Philadelphia doula program could promote recovery and prevent drug overdose deaths, study finds

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Research shows broadly that people who have doulas involved in their pregnancy care can have better maternal and infant health outcomes.

Now, a new study looking at a Philadelphia doula program for people living with addiction shows that these non-clinical support professionals may help reduce fatal drug overdoses in the postpartum period and strengthen long-term engagement with addiction recovery services.

Researchers noted early successes and challenges of the city’s Community Doula Support Program, established in March 2020, in a paper published this month in Maternal and Child Health Journal.

“We know, based on these reflections, this is a very promising model of support,” said Nadia Haerizadeh-Yazdi, qualitative research coordinator at the Philadelphia Department of Public Health.

About a quarter of pregnancy-associated deaths in Philadelphia between 2010 and 2016 were caused by accidental drug overdoses, according to city data.

That number rose to 39% by 2018 and public health officials expect it to grow even more. Of those deaths, more than half took place after six weeks postpartum.

Haerizadeh-Yazdi said maternal support and health care services tend to drop off after childbirth as the newborn infants become prioritized. This can create serious issues for people living with addiction.

“They’re still dealing with their issues around substance use, but also they have a newborn as well,” she said. “So, these challenges really intensify.”

Seeing a gap in care for a vulnerable population, the city created the doula program, which provides support during pregnancy and childbirth, as well as up to one full year of postpartum.

The program contracts with local doulas from the Maternity Care Coalition and other organizations. It is funded by the federal Title V Maternal and Child Health Block Grant Program, which supports projects centered on mothers, children, and families.

MaryNissi Lemon, program manager and certified doula, said the support these professionals provide for this population often goes well beyond the care that is typically provided by doulas.

They get trained to provide support and guidance in medication-assisted treatments for addiction, intimate partner violence resources, trauma-informed care, housing assistance, child welfare protocols, hospital policies on infants born with neonatal abstinence syndrome, and more.

“Our doulas are going to family court to support our participants,” she said. “There’s a lot more elements that they’re being affected by.”

The community doulas can also advocate for their clients when they feel judged and stigmatized within the health care system, sometimes even by their own health care providers, Lemon said.

“They’re an ally,” she said, “someone who is standing with them advocating, knowing that, ‘You know what, I have a trusted relationship with my doula and I know that they’re here, they’re the ones who are judgment free, they’re the ones who actually approach me as a human being, and I can lean on this person even in this intense environment.’”

Study authors interviewed program managers, founders, doulas, and patients who participated in Philly’s initiative from March 2020 through July 2022, and reviewed early data on patient engagement and health outcomes.

Researchers found that while patient referrals through treatment providers and other health or social service agencies were successful, the program lacked resources to reach people using drugs who are living on the street and who are not yet connected to a service organization.

“These are people who are possibly slipping through the net,” Haerizadeh-Yazdi said. “Right now, we’re not in that position to meet people at that level, but we’re certainly moving in that direction and it all depends on that networking and building that trust within the community.”

Philadelphia’s doula program also serves people who do not have substance use disorder, although its primary focus remains on people struggling with addiction.

The study found that people with substance use disorder who were paired with a doula at any point during or after pregnancy were more likely to be lost to follow-up care when compared to participants who did not struggle with addiction.

Some retention issues were due to COVID-19 pandemic policies, participant relocation, and restricted use of phones and other communication methods based on their housing situation.

Those with substance use disorder who remained in the program were highly engaged with their doulas and other support services, had a higher number of visits with physical and behavioral health providers, and saw no incidences of drug overdoses, according to the study.

Haerizadeh-Yazdi said more long-term research needs to be done to conclusively determine whether a program like this directly leads to a reduction in drug overdose deaths, and how exactly it affects maternal and infant health outcomes.

City officials said they’re pursuing additional funding in order to expand the program and hire more doulas in order to meet an expected growth in the number of people living with addiction.