Supporting Birthing People and Supporting Doulas: The Impact of the COVID-19 Pandemic on a Community-Based Doula Organization in San Francisco

Ashley Nguyen; Stephanie Arteaga; Marlee-I Mystic; Alli Cuentos; Marna Armstead; Jennet Arcara; Andrea V Jackson; Cassondra Marshall; Anu Manchikanti Gomez

doi:10.1089/heq.2022.0194

Supporting Birthing People and Supporting Doulas: The Impact of the COVID-19 Pandemic on a Community-Based Doula Organization in San Francisco

Health Equity. 2023 Jun 13;7(1):356-363. doi: 10.1089/heq.2022.0194. eCollection 2023.

Authors

Ashley Nguyen¹, Stephanie Arteaga², Marlee-I Mystic³, Alli Cuentos³, Marna Armstead³, Jennet Arcara², Andrea V Jackson⁴, Cassondra Marshall¹, Anu Manchikanti Gomez²

Affiliations

¹ School of Public Health, University of California, Berkeley, Berkeley, California, USA.
² Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California, USA.
³ SisterWeb San Francisco Community Doula Network, San Francisco, California, USA.
⁴ Department of Obstetrics, Gynecology and Family Planning, Maternal, Child, and Adolescent Health Program, University of California, San Francisco, San Francisco, California, USA.

Abstract

Background: Beginning in March 2020, health care systems in the United States restricted the number of support people who could be present during pregnancy-related care to reduce the spread of COVID-19. We aimed to describe how SisterWeb, a community-based doula organization that employs Black, Pacific Islander, and Latinx doulas in San Francisco, California, adapted to the COVID-19 pandemic.

Methods: As part of process and outcome evaluations conducted through an academic-community partnership, we interviewed SisterWeb doulas, mentors, and leaders in 2020, 2021, and 2022 (n=26 interviews). We identified preliminary themes using the Rapid Assessment Process and then conducted thematic analysis of data related to COVID-19.

Results: SisterWeb leadership remained committed to safeguarding doulas by shifting to virtual support until doulas were onboarded as benefitted employees. Doulas reported hospital policies impacted clients' pregnancy-related care. Initially, doulas adapted to virtual support by connecting with clients more frequently through phone and text. When permitted to meet in person, doulas adjusted to client preference. Finally, as the pandemic impacted doulas' well-being, they turned to mentors for emotional support.

Discussion and health equity implications: This analysis contributes to a growing body of literature describing doulas' experiences during the pandemic. By shifting to virtual support, SisterWeb leaders prioritized the health, safety, and financial stability of doulas, who were members of communities disproportionately impacted by COVID-19. Our findings suggest that public health guidance, organizational COVID-19 precautions, and hospital policies hindered SisterWeb's goal of ensuring clients receive equitable medical care. In addition, we found that emotional support for doulas is vital to their work.

Keywords: COVID-19; community doula; community network; ethical issue; maternal health services; mental health; public health.