黑人产妇保健中的导乐支持

The U.S. 目前面临着黑人孕产妇健康危机. Black women die from pregnancy complications at a rate 2 to 4 times higher than White women, 而且她们更有可能出现危及生命的分娩并发症, 也称为严重产妇发病率. 黑人产妇保健危机反映了许多因素, 包括结构性种族主义以及保健和社会中的歧视.

导乐护理作为解决方案的一部分

One way to improve care for pregnant Black women is to increase access to doulas. 助产师是训练有素的, emotional, 以及之前的信息支持, during, 在人们生孩子之后. They are not nurses or doctors but work with health care providers toward a safe and positive birth experience. For example, 助产师帮助孕妇了解她们在制定生育计划时的选择, 分娩时给予鼓励, 确保他们的愿望和担忧被医疗团队听到.

在某些情况下，助产师在她们居住的社区工作. These community-based doulas are particularly important because they often have similar backgrounds as the people they help. Studies demonstrate that the personalized support provided by doulas improves birth experiences and outcomes for both mother and baby, with even greater benefits observed among families using community-based doula services.

增加医疗补助中助产师护理的机会

医疗补助在产妇保健方面发挥着关键作用, 覆盖了美国65%的黑人妇女.S. Increasing doula access for people enrolled in Medicaid is a primary focus of the Centers for Medicare & 医疗补助服务(CMS)即将推出的孕产妇健康模式转型(TMaH). States have several implementation options to provide Medicaid coverage for doulas:

• 各州可以向CMS提交其医疗补助计划的修正案以获得批准.
• Medicaid managed care organizations (MCOs) can choose to reimburse doula services for all their patients or for patients who meet certain criteria.
• States can use the Title V Maternal and Child Health Services Block Grant to support community-based organizations that provide doula services to pregnant women covered by Medicaid.

State Medicaid agencies must address 2 key issues to increase access to community-based doulas for Medicaid patients:

• Training. State-required training and licensing fees for doulas to be reimbursed by Medicaid can be expensive. 当各州将认证限制在选定的组织时, they exclude local and community-based organizations that might align closest to Black Medicaid populations. 解决方案包括:
  • 以弃权的形式提供经济帮助, grants, 或者调整比例，让助产师培训更实惠.
  • Move away from requiring certification from specific organizations for doula qualification standards and permit local, low-cost programs to train doulas to care for the specific communities they serve. 
  • Create a “legacy pathway” or “experience pathway” for certifying doulas who have extensive experience but do not have recent formal training. 这意味着不需要来自培训小组的证书, these experienced doulas can use evidence of the number of births they have supported to qualify for certification.
• 报销. Although it is important for doula Medicaid programs to be financially sustainable, reimbursement rates that are too low will limit the number of doulas who participate. 解决方案包括:
  • 确定一个费率或费用，支付一个公平的工资给多拉, 考虑到助产师居住地的生活成本, 他们提供的服务范围, 以及他们每个月可以服务的客户数量.
  • 补偿在农村地区服务的助产师的交通费, 在哪里获得产科护理的机会往往有限.

与社区合作

韦斯特支持联邦资助的孕产妇保健项目的经验, including the CMS Maternal Opioid Misuse (MOM) Model and the National Institutes of Health (NIH) 孕产妇健康 Community Implementation Program (MH-CIP), highlights the importance of adopting a community-centered approach to addressing maternal health inequities faced by Black women. 通过将社区观点和资源纳入护理服务模式, 主动行动会更有效, sustainable, 并对妇女和家庭的各种需求作出反应.

将助产师护理纳入医疗补助计划, we recommend that states partner with community-based doula organizations or form working groups that include doulas and community members. 从一开始就包括社区的意见, states will have the best chance at increasing access to doulas and supporting equitable, 尊重黑人妇女.

助产师并不是解决黑人产妇健康危机的唯一办法. We need to continue finding ways to support Black women and their families more widely. This involves advocating for environments that promote good health during pregnancy, 例如确保获得负担得起的健康食品, 运输, and safe, 稳定的住房. 这些努力必须与黑人社区合作进行.

作者注: 在本简报中, the terms “women” and “maternal” are used to refer to individuals who are pregnant or give birth. However, we acknowledge and affirm that not all people who experience pregnancy or childbirth identify as women or mothers. We recognize and respect the diversity of gender identities and expressions and strive to be inclusive and respectful of all individuals, 无论他们的性别认同或表达如何.

由西方专家贡献 瑞秋Neenan行为健康和健康政策研究助理; 多米尼克·埃斯波西托博士, a 副总统, 行为健康 and Health Policy; and 妮可Harlaar博士公共卫生首席研究员.