We’re thrilled to announce the release of our new report…

Doula Care in New York City: Advancing the Goals of the Affordable Care Act, examines the impact of doula care in New York City and makes recommendations on how to expand access to and improve the effectiveness of this valuable service.

Our new report brings together the medical evidence with the voices of women and doulas across New York City to show how doula care supports the “triple aim” of the Affordable Care Act by:

• improving health outcomes
• enhancing women’s experience of care
• reducing spending on unnecessary and unwanted medical interventions

The report provides an overview of the medical evidence supporting the benefits of doula care, and brings these issues to life with original research with mothers, doulas, maternity care providers and key stakeholders throughout New York City. Doula Care in New York City: Advancing the Goals of the Affordable Care Act reflects the experiences of women across the city to highlight the ways doula support can improve maternal health outcomes and help women have a more satisfying and empowering birth experience.

Our Toolkit

Read our report and take a look at our other resources to learn more about the issue.

• Doula Care in New York City: Advancing the Goals of the Affordable Care Act
• Executive Summary (including our Key Recommendations)
• Our infographic, Facts and Figures on Doula Care in NYC
• Our resource for families, Doula Care in New York City: Making a Difference for Women and Families
• Action Steps

How Doulas Help

Doulas are trained to provide non-medical, emotional, physical, and informational support to a woman before, during, and immediately following childbirth. In addition to sharing information about labor and comfort measures, doulas also facilitate communication between women and maternity care providers and hospital staff by helping women to articulate their questions, preferences, and values.

Doula support is an evidence-based practice that can significantly improve maternal health outcomes, specifically by decreasing rates of cesarean delivery, reducing the likelihood of medical interventions, and providing essential emotional support. Although there were 123,231 births in New York City in 2012, we estimate that only 5% of births are currently attended by doulas.

Improving Maternal Health

Poor maternal health outcomes in New York City indicate the critical need to improve access to evidence-based maternity care practices that will improve the health of women and babies. For 40 years, New York City’s maternal mortality ratio has surpassed that of the nation. One in three births (32.7%) is now delivered by cesarean, and though equal to the national average, this rate is more than twice than that recommended by World Health Organization (5-15%). Women of color and low-income women face significantly increased risks. In New York City, African-American women are 7 times as likely to suffer a maternal death compared with white women, and Hispanic women are twice as likely.

Women who undergo cesarean delivery are at increased risk for a number of serious and potentially life-threatening complications, including cardiac arrest, hemorrhage, major infection, and death. Babies born by cesarean face increased risk of immediate and long-term health problems such as respiratory distress, asthma, obesity and diabetes.

Women in at-risk communities also report the highest cesarean rates in New York City: in 2012 the rate of cesarean delivery among Non-Hispanic Black women was 38%. In low-income neighborhoods such as East Flatbush (39.9%) and East New York (37.2%), reported rates were well beyond that of the city as a whole.

The Affordable Care Act

With the implementation of the Affordable Care Act comes an unprecedented opportunity to ensure that women receive quality, respectful maternity care throughout their pregnancy and childbirth experience. Doula Care in New York City: Advancing the Goals of the Affordable Care Act examines doula care within the “triple aim” framework to demonstrate how doula care can help to improve outcomes, reduce spending and improve the patient experience of care. The report also considers the powerful role that doulas can play in fostering greater patient engagement in health care decision-making and reducing disparities in health outcomes, additional goals outlined in the ACA.

Next Steps

Doula Care in New York City: Advancing the Goals of the Affordable Care Act presents tangible recommendations to providers, facilities, policy-makers and local, state and the federal government to increase access to doula care. Take a look at our Action Steps and the Key Recommendations listed in our Executive Summary to see what you can do.

Access to safe, healthy, and respectful childbirth is a basic human right. We encourage you to read the report and share it widely to ensure that this right becomes a reality.