Association of Black Women Physicians African American Infant and Maternal Mortality Prevention Working Group  Doula Physician Education Project 

The California Department of Health Services added Doula Care as a new Medi-Cal benefit in January 2021. The benefit is available to all pregnant Medi-Cal recipients and those who have been pregnant in the past year. Successful benefit implementation will be enhanced, and mothers served, if physicians and providers encourage the usage of doulas and make referrals for doula care to all eligible beneficiaries. The Association of Black Women Physicians (ABWP) has a history of training physicians on the role of doulas in improving Black maternal morbidity and mortality outcomes and maternal satisfaction.  Doulas are clearly one of many solutions to a complex problem. Recognizing a potential contentious relationship between providers and doulas, ABWP is uniquely suited to provide an educational forum which includes background and context for the crisis in Black maternal health. In partnership with the Los Angeles County Department of Public Health African American Infant and Maternal Mortality (AAIMM) Prevention Initiative, ABWP educated physicians and providers about the value of doulas and the Medi-Cal benefit. 

Program Summary 

ABWP completed nine presentations for ten groups including managed care organizations, medical societies, medical groups, and hospitals. Two managed care organizations chose to combine their efforts for one presentation. A total of 324 physicians and providers attended the nine sessions, more than three times the targeted goal. Two ABWP physician members led the didactic education session followed by a panel discussion which included a doula. Twenty-five percent of the participants completed a post session evaluation. As demonstrated in the evaluation, 100% of participants believed that the program provided background and context for Black maternal mortality disparities, concurred that the roles and benefits of doulas were clearly defined and perhaps most importantly, felt that the opportunities to integrate doula care into hospital and practice workflows were detailed.

Most participants planned to make changes, including recommending doulas for their patients (67%) and advocating for doula care in their hospitals (43%). The importance of doula workforce diversity was positively highlighted by the providers (56%). Top barriers to doula integration included organizational/institutional 60%) and insurance/financial issues (46%). Despite the history of contentious relationships, few noted prior negative experiences as a barrier (7%).  The overwhelming majority “strongly agreed” or “agreed” that the content was clearly organized, and the speakers were knowledgeable about the content (96%). In addition, the participants “strongly agreed” or “agreed” that the presentation increased their knowledge and positively influenced their attitudes about doulas and doula (96%). 

For more information visit Black Infants & Families Los Angeles online: www.blackinfantsandfamilies.org.

Join our ABWP and AAIMM Working Group Calls Every Second Wednesday of the month on Zoom. The next call is Tuesday, September 7th, 2025 at 7:00 PM. To join the Zoom Meeting (click here).

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THE ROOT CAUSE

Central to the Initiative’s approach is a new understanding of the pathway from the mother’s lived experience to infant health. In this framework, the root cause of birth disparities has been identified as the stress caused by a Black person’s exposure to racism and the impact of that stress on a Black woman/birthing person’s body. This stress is further compounded by social, economic and political structures in society that perpetuate racism, as well as the presence of implicit and overt bias in the systems of support that interact with Black families.

ABWP’s strengths included relationships with the Department of Public Health (DPH), managed care organizations, medical societies, and medical groups providing the access needed to collaborate. Hospitals and other groups had limited periods when presentations could be given due to physician schedules. To ensure that providers who couldn’t attend the live presentations would have access, we made the presentation available on YouTube. 

The limited awareness about doulas among providers was unexpected, making the presentation's coverage of Medi-Cal doula training requirements particularly relevant and timely. The inclusion of doulas in the panel discussion was a natural step from the didactic session to the lived experience and was very impactful. 

Questions that surfaced in every panel discussion regarding doula integration logistics made clear the need for published individual hospital policies. 

Stakeholders in the maternal health crisis are not limited to obstetricians and labor & delivery staff. Doula integration requires involvement of anesthesia, the emergency room, neonatal Intensive care unit, primary care and administration. 

The L.A. County African American Infant and Maternal Mortality Steering Committee guides the implementation of DPH’s 5-Year Action Plan and informs the development and implementation of strategies to complement the Plan. Committee members also work to advance awareness and policy change related to AAIMM.

Steering Committee members include representatives from:

COMMUNITY ACTION ITEMS

The AAIMM Community Action Teams (CAT) are regionally based partnerships between the Los Angeles County Health Agency and local community-based organizations, health care providers, residents, faith-based organizations, birth workers (e.g., doulas, midwives), businesses and other allies. CATs consult, inform and engage their community on all AAIMM strategies and create locally based actions.

CATs currently operate in the following Service Planning Areas (SPAs):

• Service Planning Area 1 – Antelope Valley/Palmdale
• Service Planning Area 2 – Santa Clarita/San Fernando Valley
• Service Planning Area 3 – San Gabriel Valley/Pasadena
• Service Planning Areas 6 and 8 – South LA/South Bay
• 
  

Each CAT has various work groups focusing on issues such as Policy, Engagement, Fundraising, Family-Centered Models of Care and more.

NEXT STEPS

Girded by learnings from this project, we are charting our future course. We will continue to educate providers, hospitals and managed care plans about the benefits of doulas and the advantages of incorporating them into practice workflows. The sessions will be extended to all stakeholders, including emergency room doctors and staff, anesthesia, labor and delivery staff, neonatal staff and administrators. The need for defined hospital policies for each site is made clear by varying landscapes and demands but also by the need to codify practices to avoid modifications based on personnel or shift changes. ABWP is developing templates that practices might utilize to inform hospital policy. It has become apparent to us that social media has great potential to educate providers even beyond our targeted audience of providers involved in pregnancy and childbirth. As doulas may continue to follow mothers for a year post-partum, late postpartum morbidities and preconception planning may fall into their purview, so primary care providers should also be introduced to doula support. 

In summary, ABWP’s comprehensive approach to educating providers about the Medi-Cal doula benefit has fostered greater awareness, engagement, and commitment to improving Black maternal health outcomes. Through strong partnerships, targeted presentations, and use of social media, the initiative has successfully reached the desired audience. Continued efforts to promote doula integration will further advance equitable, patient-centered care for birthing people across Los Angeles County. 

Co-Creating an Oasis: A New Context for Care of African American Mothers – First 5 LA Commissioned a focus group of 100 black women about their experiences with the health care system as well as pregnancy to further understand the impact of racism on a black woman’s well being. 

AAIMM PARTNER WEBSITES & RESOURCES FOR BLACK FAMILIES:

• L.A. County AAIMM Initiative website: Blackinfantsandfamilies.org 
• Home Visitation Programs (https://edirectory.homevisitingla.org/Home/Programs)
• Black Infant Health (http://www.publichealth.lacounty.gov/mch/BIH/bih.htm)
• Breast Feed LA (http://breastfeedla.org/)
• Black Women for Wellness (https://www.bwwla.org/)
• California Black Women’s Health Project (https://www.cabwhp.org/)
• Cinnamoms (https://www.cinnamoms.org/)
• Essential Health Access (www.essentialaccess.org)
• Healthy African American Families (https://www.haafii.org/)
• iDREAM for Racial Health Equity (www.idreamnow.org)
• Los Angeles County Health Agency (http://healthagency.lacounty.gov/)
• March of Dimes (www.marchofdimes.org)
• Maternal Mental Health Now (https://www.maternalmentalhealthnow.org/)

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