According to the U.S. Centers for Disease Control and Prevention (CDC), maternal death ratios are severely racially stratified as African American women face the most significant risk. Currently, Black women are four times more likely to die from pregnancy-related death in the United States than white women. Race disparities in maternal health outcomes may be exacerbated by the Covid-19 pandemic as preliminary research suggests that the pandemic's disproportionate impact on Black communities and existing concerns about Black women's medical treatment may indicate an increase in mortality within the next few years. Racial health disparities reflect the nation's flawed maternal healthcare system and highlight a need for alternative healthcare models, including the increased use of doulas, who provide physical, emotional, and educational support during pregnancy, childbirth, and postpartum. Research has shown that doula care effectively mitigates adverse perinatal outcomes for socially disadvantaged women and their infants. Black doulas have distinct knowledge and insights about how race operates in the maternity care system as birth workers who serve Black birthing women, however, there is little research illuminating their perspectives. The current study is a qualitative analysis of the perspectives of Black doulas on their experiences with birth work in the U.S. maternity health care system during the Covid-19 pandemic and beyond using a critical intersectional lens. Data consist of in-depth, semi-structured qualitative interviews with 11 Black doulas throughout the U.S. Interviews were transcribed with the aid of Otter.ai and coded and analyzed thematically using NVivo. The results yielded four overarching themes: Advocacy and Trust are Key Components of Doula Work, Barriers to Accessing Doula Services and a Need for New Hospital Policies, COVID-19 Worsened Restrictions on Doula Work, and Increased Distrust of Hospitals among Black Indigenous and People of Color (BIPOC). The final theme focused on the History of Racism in Reproductive Health affects the Quality of Care Today and included a sub-theme regarding the Prevalence of Dismissive and Abusive Care. This study expands existing knowledge of race inequalities in maternal health by contributing the experiences and perspectives of Black doulas, who are uniquely positioned to observe Black patients' treatment in maternity care. Findings demonstrate a need for medical institutions to address systemic racism within their policies and procedures and highlight actionable solutions proposed by doulas to mitigate existing injustices.


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Graduation Date





Carter, Shannon


Master of Arts (M.A.)


College of Sciences



Degree Program

Applied Sociology


CFE0009225; DP0026828





Release Date

August 2022

Length of Campus-only Access


Access Status

Masters Thesis (Open Access)