Building a Community of Doulas in Springfield Worcester

Building a Community of Doulas in Springfield Worcester Infant Mortality Summit September 22, 2017

In Springfield, the Infant Mortality Rate For African-American (non Hispanic) babies 12 per 1000 live births

What is a doula? A doula is trained & Experienced in pregnancy, labor, Birth, Breastfeeding and the postpartum period

A Doula Provides Education about childbirth and newborns for the mother-to-be Continuous support to a mother before, during, and after birth. Help to mother-to -be to identify her birth preferences and advocate for herself with her care providers

In May of 2016 Dr. Andrew Balder and Project Baby began to Explore how a doula program could help address these disparities The Community-Based Doula Initiative (CBDI)

Issues for CBDI 1. How to organize 2. How to inform the community about doulas 3. How to train a group of people to serve as doulas 4. How to fund the program 5. How to pay doulas

Issue #1. How to Organize Glenda Datsco, Prime Mover. CPM, Homebirth midwife, Doula, Childbirth Educator, veteran community organizer In Tampa

Erika Laquer DONA and CAPPA-trained Doula Childbirth Educator first served as a doula in 2006 in the Dominican republic Worked with volunteer doulas in DR March of Dimes Project in 2010 At Risk Mothers

Community-Based Doula Initiative Model is the Chicago Doula Project begun in 1990 s; Evolved into Health Connect One At Over 50 sites in U. S. www. healthconnectone. org

Issue #2: How to inform the community & collaborate Tabling at local events to engage community members And to Invite them for doula training

Outreach to local organizations June-August 2016 to introduce the project and gain support Head Start Early Learning Community Groups/ Members Hospitals Springfield Dept. of Health and Human Services YWCA Healthy Families & Square One WIC & The Breastfeeding Coalition

What does a doula do? A Doula “mothers the mother” Provides continuous support and reassurance to birthing Persons and supports partners https: //www. youtube. com/watch? v=Ihg. Gr. F_k. MAc

What does a doula do? A doula is present

Doulas make a difference. . . Fewer c-sections; fewer repeat c-sections Fewer interventions Increased breastfeeding rates Shorter hospital stays More satisfaction with birth experience Lower costs $$ to family, insurers, hospitals

In 2002, the Cochrane database review of 22 studies involving 15, 288 women found that Women who had continuous labor support from a doula experienced : 9% Pain relief medications 28% risk of cesarean section 31% use of Pitocin 14% newborns beingr admitted to nursery for care

Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. March 2014 “One of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula” [for low risk, term, singleton, vertex births]

ACOG Committee Opinion February, 2017, No. 687 Approaches to Limit Intervention During Labor and Birth “The desire to avoid unnecessary interventions during labor and birth is shared by health care providers and pregnant women. Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction. ”

Medical Interventions Iv therapy Electronic fetal monitoring Cervical ripening Induction Epidural Pain medication Directed pushing Episiotomy Early cord clamping Removal of newborn Cesarean section doula support Hydration Position changes Setting mood of room Relaxation massage/touch Vocalizing visualizations Intuition Delayed cord clamping Skin to skin

Issue #3 Training Who wants to be a doula? We ran 4 Introductions to Doula Work 17 women attended; Many more expressed interest

Who wants to be a doula? All ages; mix of Ethnicities, Reflecting some of The Diversity of the city of Springfield

Trainings

What has been accomplished by CBDI & its collaboration with Project Baby members 4 free trainings for women in the community : total of 17 women Building community partnerships with hospitals and care-givers Informing birthing women about existence of community doulas Recent collaboration with the Prison Birth Project, and their doulas Possibility of training Recovery Coaches as Doulas

Other Tasks Identified by CBDI Increase knowledge about doulas in the community Build an advisory board and move to 501(c)3 status Explore city-wide projects in other places: Philadelphia, Uzazi Village Sister Doula Program (Kansas City, Missouri), Everyday Miracles(Minneapolis, Minnesota)

Issue #4: Funding & Sustainability BIG CHALLENGES

Issue #5: Pay for Doulas! THE GOLD RING

How to Pay Doulas Transforming Maternity Care Blog. 2017 Issue Brief, “Medicaid and Private Insurance Coverage of Doula Care”http: //transform. childbirthconnection. org/reports/doula/ “Because the benefits [of doula care]are particularly significant for those most at risk of poor outcomes, doula support has the potential to reduce health disparities and improve health equity. Doula programs in underserved communities have had positive outcomes and are expanding, but the persistent problem of unstable funding limits their reach and impact” Executive Summary p. 2

How to Pay for Doula Care Work towards Funding through Medicaid reimbursement. Recommendations from the 2017 Issue Brief, published before the election

How to Pay Doulas See Table 2. Comparing Strategies to Expand Coverage of Doula Services in “Medicaid and Private Insurance Coverage of Doula Care”, p. 13. http: //transform. childbirthconnection. org/reports/doula/

Birth is better with a doula Contact: Erika Laquer, ejlaquer@gmail. com Resources Springfield Community-Based Doula Initiative [CBDI], cbdispringfield@gmail. com, P. O. Box 6313, Springfield, MA 01101 Health. Connect. One www. healthconnectone. org Doulas of North America International. DONA www. DONA. org Childbirth and Postpartum Professional Association CAPPA www. cappa. net Transforming Maternity Care Blog 2017 “Overdue: Medicaid Blog | Transforming Maternity Care Medicaid and Private Insurance Coverage of Doula Care” transform. childbirthconnection. org/reports/doula//