Want to improve maternal health outcomes? Employ doulas.


Dec 1, 2022

To put it bluntly, maternal health in the US is in crisis

Year after year, the US health care system fails to meet the health needs of soon-to-be and new mothers. Additionally, there are jarring racial disparities in maternal health. In particular, Black mothers increasingly face adverse pregnancy and birth outcomes, including higher rates of maternal mortality and preterm birth. 

Dr. Neel Shah, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, believes that, “It is important to remember that people have goals other than simply emerging from childbirth unscathed. Safety during labor is the floor of what people deserve. What we should all really be aiming for is the ceiling: care that is not just safe, but also supportive and empowering.” 

He is absolutely right: pregnancy, childbirth, and the postpartum period should not only be a safe experience, but also an empowering one. One way to achieve this is by employing doulas. Doulas are shown to improve maternal and infant health, particularly for communities of color. They accomplish this by addressing women’s Jobs to Be Done during and beyond pregnancy.

Jobs Theory

A job is the progress someone seeks in a given situation, dictated by the context or situation in which the individual finds themselves. People “hire” products or services to serve their job. If something comes along that does the job better, they will fire the old way, and hire the new one. 

Jobs have three components that explain why people make the decisions they do. They are as follows:

  • Functional, or the physical need the consumer sets out to accomplish,
  • Social, or how the solution impacts perception by others, and
  • Emotional, or how the solution will make the consumer feel.

Specific jobs throughout pregnancy, childbirth, and the postpartum period can, and will, be different for each mother. When most people think about pregnancy-related jobs, functional aspects, such as “help me deliver a healthy baby,” are likely the first that come to mind. However, emotional aspects of jobs, such as “help me feel as little stress as possible during a high-stress period of time,” “help me feel supported in my birth experience,” or “help me assuage fears I have walking into the childbirth process,” are just as important as the functional aspects and should be addressed by health care offerings. Doulas are uniquely well-positioned to address these emotional aspects of the job. 

So, what is a doula?

Doulas are not doctors or medical providers. Instead, they are “trained professionals who provide continuous physical, emotional and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.” They provide tailored support to each individual mother, such as:

  • Assistance with breathing techniques,
  • Information on pregnancy, birthing, and the postpartum experience for women and their support systems,
  • Facilitating discussions with medical providers, and
  • Assistance with developing a personalized birth plan and postpartum care (such as breastfeeding support). 

Doulas start off by gaining a full understanding of a mother’s goals during the pregnancy, childbirth, and postpartum phases, including their history, preferences, worries, and desired outcomes—or, in other words, their jobs. They use that information to create a plan to serve those jobs. Through their work, doulas build deep relationships with mothers. This has been shown to decrease pre- and post-natal stress and improve birth outcomes. In particular, community-trained doulas with experience in how structural racism negatively impacts pregnancy are well positioned to address the specific needs of Black mothers. 

Addressing women’s jobs throughout pregnancy, birth, and beyond

Doulas see pregnant women not just as future parents, but also as individuals with their own desires and within their own unique circumstances. In working to understand women’s fears and worries, and their pregnancy, childbirth, and postpartum goals, doulas help serve the jobs of mothers, thereby helping them feel empowered during what can be a high-stress experience. 

By looking beyond safe delivery into what will make moms feel most at ease, empowered, and supported, doulas address women’s jobs throughout pregnancy, childbirth, and the postpartum period. In doing so, doulas are able to support the safe delivery of healthy babies in a way that extends beyond a functional outcome, and into the emotional component as well. Uncovering women’s jobs regarding pregnancy and childbirth creates the opportunity to develop maternal care that is more impactful and better addresses what women really need and desire. The result is an improved childbirth experience and enhanced mental and physical health for the mother throughout and after the process.  

Dr. Shah hit the nail on the head by saying safety should be the minimum goal of childbirth. Women don’t just want to be safe—they have an entire range of Jobs to Be Done surrounding childbirth. Doulas provide support and empowerment, addressing not just the functional aspects of pregnancy, birth, and postpartum-related jobs, but also the emotional aspects. Providers and health systems looking to improve their maternal health outcomes, particularly in underserved communities, should further consider the variety of Jobs to Be Done that arise during pregnancy, and how doulas are uniquely positioned to serve them.  

Jessica is a research associate at the Clayton Christensen Institute for Disruptive Innovation, where she focuses on business model innovation in health care, including new approaches to population health management and person-centered care delivery.