Virtual doulas

Virtual doulas close care gaps. Our new research proves it.

This week, our team at Maven Clinic published a remarkable research finding. Virtual doula care on our platform can improve birth experiences and birth outcomes at a rate comparable to in-person doula care–especially for Black women. 

Among 9,000 Maven users, we found that those who completed at least two appointments with a virtual doula had a 20% reduced odds of C-section. Those who were Black had a 60% reduced odds of C-section. This is a striking finding in a country where Black women are significantly more likely to be delivered via c-section and experience worse birth outcomes. 

These results are promising and also somewhat surprising. Virtual visits are not fully substitutable with in-person care. But despite growing momentum amongst policymakers and employers, for many families across the country doulas are not locally available or affordable. Virtual access also has distinct advantages. Eliminating the barriers of time and space make it more likely that people will get support when they actually need it.

What makes doulas so great?

If you know, you know. But for a long time, I didn’t. As an obstetrician, I didn’t initially understand what the doula could do that the doctors and nurses couldn’t. It wasn’t until after medical school that I even met one.

I completed my residency at a major medical center with state-of-the-art resources…think 24/7 on-call staff and a helipad on the roof. I was trained to act when things go wrong but had significantly less training in how to help things go right. Doulas are uniquely skilled at empowering pregnant people through the awesome acts of growing a baby, giving birth, and caring for an infant. The more I had the opportunity to work with doulas, the more my limitations as a doctor became apparent.

One day towards the end of my training a colleague handed me a worn and dog-eared copy of The Labor Progress Handbook. To my amazement, it contained much of the wisdom I seemed to be missing. Authored by Penny Simkin, who founded the modern doula movement, the book is a manual for treating prolonged and difficult labors with non-invasive, low-technology strategies—movement and positioning; coaching and affirmation. The book helped me understand that most of the time, my role in the room wasn’t to treat the pregnant person, but to support them. Ideally alongside a doula.

Standing alongside the legend herself, Penny Simkin, founder of the modern doula movement. 

Five years ago, I attended Penny’s 80th birthday party and celebrated her impact on the world in a room full of doulas. That room had an energy–and an optimism–that is hard to forget. 

Doulas observe deep truths that are beyond the gaze of the medical establishment. They serve as steadfast allies to pregnant people and their families, acting as advocates as well as cushions in an often-callous system. They do this work with minimal compensation and minimal recognition because they know it matters.

Today, Penny’s initial, groundbreaking work to professionalize doula knowledge has proliferated. Her wisdom crystallized a realization for me as a clinician that I bring to all of my work: while some mothers benefit from intensive medicine, all mothers benefit from affirming guidance. And yet everyone gets the intensive medicine–and few truly get the guidance. It’s a backwards system.

At Maven Clinic, our mission is enabling reliable access to the health care that everyone deserves, in spite of that system. This week’s paper is part of a growing library of evidence demonstrating that digital health can be an effective instrument for this purpose, even for challenges as substantial as racial equity. Virtual Maven doulas can meet those who need them most, at all hours and across long distances. 

I’m super proud of the group that co-authored this work. In addition to myself, the Maven research team included Smriti Karwa, Dr. Hannah Jahnke, and Dr. Natalie Henrich, as well as our student fellow Alison Brinson–a PhD candidate at the University of North Carolina, Chapel Hill, and our 2023 visiting scientist Dr. Constance Guille–a professor of psychiatry and obstetrics at the University of South Carolina.

What my team is reading, considering, and building against: 

• Speaking of evidence and digital health: in JAMA, the largest ever meta-analysis on the impact of digital mental health care finds that well-designed apps effectively reduce depression symptoms, including among marginalized groups. Surprisingly, shorter and more focused interventions, no human interaction, and fewer notifications were associated with better outcomes.

• The March of Dimes released its 2023 report card, and as a country we will not make valedictorian. The alarming preterm birth rate improved only to 10.4 percent—compared to last year’s all-time high of 10.5 percent. The U.S. earned a D+ grade in maternal and infant mortality and morbidity…for a second consecutive year. Beneath those headlines is a case study in federalism. While no state earned an A, some like Washington earned a B while others like Arkansas earned an F. It is no coincidence that states with failing grades also have some of the most restrictive policies for abortion care.

• A new piece from the New York Times chronicles the widespread effects of weight gain amongst menopausal women, and the potential (pricey) impact of Wegovy on their symptoms. Estimates suggest that 70 percent of women gain up to 1.5 pounds per year during the menopause transition. In the article, friend of the Preprint Dr. Stephanie Faubion notes her patients raise concerns about weight gain as often as they do about hot flashes, or night sweats. At Maven, we see similar numbers. It is safe to say the entire medical community has their eyes on the long-term effects of Wegovy and Ozempic. 

• For the last few years I’ve served as a member of the U.S. News and World Report working group for maternity care, which unveiled their annual Best Hospitals list yesterday. New this year, they’ve included a list of “Maternity Care Access Hospitals.” These 73 hospitals are not just delivering high-quality care, but serving as the last line of defense against their communities becoming maternal care deserts, often working against challenging economics that have forced many rural hospitals to close. In a country where 2.2 million mothers live in such deserts, these hospitals—in places ranging from Chico, California to Greensboro, North Carolina—are crucial and lifesaving.