Supporting the Perinatal Experience With a Doula

Presenter

Angie Whatley, RN

University of Arkansas Medical Sciences Area Health Education Center

Nurse Educator

CAPPA Certified

Labor Doula/Childbirth Educator and Trainer

This program reflects the AHEC’s mission:

connecting healthcare professionals to communities

promoting better health outcomes

Objectives

• understand the need for better birth outcomes

• understand the doula/client relationship and its impact on birth

• Understand the doulas role within a hospital’s healthcare team

• understand the financial considerations and funding opportunities

Benefits of a Doula Program

links hospitals and physicians with community supportive services

promotes a positive, caring attitude for clients

builds trust within the hospital, physicians, communities and clients in relationships

decreases negative birth statistics and outcomes in the community

initiates Mother-Friendly Services

Infant MortalityPreterm BirthsLow Birth WeightsMaternal Deaths

Birth Statistics

Healthcare Dollars

Maternity care holds a major position in the health care system

$ 86 billion in 2007

In 2007 there were 4.3 million births

Cesarean Birth was the most common operating room procedure

(Levit, Wier, Stranges, Ryan, & Elixhauser,2009)

Goals for Care

provide support physically and emotionally throughout pregnancy, labor, birth and postpartum periods

care processes should protect, promote, and support physiologic childbirth

access to evidence-based, nonpharmacologic and pharmacologic strategies for pain management and relief

providers to be knowledgeable and trained in programs that offer system support

Goals After Giving Birth

provide strong support for breastfeeding

provide strong support for mother-baby attachment that includes parenting skills

the immediate hours after birth mothers and babies shouldbe encouraged to have skin to skin contact with minimal disruptions to promote early attachment, bonding and the initiation of breastfeeding

provide adequate help to cope with the challenges after birth, including emotional and physical changes

provide practical support at home as needed to cope with increased demands, fatigue and help to develop confidence as a new mother

ensure that each woman is valued and supported by society in her role as a new mother

How can a Doula

Program help

achieve these

goals?

Doula ? Labor Assistant

How Does a Doula Promote Positive Birth Outcomes?

(Nichols and Humenick 1988)(Mothering the Mother: How A Doula

Can Help You Have A Shorter Easier And Healthier Birth, by Klaus, Kennell, and Klaus (1993)

Doula/client Relationship

Doula-Client Relationship

•Trust•Communication•Encourage education•Support•Confidentiality•Advocate

Healthcare Team Benefits From a Doula

•Decreased anxiety•Continuous support•Reduction in interventions•Faster progression of labor•Familiar with community resources•Promote healthier outcomes•Increased initiation of breastfeeding

and attachment

• Valued as a team member

• Concise view of the doula’s role

• Promote positive effects

• Policy and procedure guidelines that promote team work

• In-service on team roles

• Support by upper management

Tips for the success of a doula program

This brings out the unity of the medical

community

Teams must be interdisciplinary to examine

the viability of doula care in a facility

CommunityServices

ProviderServices

Social Services

Hospital Services

Client

Choosing the Right Program

Community Based

On Call Program

Continuum Care Program

Dealing With Conflict

instituting change

develop a multidisciplinary team or committee to address issues

How to find funding for a Doula Program

Funding opportunities are available for many programs that target and focus on decreasing maternal and infant mortality

Funding Sources

• Department of Health and Human Services

• March of Dimes

• United Way

• Blue Cross and Blue Shield

• HRSA

• CDC

Research

Look at your area

resources

Research Questions

volunteer doulas?

free evidenced-based childbirth classes?

birthing centers?

hospital participation?

Support for this type of program?

How to Begin

Identify Funding Sources

• Have all parties on board

• Establish a small committee of involved party members

• Establish a coordinator for the program

Cost

• Trainings

• Materials

• Reimbursement fee’s

• How to structure payments for services

• Supplies for Program

• Mileage Reimbursement

• Marketing and Advertising

• Administration Cost

• Credentialing or Identification

Look at Target Population

Who are you going to provide service to

Target at risk clients in early pregnancy

Doula Training/Certification

Doula Trainings

Skills a Doula Brings

• Massage

• Breathing

• Support and Encouragement

• Trust

• Communication

• Knows positioning to advance and progress

baby through the birth canal

The Effects of Doula Support and RelaxationMuscle relaxation through massage,aromatherapy music therapy, guided

