(663) Doulas In Black Birthing Experiences: Perceptions And Utilization Among Black Participants Following Doula-led Education Initiative.

ACOG and CDC endorse doula use as an evidence-based practice to narrow disparities in Black maternal health outcomes. Despite their benefit, doulas remain underutilized, particularly in Black birthing experiences. Our objective is to assess baseline doula awareness, knowledge, and utilization among Black birthing people and evaluate changes in their attitudes toward integrating doulas into obstetric spaces following an education initiative.

 

Study Design:

During a Black maternal health community initiative, three Black doulas led 15-minute education sessions with small groups. Surveys were given to assess participant knowledge and awareness of doula care, pre- and post-doula education sessions (pre-DES and post-DES). Inclusion criteria were Black participants of reproductive age. Data were analyzed using paired t-tests and McNemar's tests; p-values < 0.05 were considered significant.



Results:

Fifteen participants met criteria. All reported no previous doula use or physician-dispensed doula education. Pre-DES, 40% felt well-informed about doulas, compared to 87% post-DES, p = 0.04. Participants knew an average of 4.1 doula health benefits pre-DES and 6.5 benefits post-DES, p = 0.0007 (Graph 1). This mirrors the 54% increase in people who felt more well-informed about what doula care entails post-DES, p=0.005 (Graph 2). There was no significant difference in number of cited barriers to doula use pre- vs. post-DES, p=0.31, but the main barrier changed from not knowing how to access doulas (N=7) to lacking doula insurance coverage (N=9). Lastly, 87% indicated intent to use doulas in the future.

Conclusion:

While baseline knowledge of doula health benefits was high, DES still increased participant knowledge and intent to use doulas in future pregnancies. However, their utilization barriers reveal that increasing doula use among Black birthing people will require an equity framework for better integration of doulas into our health system. Reform is needed in medical trainee education on doula care and patient resourcing, health policy, and legislation for equitable doula insurance coverage and reimbursement.