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Are Doulas the Key to Closing Maternal Mental Health Treatment Gaps?

Doulas center an interdisciplinary care team at NewYork-Presbyterian as the organization sets its sites on better maternal mental health treatment.

NewYork-Presbyterian wants to do something about the nation’s maternal mental health crisis. In an effort to prepare pregnant people in their third trimesters for their new, child-filled lives, the healthcare organization is tapping doulas as patient advocates.

“Disparities in maternal and early childhood health really have been pervasive and deep-rooted in the United States for some time but were exacerbated during COVID in 2020,” Davina Prabhu, vice president of the Ambulatory Care Network at NewYork-Presbyterian (NYP), said in the most recent episode of the Healthcare Strategies podcast.

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According to the Centers for Disease Control and Prevention (CDC), around one in eight women experience postpartum depression, and only around half of those women get treatment. And like much of healthcare, Prabhu pointed out that there are racial health disparities at play. People from Black and Hispanic families, plus those with low incomes, face a litany of social determinants of health that bar mental healthcare access and good maternal health outcomes.

Between food and housing insecurity, poor transportation access, and limited access to comprehensive health insurance coverage, the deck is stacked against a lot of moms, Prabhu suggested. Add in pregnancy and eventually a new baby, and it can create a lot of toxic stress.

“It's sad when you're carrying a baby, and you face all of this toxic stress,” Prabhu remarked. “It actually impacts the baby, and then, therefore, after birth, in the first critical time period of the child, the first thousand days, it impacts the child, and those health factors start to seep in. And if there's delayed treatment to care or no treatment to care, then again, it's pervasive, and it continues in a cycle generationally.”

NYP wants to tackle the pervasive maternal mental health problem by going after patient access to care and eliminating the barriers that so often block it. Through its work at the Dalio Center for Health Justice, as well as examining its recent community health needs assessments, the healthcare organization was able to dial into the strategies that would help them succeed in promoting maternal wellbeing.

“When we were looking at what we currently have and what we provide, we have primary care centers, we provide state-of-the-art world-class care from world-class physicians to be able to provide that episodic care when people need treatment,” Prabhu said.

But that existing model of care clearly wasn’t working, as made evident by health equity and CHNA assessments, she acknowledged.

“What we realized was necessary was an interdisciplinary team model, a model where we're not taking the patient to have to go to the OB, to have to go to a pediatrician, to have to go to a mental health provider,” Prabhu said. “We wanted to bring the care to the patient.”

That mindset stemmed into the NYP Postpartum Doula Program, which engages pregnant people in their last trimester and into the postpartum period, often referred to as the fourth trimester. The model is patient-centered and connects the OB, the pediatrician, a psychologist or psychiatrist, and a doula to meet weekly about patients who were referred to the program. Eligible patients range from low to medium to high risk, Prabhu said.

The program sets out to ease the transition from OB-provided care to the pediatrician and offers mental health support in an ongoing manner to ensure the detection of and treatment for any postpartum depression or anxiety that may be present. Using the EHR, each member of the care team is able to track the mother and child’s wellbeing and outcomes and collaborate on a care plan.

Ideally, this makes for a holistic service for the patient that can lead to what Prabhu called a two-generational care model. By caring for the mother—particularly in terms of mental health—NYP hopes to promote wellbeing for the baby, creating two generations of good clinical outcomes.

And at the center of everything is the doula, a centuries-old model of care that Prabhu said is becoming more common as modern medicine embraces patient-centered care.

“Women supporting other women during labor and birth—we've seen that historically,” Prabhu explained.

But as nations became more industrialized and medicalized, the role of the doula diminished.

“The good news is we see the perceptions changing and that people are becoming more aware of the positive impacts of having a doula as a part of the care team on patient outcomes, which is really exciting for this doula movement,” Prabhu said.

Doulas are seen as advocates for the mother throughout the prenatal phase and into the postpartum phase. Prabhu said doulas are instrumental in supporting the family, helping with infant feeding, and addressing both the emotional and physical recovery from delivering a child.

The NYP Postpartum Doula Program is in close partnership with the organization’s Dalio Center for Health Justice, where program leaders are able to look at key data to assess program efficacy. Prabhu said she’s concerned with quality outcomes, like whether they could decrease preterm births or improve health literacy and engagement around prenatal care.

“We can disaggregate data by race, by ethnicity, by language, by payer, just to really understand who we served and who was impacted by these outcomes,” Prabhu said.

“That's why it's been so important for us to partner with the NYP Dalio Center for Health Justice,” she concluded. “We really have been able to get better data through campaigns of making sure that we're collecting all the demographic information so that it's accurate, and also be able to disaggregate the data in the ways that we need to, to study the continuous improvements that we need to make in the programming that we provide.”

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