Sanctuary CARES: Fighting to Reduce Maternal Morbidity and Mortality
Postpartum Doula Support
How Sanctuary CARES Is Researching Postpartum Doula Support to Combat Maternal Morbidity and Mortality
Maternal morbidity and mortality in the U.S. is a public health crisis—and it's rising. Depression, anxiety, and hypertension are among the top drivers of preventable maternal deaths. Sanctuary CARES is in the final phases of completing a research study exploring how in-home postpartum doula care can directly reduce these risks, particularly for Black, Indigenous, People of Color (BIPOC), Latina/Hispanic and other mothers of color. This blog explores why this research matters, how we’re approaching it, and what we hope it will change.
What’s Behind Maternal Morbidity and Mortality Rates in the U.S.?
Maternal morbidity and mortality rates in the U.S. are notably higher than in many other high-income countries. There are several interconnected reasons for this, including racial and socioeconomic disparities, a fragmented healthcare system, poor access to maternal care during and after pregnancy, lack of postpartum support, and high levels of chronic and mental illness. Inequitable access to quality health care services, health education, and resources is also a factor.
Mental Health and Hypertension Are Major Contributors
Depression, anxiety and hypertension are leading factors that contribute to maternal morbidity and mortality in the United States. For BIPOC and Latina/Hispanic mothers, the postpartum period is more likely to include these factors than in other races and ethnicities.
Postpartum depression and anxiety are not just emotional burdens—they’re medical risks. Hypertension, often stress-related, is a leading cause of postpartum complications and death. These issues are often underdiagnosed, untreated, or dismissed—especially for BIPOC women.
Racial Disparities in Maternal Outcomes
Black women are 3–4x more likely to die from pregnancy-related causes than white women. Structural racism, medical bias, and lack of postpartum support are contributing factors. Traditional medical systems often miss opportunities to intervene early—especially after birth.
Why We Chose to Study Postpartum Doula Care
The weeks following birth are a critical period for postpartum mothers, setting the stage for long-term health and well-being. Postpartum mothers are ideally adapting well to multiple physical, psychological, and social changes recovering from pregnancy, childbirth and adjusting to these changes while learning to care for and feed their newborns. While a postpartum doula’s scope is non-medical care, the acceptance of postpartum doula care as an in-home intervention would allow for earlier clinical referral and intervention for maternal health risk factors including depression, anxiety, and hypertension.
A Healing Presence in the Home
Postpartum doulas are trained, non-medical professionals who provide care in the home setting with direct support in several primary categories: (1) mother care (emotional well-being, physical recovery, education about nutrition, self-care, exercise); (2) sleep and rest support; (3) newborn care, feeding, and education, (4) household support (meal preparation, laundry, organization, light householding, errands). Postpartum doulas work within their professional, non-medical scope of practice by serving the mother and family system, observing potential needs and challenges, and discussing and collaborating with her to address these as appropriate. When a medical concern is observed and/or reported, postpartum doulas refer mothers to their medical provider(s).
Community-Based Care That Builds Trust
Radicalized families are more likely to distrust healthcare systems—and for good reason. Postpartum doula care could be impactful in bridging the gap for BIPOC families while the maternal medical care system strives to rebuild from BIPOC mothers’ distrust in its care. Doulas, especially those from shared communities, offer relational, nonjudgmental care. This builds confidence, reduces stress, and creates safer healing spaces.
Inside the Study: Measuring What Matters
With funding awarded through participation as a finalist in NIH’s IMPROVE Initiative, and in partnership with maternal health researchers at the Colorado School of Public Health and the University of Colorado - Boulder’s Renée Crown Wellness Institute, our pilot intervention study is examining the impact of postpartum doula care on depression, anxiety and hypertension in BIPOC mothers. Study participants receive 24 hours of postpartum doula care in the home setting, generally across 6 visits, occurring within the first year postpartum, with assessment visits occurring at three time points across the intervention window. Quantitative and qualitative data is collected through self report questionnaires, the PHQ-9 (depression) and GAD-7 (anxiety) assessments, and live blood pressure measurements during the assessment visits.
Research Questions
Our research questions are: (1) Is postpartum doula care effective in reducing maternal symptoms of depression, anxiety and hypertension? (2) What is the acceptability and feasibility of postpartum doula care as an intervention? (3) How does postpartum doula care impact a mother’s postpartum experience?
What We’re Tracking
The preliminary data from this study suggest that postpartum doula care is a promising intervention to improve depression and anxiety in BIPOC mothers and that there is strong engagement and satisfaction with the delivery of the intervention. We find these early notes vitally important as they begin to provide evidence for the practical application of postpartum doula care as an agile, non-medical solution that could address the disparity in maternal mortality and morbidity rates related to anxiety and depression, and potentially also maternal hypertension. To learn more about this study and access eligibility forms, check out our Research page.
Why This Research Matters for Maternal Health
There's a gap in evidence for community-based interventions in postpartum care. Substantial qualitative research exists on the positive impact of non-medical postpartum social and practical support, which can include non-medical professionals, community, and family. This kind of postpartum social support improves outcomes in mother’s mental health, including less depression and anxiety, more success in breastfeeding, improved confidence as a new parent, and a lower incidence of abuse than those who do not receive such support. Although there is much qualitative research on the positive impact of postpartum doula care, a significant research gap exists in conducting quantitative studies on postpartum doula care’s impact. By demonstrating measurable health outcomes, we aim to show that postpartum doulas are not a luxury—but a lifesaving intervention.
What We Hope to Change
Our findings could influence healthcare policy by promoting the integration of postpartum doula services into standard maternal health care. This could potentially lead to insurance coverage expansion or subsidization of doula care for marginalized groups, shifting policy toward funding and integrating postpartum doula care into standard postpartum care. Our goal with this research is to highlight postpartum doulas as critical partners in mental and physical health improvements while reducing racial disparities in maternal outcomes through evidence-based community care.
How You Can Help
Donate to Sanctuary CARES to expand access to doula care and support ongoing research
Share this blog with fellow community members, public health advocates, researchers, and care providers
Partner with us to bring this intervention to your healthcare or birth equity organization by reaching out via email: hello@sanctuarycares.org.
Maternal health doesn’t end at birth—and neither should maternal care. Sanctuary CARES is leading the charge to show how in-home postpartum doula care can improve mental and physical health outcomes, especially for those most at risk.
Join us in advancing this vital research. Donate here, spread the word, or collaborate with CARES to make postpartum healing equitable—and life-saving.
