New doula program helps parents tackle substance use disorders

Nearly 650,000 adults died from a drug overdose from 2011 to 2021, a dismal snapshot of the opioid epidemic’s impact on the nation. But a new study highlights an even sadder reality: As the number of adults who die from the drug crisis grows, so does the number of children who have lost a parent to addiction.

An estimated 321,566 children had a parent die in that same time frame, according to federal researchers. That’s roughly the same as the population of Riverside, California. Youths with non-Hispanic Indian/Alaska Native parents saw the highest rate of parental death in 2021(187 per 100,000). Children with young, non-Hispanic Black parents saw the highest increase in rate of loss every year (24%), with more children losing their fathers than their mothers.

The data indicates a need for policymakers to support more “whole-person health care” in recognition of substance users’ role as family members, officials with the National Institutes of Health said in a statement earlier this month. 

One way communities are providing whole-person health care is by helping new parents navigate pregnancy and childbirth while they recover from a substance use disorder. 

Take the Philadelphia Community Doula Support program, which launched early during the pandemic under the city’s Department of Health. The program links pregnant and postpartum parents with trained doulas who offer assistance in both childbirth and addiction recovery journeys. 

“Being a community doula-based model, [the program] meets a diverse set of needs,” said MaryNissi Lemon, program manager of the Community Doula Support program and certified doula. While a private doula closely works with new parents to offer emotional support during the pregnancy and educates parents on birthing services and resources, community doulas like those in Philadelphia’s program “provide a wider range of services outside of just birthing support.” 

Beyond supplying new parents with child care necessities like monthly provisions of diapers and support during labor, delivery and recovery, the city’s doulas also support parents overcoming a substance use disorder for up to a year postpartum. 

Under Philadelphia’s program, doulas can accompany parents to medical appointments, refer them to recovery-related resources and services and provide support when they engage with government entities such as family courts or the child welfare system. For instance, doulas can advocate for the reunification of families that have been separated by the city's family welfare policies.

Nadia Haerizadeh-Yazdi, the program’s qualitative research coordinator, said the model aims to prevent and mitigate instances of a parental overdose or government intervention. Events like those can negatively impact the family and contribute to poorer life outcomes for the child, so the program helps parents avoid those disruptions. 

It’s too soon to evaluate program impacts, Haerizadeh-Yazdi said, but anecdotal evidence suggests new participants are highly engaged and stay with the program longer. Parents have reported expanded health literacy and improvements in stress and anxiety levels. And while there have been cases of relapse, there have been no recorded overdoses thus far, she added.

Offering doula services through the postpartum period is crucial, as research shows women are at an increased risk of a relapse—and a resulting overdose—during the first year after childbirth, said Jessica Simon, senior program manager for health systems transformation at the Association of Maternal and Child Health Programs. 

In Philadelphia, for instance, a 2020 study of maternal mortality found that about 74% of fatal accidental overdoses occurred postpartum, and 66% of drug-related deaths occurred after the traditional 6-week postpartum period.

Plus, the number of babies born nationwide with neonatal abstinence syndrome has increased by 82% from 2010 to 2017. The trend highlights a dire need to address substance use disorders amid a growing maternal and infant health crisis, Simon said.

Substance use-related doula programs have taken root in other communities as well. In Montana the One Health program, supported by state and federal funds, links mothers with doulas and peer support specialists to help them manage mental health and addiction issues. And the Alabama Department of Mental Health launched a pilot program in 2021 that provides new moms doulas to help them manage court hearings, welfare visits and doctor appointments, among other responsibilities. 

Doula programs can offer “compassionate, nonstigmatizing support,” to pregnant parents with substance use disorders who often fear medical intervention due to judgment, Simon said. "Doula peer recovery specialists also provide that extra layer of understanding of the challenges someone might be going through with their substance use disorder.” 

For communities looking to reduce substance use among parents, officials should partner with local medical providers and social services organizations to engage doulas to help spread the word about health care and government resources. Simon added they should also consider providing housing, transportation and food insecurity assistance. 

Officials should also determine how to keep their doula programs sustainably funded. Simon said officials can leverage Medicaid or consider tapping into opioid settlement funds for substance use-related doula care. 

Ultimately, we know it takes a village to raise a child, Lemon said, but it also “takes a village [to support] the birthing person.”