Case Study
Spotlight on Success: Open Arms Perinatal Services

Improving Our Maternity Care Now

September 2022
Maternal Health


Open Arms Perinatal Services illustrates how community doulas who provide extended support from pregnancy through the postpartum and early childhood periods can dramatically improve the health of childbearing women and people and their babies. This program has served families with low incomes in the Puget Sound region of Washington state since 1997. Open Arms hires doulas directly from the communities it serves. By working with a broad range of sponsors and funders, Open Arms is able to provide all programs at no cost to clients. They provide about 300 birthing people annually with doula services and, when possible, match them with culturally and linguistically concordant doulas. Open Arms has offered services in 17 languages.Open Arms Perinatal Services. “Thriving Children, Healthy Families, Powerful Communities,” accessed August 14, 2022,

Open Arms is an accredited community-based doula site of HealthConnect One. Open Arms trains doulas with an emphasis on equity and on helping clients advocate for their health care and educational needs. Open Arms works to provide doulas with a living wage and, as desired, a pathway to other health and social services jobs.Open Arms Perinatal Services. “Thriving Children, Healthy Families, Powerful Communities,” accessed August 14, 2022,

A less intensive Birth Doula program supports birthing women and people with several home visits during pregnancy, support during childbirth, and several early postpartum home visits. Families also have access to a social worker for referrals to needed social services. The longer, more intensive community-based Outreach Doula program provides home visits by the second trimester of pregnancy, continuous support at the time of birth, and home visits and many family support services through two years postpartum. Other available services include group prenatal care, lactation support, childbirth education, and baby supplies.3 Open Arms Perinatal Services. “Referral Form,” accessed August 14, 2022, https:// Examples of the services provided to childbearing people participating in the Outreach Doula program include advocating to ensure that the client’s childbirth goals are realized, accompanying the client to social services visits, finding resources of payment for utility bills, and connecting with partner organizations to bring clothes and toys to families.—. “Open Arms 2019 Video: Rokea, Erica, Eriona & Yasira,” February 14, 2019,

An independent evaluation of all Latina and Somali mothers and babies enrolled in the more intensive community-based Outreach Doula program between 2008 and 2016 documented a broad range of benefits, including:

  • Both Latina and Somali clients had lower rates of preterm birth (below 4 percent) and low birthweight (5 percent) compared to King County, Washington, rates.
  • 99 percent of clients initiated breastfeeding, exceeding the King County rate, and 94 percent were still breastfeeding at six months, far exceeding the rate of comparable statewide home visiting program clients (35 percent).
  • Babies had high rates of resolution of developmental delays resulting in low rates of child developmental concerns.
  • 72 percent of clients completed the first year of the outreach doula program, in comparison with 47 percent completing comparable statewide home visiting programs.

This evaluation concluded that rates of low birth weight, preterm birth, cesarean birth, and breastfeeding compare favorably to a broad range of possible comparators.Open Arms Perinatal Services. “Thriving Children, Healthy Families, Powerful Communities,” accessed August 14, 2022,

The outcomes favoring the Open Arms doula program are even more impressive when considering the challenges facing the program’s clients. To be eligible, income must be at or below 200 percent of the federal poverty level. Eighty-nine percent of the clients are people of color, speaking 19 languages, 18 percent are homeless or experience unstable housing, 55 percent are immigrants or refugees, and 63 percent had neither high school diploma nor equivalent. The participation and trust are also notable in the context of immigration raids that took place during most of the evaluation period.Open Arms Perinatal Services. “Thriving Children, Healthy Families, Powerful Communities,” accessed August 14, 2022,

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