Moving Theory into Action: Open Arms Perinatal Services

Moving Theory into Action: Open Arms Perinatal Services

Equity & Anti-Oppression in Midwifery Care: Understanding Difference, Power & Privilege

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Open Arms Perinatal Services (Open Arms) is a non-profit organization specifically focused on working with low-income birthing individuals in the Puget Sound region since 1977. They have been working to create strong community support for women and pregnant persons through the last three months of pregnancy, birth and the first two years of life. Whenever possible, Open Arms serves over 300 families each year by carefully matching them with trained doulas who are a cultural and/or language match to each family. Having served over 3000 families and done over 18,000 home visits, they have worked and continue to work on improving maternal and infant health, both in the immediate and the long run. Their mission: “Open Arms provides community-based support during pregnancy, birth, and early parenting to nurture strong foundations that last a lifetime.” Their vision: “Thriving children. Healthy families. Powerful communities.” (Open Arms Perinatal Services, 2018).

Open Arms provides low-income birthing families with doulas in the Puget Sound region. Often clients are referred by their maternal care providers, Women Infants and Children (WIC) and other community services. Maternity care providers may also fax in a referral to Open Arms. Over 75% of Open Arms clients identify as people of color and are matched with doulas that are culturally and/or linguistically similar (Open Arms Perinatal Services, 2018). For example: if a Latina Spanish speaking low-income woman contacts them looking for a doula to support her, they will match her with a Latina, Spanish speaking doula. “Midwives of color are uniquely poised to serve communities of color,” (Serbin & Donnelly, 2016). The same can be said about doulas. By diversifying the profession of Doula work, Open Arms is helping to create sustainable care to low-income families of color.

In 2013, 32% of babies in King County were born via cesarean section, the numbers were even higher for Asian and Black families ranging from 33-35% (Public Health: Seattle and King County, 2015). Of the 300 clients Open Arms served in 2017, only 16% of them delivered via cesarean section. Their clients also saw a reduced rate in preterm birth (Thrive Washington, 2017) despite their higher risk factors from being low-income and primarily people of color (Brumberg & Shah, 2015), in comparison to the Public Health cohort in King County (Open Arms Perinatal Services, 2018). Breastfeeding success rates of clients are also significantly higher; nearly 100% of Open Arms clients began breastfeeding at birth, and 95% were still breastfeeding after 6 months (Open Arms Perinatal Services, 2018). Compare that to the King County report where 78% of babies born to low-income families were still breastfeeding at 4 weeks and 57% at 6 months (Public Health: Seattle & King County); a remarkable 38% difference.

In chapter 13 of Racism in the United States, the authors talk about dismantling racism by creating a web of resistance. Open Arms has created its own web by creating an organization that provides care and support to families, primarily families of color, during pregnancy and for two years after. They work on building community support for their clients. The outreach doula program links people with doulas in their community to bridge social and linguistic barriers. These doulas are trained to work around birth and postpartum and are specially trained cultural navigators, helping families access resources for their children. The outreach doula program is currently serving African American, Latina, Native, and Somali communities (Open Arms Perinatal Services, 2018).

Volunteer doula work is not a new concept. Several hospitals have volunteer or employed doulas as part of their programs. Some doulas even offer free or sliding scale services to low income families. One thing to consider is WHO is open to providing low-cost or free service as an investment into the community. Often it is doulas that are in these communities who see the benefit their services can have for people. But, doing the work of being a doula for free, and sometimes at a cost to you and your family, can eventually lead to burn out and marginalized communities shouldn’t have to carry the weight of supporting their community members by doing the work for free. Providing families with free doulas doesn’t just make a difference to low-income families, it provides doulas with the ability to do the work they love, while getting paid as well. A certified doula, trained with Open Arms can expect to work with either a full-time or part-time case load of clients, while a trained doula working towards certification is supported through the certification process by having access to enough births needed to certify.  

Open Arms continues their mission beyond working with families, and doulas. They work politically on the Adverse Birth Outcomes Disparities Advisory Committee for the state of Washington. They are currently working to get reimbursement for doulas who work with families on Medicaid (Heath Equity, 2015). Doulas and other professionals who provide continuous support through labor have been shown to reduce childbirth costs to both the state, the client, and the insurance companies because doulas reduce the likelihood of a cesarean section or, instrumental delivery, decrease the length of labor, and reduce pain medication and labor augmentation (Hodnett, Gates, Hofmeyr & Sakala, 2013).

In addition to bridging the gap between health inequities and supporting families until their child’s second birthday through the outreach program Open Arms is currently working on opening a free baby boutique, where their clients can access things they need for baby care.

Open Arms relies on various outlets for funding. They are partnered with several groups, including Molina Health Care of Washington, Midwives of Washington, United Healthcare, and the American College of Nurse Midwives. Open Arms accepts donations from companies and individuals in addition to programs like Amazon Smile and Facebook Fundraisers.


Brumberg, H.L. & Shah, S. I. (2015) Born early and born poor: an eco-bio-developmental model for poverty and preterm birth. Journal of Neonatal and Perinatal Medicine, 8, 179-187. doi: 10.3233/npm-15814098

Health Equity (2015) State action plan to eliminate health disparities. Retrieved from the Health Equity website:

Hodnett E. D., Gates S., Hofmeyr G. J. & Sakala C. (2013) Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7. CD003766. DOI: 10.1002/14651858.CD003766.pub5.

Miller, J. L. & Garran, A. M. (2017) Racism in the United States: implications for the helping professions. New York, NY: Springer Publishing Co.

Open Arms Perinatal Services (2018, April 18) Retrieved from the Open Arms Perinatal Services website:

Public Health: Seattle & King County (2015) Health of mothers and infants by race and ethnicity. Retrieved from the Public Health website:

Serbin, J. W. & Donnelly, E. (2016) The impact of racism and midwifery’s lack of racial diversity: a literature review. Journal of Midwifery & Women’s Health 61(6) 694-706. doi: 10.1111/jmwh.12572

Thrive Washington. (2017) Community-based doula outreach program: report on program outcomes. Retrieved from the Open Arms Perinatal Services website:


Aurora ChristyComment