See My Work

Focusing on interventions for the baby without a focus on
supporting the parent leaves out a significant window of opportunity
for successful health and developmental outcomes. Strategies
to provide both the baby and their parents with safe, sensitive,
nurturing environments and appropriate support are essential.

In total, 17 PFAs participated across 5 focus groups (4 in English, 1 in Spanish). We identified 6 themes: (1) PFA diversity is necessary to understand existing health inequities; (2) diversity needs to be considered broadly; (3) recruiting for diverse PFAs requires intentionality, visibility of PFACs within and outside of the hospital, and deliberate connections with families and communities; (4) efforts to increase PFAC diversity must be accompanied by work to develop inclusive environments; (5) diversity efforts require meaningful engagement and equity; and (6) diverse PFACs can enrich DEI efforts but require organizational commitment and follow-through.

The work to ensure that PFACs are diverse and truly representative and to develop meaningful partnerships with PFAs requires true commitment from health care organizations accompanied by actions that demonstrate to those with lived experiences how much their presence and voices matter. This requires structures for partnership that promote meaningful engagement, a strong sense of community, and connections to organizational initiatives.

Comparative studies can be done to assess the advantages and drawbacks of virtual compared to traditional doula support and examine outcomes such as birth satisfaction, cost-effectiveness, and accessibility while also considering factors like trust-building, rapport with clinicians, and the digital divide. Future research should assess the effectiveness of policies mandating doula coverage in private insurance plans and examine reimbursement processes, coverage disparities, and cost-effectiveness from the insurer and doula perspectives. Future research could focus on the effectiveness of different support mechanisms such as peer support groups, trauma-informed care training, mandatory counseling services, and policy interventions aimed at promoting doulas’ well-being and sustainability in the workforce.

Caring for a medically complex child comes with its challenges. Children with special health care needs are more severely impacted by the adverse effects of inequities and the social determinants of health [26]. Recognizing the toll the NICU experience can have on the family and identifying the appropriate support can change the culture of the NICU. From our personal experiences, we believe the recommendations described can transform NICU care and improve outcomes for both families and babies.

We need to empower families to better navigate the systems of care and to anticipate care needs due to long waitlists. Families need an advocate to ensure their child receives their recommended therapies and early interventions and an easy-to-follow schedule to survive this intensive period of clinical encounters. With support, families and their NICU babies can thrive through adversity and experience a successful transition to the home that sets them on a path of positive health and well-being across the life course.

Black individuals with lived experience of chronic conditions and racism have highlighted key concerns related to inpatient stays. Intentional and focused strategies are needed to address systemic racism and ensure equitable care and support for Black families during hospitalization.

Quality measurement can be a critical force in reducing health disparities. Leveraging race and ethnicity stratifications in HEDIS quality measures will allow for greater transparency regarding where gaps in care lie, as well as propel health plans and other key stakeholders to improve data completeness and accuracy and engage in strategies to decrease disparities.

In working to improve the health of North Carolinians, a
critical focus starts with our mothers and infants and their
surrounding communities. North Carolina’s perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context
of lifelong physical and mental health of our citizens, offer
areas for improvement and policy implications. In addition,
the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This
issue of the NCMJ highlights the state of perinatal health in
North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our
parents, children, and families; and how we as a state and as
a community can come together to improve the safety and
experience of giving birth in North Carolina and beyond.