City of New York expands access to doulas and midwives to reduce maternal and infant mortality

New York City Mayor Eric Adams took steps on March 23, 2022, to reduce maternal and infant health inequities in New York City and provide critical resources to new families — announcing the citywide expansion of the doula program, the expansion of a Midwifery Initiative, and the expansion of a maternal health care services program. The Citywide Doula Initiative will provide free access to doulas for birthing families and focus on 33 neighborhoods with the greatest social needs. The Midwifery Initiative will be expanded to all 38 public and private birthing facilities citywide and will allow the New York City Department of Health and Mental Hygiene (DOHMH), for the first time, to gather data on births and care with midwives; create partnerships with midwife organizations, private practices, and community members; and develop a report on midwives in New York City. Finally, the Maternity Hospital Quality Improvement Network (MHQIN) will be expanded across all 38 birthing facilities across the city in an effort to improve maternal care at local hospitals and birthing centers.

“Systemic racism should not be a New Yorker’s first experience upon coming into the world,” said DOHMH Commissioner Dr. Ashwin Vasan. “The voices of midwives and doulas must be included in the work we are doing to lower the glaring inequities in complications from childbirth. I thank Mayor Adams for taking action to improve birth equity in New York City.”

All three initiatives are part of Mayor Adams’ mission to reduce health inequities in New York City, particularly amongst marginalized Black and Latino/a families and pregnant people. They build on DOHMH’s existing “By My Side Support Program” and are a key part of the “New Family Home Visits Program”— a new, comprehensive $30 million package of home-visiting services for first-time families.

Maternal and infant health inequities are rooted in generations of structural racism and disinvestment. In New York City, Black women are nine times more likely to die of a pregnancy-related cause than white women, and their rate of infant mortality is more than three times higher. For Puerto Ricans, the infant mortality rate is twice that of white New Yorkers.

Citywide Doula Initiative
The Citywide Doula Initiative will aim to train 50 doulas and reach 500 families by the end of June. Families who enroll in the program will receive doula support both at home and in the clinical setting, with three prenatal home visits, support during labor and delivery, and four postpartum visits. Clients who give birth at home will receive the same number of visits. The program will include screening and referrals for family needs and stressors, such as food insecurity. The model of care will be consistent across the city, and uniform data will be collected for a rigorous evaluation of the doula services provided through this initiative.

Doulas provide physical and emotional support during pregnancy and childbirth, which helps lower the risk of complications during childbirth for the parent and the infant. Studies show that doulas can reduce preterm births and low birthweights, which are the leading causes of infant mortality. Rates of cesarean birth and medical pain management also improve with doula support.

The Citywide Doula Initiative will focus services in three main categories:
*Providing equitable care — Doulas will be provided to eligible residents of the 33 neighborhoods identified by the Taskforce on Racial Inclusion and Equity (TRIE). Priority will be given to people who are income-eligible for Medicaid and/or are giving birth for the first time (or the first time in over 10 years), as well as those who have had a previous traumatic birth experience, have no other labor support, live in a shelter, are in foster care, or have a high-risk medical condition.
*Expanding the doula workforce — To increase capacity, DOHMH is aiming to train 50 community members as doulas by June 30 and provide additional opportunities for professional development. DOHMH will also help uncertified doulas become certified; about 70 uncertified doulas are expected to take advantage of this opportunity.
*Creating partnerships with hospitals — The initiative will strengthen DOHMH’s work with hospitals though the MHQIN, which creates doula-friendly hospital policies and practices and increases provider referrals to doula services. Staff will also collaborate with community-based, governmental, and health care partners to advocate for system-level change.

The initiative will integrate community-based doula organizations that serve clients in TRIE neighborhoods around the city — bringing additional funding to expand their services, build the capacity of their doula workforces, and partner with hospitals. Seven vendors have been chosen to partner in this work:

*Community Health Center of Richmond will provide services in Staten Island,
*Hope and Healing Family Center will provide services in central and eastern Brooklyn,
*The Mothership will provide services in Harlem and northern Manhattan,
*Northern Manhattan Perinatal Partnership will provide services in Harlem, northern Manhattan, and the southwest Bronx, and
*Ancient Song Doula Services, Caribbean Women’s Health Association, and the Mama Glow Foundation will provide services in the rest of the city.

Midwifery Initiative
The Midwifery Initiative builds on research about existing midwifery care models across pregnancy, birth, and the postpartum period. Midwives are clinicians who receive formal education, training, and licensure to provide a full range of highly personalized maternal and primary health care to meet their clients’ unique physical, mental, emotional, and cultural needs. Studies have shown that midwives help lower rates of cesarean births and unnecessary interventions during childbirth, and pregnant people cared for by midwives are less likely to report disrespectful care.

The Midwifery Initiative includes:
*Convening a steering committee of stakeholders and key informants to recommend ways to better understand the quantitative and qualitative data about pregnancy care and birth outcomes in both hospital and home-based settings.
*Partnering with midwives conducting research at New York University to develop an assessment tool to measure successful integration of midwifery care models into maternal health care settings.
*Identifying models for enhancing and expanding midwifery training opportunities, including cross-training between midwives and medical doctors.

Maternity Hospital Quality Improvement Network
The MHQIN is a clinical and community initiative that seeks to reduce disparities in preventable maternal morbidity and mortality. Key strategies focus on the drivers of racial and ethnic disparities in maternal outcomes. The expansion of the program will invite 23 new birthing hospitals and centers, reaching all 38 birthing facilities in New York City.

The MHQIN includes:
*Increased surveillance of severe maternal morbidity data to improve health outcomes.
*Trainings for staff in racial equity, implicit bias, and trauma-informed care.
*Partnerships with community-based organizations and doula services.

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