BELKIS A.

Reducing Maternal Mortality and Severe Morbidity via Culturally Tailored Doula Integration 1

Reducing Maternal Mortality and Severe Morbidity via Culturally Tailored Doula Integration

Reducing Maternal Mortality and Severe Morbidity via Culturally Tailored Doula

Integration

Belkis Palacio

Florida National University

Instructor: Dr. Nora Hernandez Pupo

Course: Health Promotion and Role Development in Advanced Nursing Practice

Date: September 9, 2026

Maternal mortality and maternal morbidity remain significant public health issues, particularly among low-income, uninsured, and Medicaid-insured Non-Hispanic Black women expecting a child. Maternal hypertension that may lead to such serious consequences as a stroke, seizures, multiorgan dysfunction, and ultimately, death can arise rapidly. It is important to provide postpartum care since complications may arise not only during but after delivery as well, when interactions with the medical personnel become less frequent. A culturally modified approach that involves remote BP monitoring and home visits by postpartum doulas with mHealth incorporation will ensure continuous support and the ability to identify abnormalities in BP. Remote monitoring will enable the medical personnel to detect problems, while doulas will help educate and advocate for patients (Corlin et al., 2023; Lewkowitz et al., 2024).

The issue of maternal deaths in the world remains a challenge for people living in poverty, with no access to healthcare, and who are socially disadvantaged. According to estimates by the World Health Organization (WHO), 260,000 women lost their lives due to complications in pregnancy or childbirth in 2023 (World Health Organization, 2025). In statistics, 700 women are losing their lives every day; that is, one woman every two minutes due to maternal causes. Almost 92% of all maternal deaths happen in low- and lower-middle-income countries, while sub-Saharan Africa and southern Asia contributed to 87% of all maternal deaths in the world.

There are racial disparities when it comes to maternal mortality in America. According to a study conducted in 2024, 649 deaths occurred due to maternal causes, resulting in a maternal mortality rate of 17.9 per 100,000 live births (Hoyert, 2026). Notably, there were 44.8 maternal deaths among Non-Hispanic Blacks per 100,000 live births, whereas among Non-Hispanic Whites, the figure was 14.2 deaths, and 12.1 per 100,000 live births among Hispanic women (Hoyert, 2026). The reason why hypertensive conditions are pertinent is the fact that postpartum hypertension can cause significant maternal morbidity. The literature review indicates that the application of remote BP monitoring allows for more frequent postpartum BP evaluations and fosters connections between obstetric and primary care. There is evidence that cell-enabled remote BP monitoring is feasible in postpartum patients at a safety-net hospital (Mujic et al., 2024).

Miami-Dade County in Florida presents an interesting opportunity to look at maternal health disparities in the Black community. There are local maternal health data that show that racial disparities continue to exist even within the large metropolitan area healthcare system. This is especially relevant in light of the fact that socioeconomic issues, insurance concerns, transportation issues, lack of postpartum care, and poor experiences with healthcare facilities can prevent proper diagnosis and treatment of problems. Remote blood pressure monitoring can decrease reliance on office visits, as it will allow for transmission of the information from the patients’ homes. A study done on a primarily Black and Medicaid population showed that remote blood pressure monitoring was feasible and acceptable, with 77 out of 98 enrolled participants successfully utilizing it, without any maternal or neonatal deaths occurring during the 60-day postpartum follow-up period (Zhang et al., 2024). However, while technology can be helpful in addressing disparities, research shows that just providing technology does not necessarily solve the problem of race.

Indeed, interventions aimed at promoting maternal health need to be designed on several levels. Individuals could get BP machines, mobile health education, and instruction in relation to symptoms like serious headaches, vision changes, chest pains, shortness of breath, and significantly high BP readings. The community level would require culturally responsive doulas who would perform home visits, provide emotional support, health education, advocate on patients' behalf, and connect individuals with healthcare and social services. The healthcare system level could include doulas who work together with nurses, midwives, obstetric providers, and telehealth teams in order to create escalation pathways for abnormal BP measurements. It has already been proven that remote BP measurement improves BP ascertainment and postpartum care linkages, but these programs have to target specific barriers to engagement among Black patients (Lewkowitz et al., 2024; Zhang et al., 2024). On the policy level, extension of Medicaid coverage for doula services, remote BP monitoring devices, and postpartum care could become beneficial for economically disadvantaged populations. Thus, implementation of culturally responsive postpartum doulas along with mobile health and remote BP monitoring can become an effective multilevel intervention to reduce preventable maternal mortality and morbidity and advance racial and socioeconomic equality in maternal healthcare.

References

Corlin, T., Raghuraman, N., Rampersad, R. M., & Sabol, B. A. (2023). Postpartum remote home blood pressure monitoring: The new frontier. AJOG Global Reports, 3(3), 100251. https://doi.org/10.1016/j.xagr.2023.100251

Hoyert, D. L. (2024). Maternal mortality rates in the United States, 2024.  NCHS Health E Stats [Internet]. National Center for Health Statistics report

Lewkowitz, A. K., Hauspurg, A., et al. (2024). Perinatal remote blood pressure monitoring. Obstetrics & Gynecology, 144(3), 339–345. https://doi.org/10.1097/AOG.0000000000005690

Mujic, E., Parker, S. E., Nelson, K. P., O'Brien, M., Chestnut, I. A., Abrams, J., & Yarrington, C. D. (2024). Implementation of a cell-enabled remote blood pressure monitoring program during the postpartum period at a safety-net hospital. Journal of the American Heart Association, 13(13), e034031. https://doi.org/10.1161/JAHA.123.034031

World Health Organization. (2025).  Strategic objectives for the development and implementation of maternal, newborn and child health quality of care programmes. World Health Organization. https://iris.who.int/server/api/core/bitstreams/217b6c16-1a41-4090-840e-3a1999e2e73f/content

Zhang, Y., Lin, Y.-Y., Lal, L., Swint, J. M., Tucker, T., Ivory, D. M., Zhang, Y., Chandra, S., & Collier, C. (2024). Feasibility of remote blood pressure monitoring for detection and management of maternal hypertension in a predominantly Black, rural and Medicaid population in Mississippi. Telemedicine and e-Health, 30(7). https://doi.org/10.1089/tmj.2023.0426