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Jan 23, 2023
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Introducing Doula-Enhanced Care to Confront Inequities in Maternal Healthcare Quality and Outcomes

Blue Cross and Blue Shield of Kansas City (Blue KC), in partnership with BioNexus KC, recently awarded the 2022 Blue KC Transforming KC Health Outcomes Research Grant to Angela Martin, MD, OBGYN, Associate Professor in the Department of Obstetrics and Gynecology, The University of Kansas Health System. The $50,000 grant – established to bolster the ongoing commitment to health equity – will support research on how doula care impacts healthcare quality and reduces poor outcomes for Black pregnant and birthing people.

The maternal mortality rate (MMR) and severe maternal morbidity rate (SMM) have increased approximately 200 percent over the past 20 years. In Kansas, Black mothers, and other ethnic minorities account for 13 percent of births but 60 percent of all maternal deaths. In Kansas and Missouri, Black women are two times more likely to die from pregnancy-related causes than non-Hispanic white women. Social and political determinants of health are significant drivers of these maternal and child health outcomes. The Blue KC Transforming KC Health Outcomes Research Grant is an important tool to spur new insights and intervention research.

Dr. Martin shared the following important context about her study with Blue KC:

“If you watch the news or follow any type of healthcare organization on social media, it probably comes as no surprise to hear that maternal morbidity and mortality is increasing in the United States, and racial disparities exist. Black women are three times more likely to die from a pregnancy-related cause than white women in the United States1 and several studies have found Black women are more likely than their white counterparts to experience severe maternal morbidity or an adverse outcome during pregnancy or childbirth.2,3 The University of Kansas Health System, BioNexus KC, and Blue KC are committed to birth equity.

In some studies, doula support during pregnancy and childbirth has been associated with improved engagement and communication with the healthcare team, increased satisfaction with the birth experience, and decreased maternal stress.4,5 This may explain why doula-enhanced care throughout pregnancy, childbirth, and postpartum has been shown to lower the rates of preterm birth, cesarean section, and postpartum depression, and improve the rates of breastfeeding.5,6,7 Unfortunately, there are often significant socioeconomic, structure, and system barriers to doula access that prevent the most vulnerable patients from receiving their services.

At the Health System, we’re thrilled to have the opportunity to leverage the BioNexus KC grant in partnership with Blue KC to explore the difference doula-enhanced care might make for our Black birthing patients. Eligible Black patients receiving prenatal care at KUMC will be asked to enroll in our study. Patients who consent will be randomly assigned to one of two groups, standard care, or doula-enhanced care. Both groups will receive the world class health care given to all our prenatal patients by one of our board-certified obstetricians. The doula-enhanced care group will be provided with a doula for support during several prenatal appointments, during labor and delivery, and for up to three postpartum visits. We’ll compare outcomes and satisfaction of care between the two groups. We look forward to getting started on the project and sharing our findings with our Kansas City community.”

Since 2012, Blue KC and BioNexus KC have partnered to award more than $1 million in grants to projects that improve the health and wellness of the Kansas City community. The Blue KC Transforming KC Health Outcomes Research Grant program aims to leverage grantee and facility strengths, leading to highly competitive proposals for future external funding and scalable innovation. For more information on the BioNexus KC Research Development Grants Program, visit

1Working Together to Reduce Black Maternal Mortality | Health Equity Features | CDC
2Mujahid MS, Kan P, Leonard SA, Hailu EM, Wall-Wieler E, Abrams B, Main E, Profit J, Carmichael SL. Birth hospital and racial and ethnic differences in severe maternal morbidity in the state of California. Am J Obstet Gynecol. 2021 Feb;224(2):219.e1-219.e15. doi: 10.1016/j.ajog.2020.08.017. Epub 2020 Aug 13. PMID: 32798461; PMCID: PMC7855283.
3Howell, E. , Egorova, N. , Janevic, T. , Brodman, M. , Balbierz, A. , Zeitlin, J. & Hebert, P. (2020). Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities. Obstetrics & Gynecology, 135 (2), 285-293. doi: 10.1097/AOG.0000000000003667.
4Kozhimannil KB, Vogelsang CA, Hardeman RR, Prasad S. Disrupting the Pathways of Social Determinants of Health: Doula Support during Pregnancy and Childbirth. J Am Board Fam Med. 2016 May-Jun;29(3):308-17. doi: 10.3122/jabfm.2016.03.150300. PMID: 27170788; PMCID: PMC5544529.
5Scott KD, Klaus PH, Klaus MH. The obstetrical and postpartum benefits of continuous support during childbirth. J Womens Health Gend Based Med. 1999 Dec;8(10):1257-64. doi: 10.1089/jwh.1.1999.8.1257. PMID: 10643833
6Thomas MP, Ammann G, Brazier E, Noyes P, Maybank A. Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Matern Child Health J. 2017 Dec;21(Suppl 1):59-64. doi: 10.1007/s10995-017-2402-0. PMID: 29198051; PMCID: PMC5736765.
7Kozhimannil KB, Attanasio LB, Hardeman RR, O’Brien M. Doula care supports near-universal breastfeeding initiation among diverse, low-income women. J Midwifery Womens Health. 2013 Jul-Aug;58(4):378-82. doi: 10.1111/jmwh.12065. Epub 2013 Jul 9. PMID: 23837663; PMCID: PMC3742682.

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