Chatman, Tasha DNP Project 

Tasha Chatman, DNP, FNP-C, MSN

DNP: California State Univeristy, Fresno

Project Title: Doula Toolkits Bridging the Gap Between BIPOC Patients, Clinicians, and Doulas: A Quality Improvement Project

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Abstract

Maternal mortality and morbidity is a public health crisis, especially for marginalized populations such as Black, Indigenous, and People of Color (BIPOC). With 700 deaths and 60,000 non-fatal pregnancy complications related to Black women yearly. Maternal death rates for BIPOC patients continue to increase across this nation, with Black maternal mortality rates rising three times higher than those of their White counterparts (Harris, 2022). This is a health problem rooted in post slavery oppression of Black people, historical racism, implicit bias and structural determinants of health. Doula services can decrease these deaths but historically, doula services have not been utilized in the BIPOC community due to cost. The passing of California State Bill 65, January of 2023, initiated reimbursement of doula services for Medicaid patients, removing the cost barrier. Community-based doulas (CBD) bridge the gap between the patient and the provider (Collins et al., 2023).

This quality improvement project was aimed to assess the barriers to clinician collaboration with CBD, having clinicians communicate with BIPOC prenatal patients about CBD services, and subsequently assessing the utilization of doula services in BIPOC prenatal patients. The project implemented an educational program the Doula Toolkit that informed clinicians about specialized services of CDB with a goal to, have said clinicians educate patients on CBD with a Doula Flyer increasing potential usage of CBD and saving the lives of BIPOC women. The implementation of the project consisted of two variables being the clinician barriers and if in fact the clinician barrier was overcome, the BIPOC prenatal patients’ usage of doula services. The initial element assessed whether clinicians consisting of medical doctors, nurse practitioners, registered nurses and medical assistants would discuss and educate pregnant BIPOC patients about CBD service via a descriptive cross-sectional questionnaire entitled Maternal Mortality and Morbidity Questionnaire completed before and after project implementation. The second element consisted of a Doula Toolkit educating clinicians and chart review that assessed if clinicians provided the doula information to the patient and if the pregnant BIPOC patient, given the education about doula services utilized a doula service.

For the Maternal Mortality and Morbidity questionnaire a Spearman’s Rank Order test was utilized and showed increased correlations post-implementation. A Paired Sample T-Test showed post-implementation an increase in the likelihood of clinician’s education and referring BIPOC patients to CBD. Although, no BIPOC patients utilized the CBD, there is understanding that limitation such as the timeframe of the project contributed to this. The project found that the doula toolkits for clinicians improved the likelihood of referring and educating patients to a doula. The doula flyers continue to be given to prenatal patients.

Project Chair

Dr. Eileen Jimenez