Maternal health disparities in the United States are not new.
They are not hidden.
And they are not accidental.

Yet for Black women and birthing people, the consequences remain devastating.

Despite decades of data, Black women in the U.S. continue to experience maternal mortality rates three to four times higher than their white counterparts—regardless of education, income, or insurance status. These outcomes reflect more than clinical risk. They reflect systemic failure.

During InspireHer’s Bridging the Gap series, Juan Michelle Martin, PT, doula, and educator, named what many providers already see in practice: outcomes improve when care is culturally informed, continuous, and collaborative.

Doulas are central to that equation.

Understanding the Reality Providers Are Working Within

Dr. Martin grounded her session in a truth clinicians know well: maternal health disparities are driven by more than biology.

Structural racism, fragmented care models, limited access to culturally responsive services, and repeated dismissal of symptoms all contribute to higher rates of:

• Maternal mortality
  
• Cesarean births
  
• Postpartum complications
  
• Psychological distress
  

Even when clinical risk factors are equal, Black women are more likely to experience unnecessary interventions, including cesarean delivery—leading to longer recovery, higher complication risk, and greater long-term impact on pelvic and whole-body health.

For providers committed to equity, this demands more than awareness. It demands different systems of care.

Doulas as a Bridge — Not an Add-On

Doulas are often described as “support,” but that language undersells their role.

As Dr. Martin shared, many of her clients seek doula care out of fear—not preference. One statement stayed with the room:

“I’m getting a doula because I don’t want to die.”

That sentence reflects a deep lack of trust in the healthcare system—and a clear signal that something must change.

Doulas provide continuity in a system that often feels disjointed. They offer advocacy in moments when patients feel least empowered. And when doulas come from the same cultural or community backgrounds as their clients, trust and communication shift in meaningful ways.

They are not replacing medical care.
They are stabilizing it.

Where Physical Therapy and Doulas Align

One of the most powerful themes of the session was collaboration.

Dr. Martin emphasized that when doulas, physical therapists, and medical providers work together, outcomes improve—not because roles overlap, but because they complement one another.

As pelvic health physical therapists, providers are uniquely positioned to:

• Address recovery beyond delivery
  
• Identify early pelvic and core dysfunction
  
• Support functional return to daily life
  
• Reduce long-term consequences of birth-related trauma
  

Doulas, in turn, help patients:

• Prepare for birth with informed consent
  
• Navigate clinical environments
  
• Advocate for their needs
  
• Recognize when referral and follow-up are needed
  

This is not parallel care. It is interprofessional care done well.

Reducing Interventions, Improving Outcomes

Evidence consistently shows that doula support is associated with:

• Lower cesarean birth rates
  
• Reduced use of pain medication
  
• Shorter labor duration
  
• Higher satisfaction with the birth experience
  

For women of color—who are at increased risk for postpartum anxiety, depression, and trauma—the emotional regulation and continuity doulas provide can be life-altering.

Dr. Martin also highlighted a gap providers can help close: pelvic health education within doula training.

Through InspireHer’s Better Birth Project, doulas receive foundational pelvic health education—equipping them to recognize red flags, normalize referral, and reinforce the role of physical therapy before dysfunction becomes chronic.

This upstream approach is prevention in action.

Access Is Still the Barrier

Despite strong evidence, doula care remains inaccessible for many—particularly those most at risk.

Limited insurance coverage, inconsistent Medicaid reimbursement, and state-by-state variability all restrict access. Where Medicaid coverage for doula services has expanded, outcomes have improved.

Policy matters. Advocacy matters.
And providers have a role in shaping both.

Why This Matters to InspireHer — and to You

At InspireHer, we believe maternal health equity is built through partnership, not hierarchy.

Doulas are not “adjuncts” to care.
Pelvic health physical therapy is not optional postpartum.
Culturally responsive collaboration is not a bonus—it is essential.

When providers, doulas, educators, and advocates work together, fear is reduced, communication improves, and outcomes change.

This is how systems heal.

Be Part of the Change

Whether you are a physical therapist, student, educator, donor, or advocate, your support fuels programs that:

• Educate doulas in pelvic health fundamentals
  
• Expand access to collaborative care models
  
• Support underserved communities
  
• Advocate for sustainable systems change
  

Together, we are building a future where no woman’s safety depends on luck—and no provider works alone to close these gaps.

👉 Learn more and support our work at gwhi.org/donations