imagery, progressive relaxation techniquesor positioning

Stress Stress

Catecholamines

StressTensionAdrenaline –

which can slowor stop labor

Efficiency of Oxytocin which

Efficacy of contractions

Enhance Labor

25 % Shorter laborDecreased need for medications/induction/augmentation50% less Cesareans40% less forceps/vacuum assisted births

breastfeeding after 6 weeks parent satisfaction self-confidenceand self-esteem

National Organizations that have Certification Programs

CAPPA DONA ICEA ALACE

The cost for certification ranges from $300 - $500 through these organizations

Our Program

Grant Funding

Received

$ 31, 385

Blue Cross/Blue Shield Blue & You Foundation

Blue & You Perinatal Support Program Grant Provided:

• Trainings

• Marketing

• Advertising fees

• Home Visits reimbursement

• Mileage reimbursement

• Administrative Cost

Compensation Costs

• Trainer

• Food - Snacks/lunch at workshops

• Materials/Books/Supplies

• Certification Packets/Exam Fees per organization

•Compensation for 30 births ($300)

•Prenatal/Postpartum Visits ($25)

•Travel for visits (.50/mile)

•Administration Cost ( $10,000)

Administrative Costs

• Childbirth Class Materials

• Consultation fees

• Books for lending library

• Identification tags or uniforms for doulas

• Trainer fee’s for workshops and

continuing education classes to keep up

credentials

Grant Services Included

• Childbirth classes

• Labor Doula Services

• Breastfeeding services

• 2 prenatal home visits

• 2 postpartum home visits

• 24 hour contact with a doula

Reimbursement for Doula Services

• Doula’s charge from $300 - $900 for birth

services depending on geographical area

• Some insurances and flexible spending

accounts will reimburse for doula service

through providers or organizations

Grant Goals

• Reduce preterm births

• Reduce interventions/anesthesia

• Increase attachment and parenting skills

• Increase more positive birth experiences

• Show the benefits of using a doula in labor to the healthcare team and the laboring mom

• Allow other AHECs and communities duplicate the program

Grant Outcomes

428 persons touched by the grant in

2009

36 Births to date

23 Vaginal Births – 64%

• 7 Natural – 30 %

• 12 epidurals after 6 cm

• 2 Augmented with Pitocin

• 20 Inductions - 86 %

• 4 instrumental/Forceps births – 17 %

3 had epidural

Birthweights over 8 #

Grant Outcomes

12 Cesarean Births – 33%

• 3 Scheduled – previous Cesarean Birth

• 4 Fetal Distress

• 1 Failed VBAC

• 1 Frank Breech

• 2 Malpresentation/CPD

• 1 – PIH/Gestational Diabetes

Outcomes

• 2 Premature births

37.2 Weeks PROM

35 Weeks PROM

No transfers to NICU

SummaryMothers who used doulas experienced:

• Continuous labor support and comfort• Prolonged need for epidural and some reduction

of epidurals; less use of IV pain medications• More positive birth outcomes• Less postpartum depression• Increase breastfeeding success for longer

periods−Increased bonding promote healthier lifestyle

behaviors

The outcomes and experiences of childbearing have a wide-ranging impact on life and society

Birth – Life-changing experience

This is a time of great opportunity to promote and improve health, because women and families often are greatly motivated to improve their lives at this time

Internet Resources

• www.cappa.net

• www.birthsource.com

• www.childbirthconnection.com

Book

Doula Programs (Paulina Perez & Deaun Thelen)

How to Start and Run a Private or Hospital-Based

Program with Success – Edition 1 & 2

Case Presentation

Conflict Situation

Case Presentation

16 y.o. first pregnancyMother of teen blindFOB incarcerated

Case Presentation

19 y.o. first pregnancyFOB not supportiveBirth at the Medical CenterTeaching Hospital using residents unfamiliar with Doula services

References

Harper, Barbara. (1994) Gentle Birth Choices

Simkin, Penny & Ancheta, Ruth.(2005) The Labor Progress Handbook 2nd Ed.

Women’s Health Issues 20 (2010). Blueprint for Action Steps Toward a High-Quality, High-Value Maternity Care System; S18-S49; November 2009

Milbank Report. Evidenced based Maternity Care “What It Is and What It Can Achieve”. (2008)

Questions