Building TrUst and UNiting Teams Through DouLa partnErship-BUNDLE

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PROJECT SUMMARY/ABSTRACT: BUNDLE Black/African American (Black/AA) birthing people experience disproportionately higher rates of mortality and morbidity associated with pregnancy. Nationwide, Black women are three times more likely to die from pregnancy-related causes than non-Hispanic white women, but in Wisconsin, they are five times more likely to die. 70% of the Black population of Wisconsin resides in Milwaukee County, which is in Southeastern Wisconsin. One of the key factors contributing to these disparities is medical mistrust, a defensive reaction against prevailing structural inequities that leads to suboptimal access to healthcare resources. In our healthcare system, we found high rates of medical mistrust among Black/AA pregnant people. Moreover, a 2021 Community Health Needs Assessment conducted in Milwaukee County, relying on residents’ survey, stakeholders’ interviews and focus groups with community leaders, found that trust in the health care system was identified as key concern for maternal and infant health in Milwaukee County. To address the critical need to build trust between our healthcare system and Black/AA birthing communities in Southeastern Wisconsin, our team has partnered with a community-based doula organization, the African American Breastfeeding Network (AABN). Community-based doulas are integral in addressing the maternal health crisis by diversifying the prenatal workforce and serving as advocates and emotional supporters for mothers as they navigate the health system. Numerous studies demonstrate that community-based doulas are associated with lower odds of cesarean, preterm birth, and postpartum depression. However, currently, AABN doulas and any other community-based doulas operate separately from healthcare professionals in Wisconsin. This leads to mixed attitudes on acceptance of doulas on labor and delivery by hospital staff. To date, no effort has been attempted to merge the strengths of these groups to improve maternal health across the region. Our central hypothesis is that earlier integration of community-based doulas in prenatal care reduces medical mistrust by uniting and diversifying the perinatal workforce and improves maternal health outcomes. We plan to test this hypothesis with a mixed methods study, titled Building TrUst and UNiting Teams Through DouLa partnErship (BUNDLE), using three specific aims: Aim 1: Develop an integrated prenatal care model of medical providers and community-based doulas in Southeastern Wisconsin, Aim 2: Compare the effectiveness of the integrated prenatal care model to standard prenatal care in improving healthcare engagement and trust, and reducing adverse outcomes, and Aim 3: Disseminate findings to scholarly and community-based forums and actively pursue opportunities for systems- and policy-level change. After the proposed research is completed, we expect to identify drivers of medical mistrust for Black birthing people and the establish a sustainable integrated doula-clinician model that builds trust through a diversified and united perinatal workforce, improves healthcare engagement, and reduces severe maternal morbidity.