse; and (e) social support, self-agency, and well-being. Well-Mama advances a Shared Care Model approach to health care delivery focused on interprofessional collaboration in relation to centering care on the individual patient. Through a Hybrid Type 1 randomized effectiveness-implementation trial of N=576 women, we will compare the effectiveness of the Well-Mama intervention relative to standard perinatal care in improving women’s receipt of recommended care components (primary outcome), reducing patient medical distrust and experience of racism/discrimination, increasing health engagement, self-efficacy, and perception of care team quality, and enhancing perinatal care team cohesion (secondary outcomes), while evaluating intervention implementation. Results will optimize doula integrated perinatal care to address the top drivers of maternal morbidity and mortality with the goal of reducing maternal health disparities experienced by pregnant and postpartum BIPOC women.