Supporting the Perinatal Experience With a Doula

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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

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• This program reflects the AHECs mission
• connecting healthcare professionals to
  communities
• promoting better health outcomes

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Objectives

• understand the need for better birth outcomes
• understand the doula/client relationship and its
  impact on birth
• Understand the doulas role within a hospitals
  healthcare team
• understand the financial considerations and
  funding opportunities

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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

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decreases negative birth statistics and outcomes
in the community initiates Mother-Friendly
Services
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Infant MortalityPreterm BirthsLow Birth
WeightsMaternal Deaths
Birth Statistics
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Healthcare Dollars

• Maternity care holds a major position in the
  health care system
• 86 billion in 2007

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• In 2007 there were 4.3 million births
• Cesarean Birth was the most common operating room
  procedure
• (Levit, Wier, Stranges, Ryan, Elixhauser,2009)

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Goals for Care

• provide support physically and emotionally
  throughout pregnancy, labor, birth and postpartum
  periods
• care processes should protect, promote, and
  support physiologic childbirth

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

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providers to be knowledgeable and trained in
programs that offer system support
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Goals After Giving Birth

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

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the immediate hours after birth mothers and
babies should be encouraged to have skin to skin
contact with minimal disruptions to promote early
attachment, bonding and the initiation of
breast feeding
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provide adequate help to cope with the challenges
after birth, including emotional and physical
changes
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• provide practical support at home as needed to
  cope with increased demands, fatigue and help to
  develop confidence as a new mother

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ensure that each woman is valued and supported by
society in her role as a new mother
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• How can a Doula Program help achieve these goals?

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Doula ? Labor Assistant
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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)

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Doula/client Relationship
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Doula-Client Relationship

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

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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

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Tips for the success of a doula program

• Valued as a team member
• Concise view of the doulas role
• Promote positive effects
• Policy and procedure guidelines that promote team
  work
• In-service on team roles
• Support by upper management

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This brings out the unity of the medical
community Teams must be interdisciplinary
to examine the viability of doula care in a
facility
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Choosing the Right Program

• Community Based
• On Call Program
• Continuum Care Program

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Dealing With Conflict

• instituting change
• develop a multidisciplinary team or committee to
  address issues

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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

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Funding Sources

• Department of Health and Human Services
• March of Dimes
• United Way
• Blue Cross and Blue Shield
• HRSA
• CDC

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Research

• Look at your area resources

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Research Questions

• volunteer doulas?
• free evidenced-based childbirth classes?
• birthing centers?
• hospital participation?
• Support for this type of program?

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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

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Cost

• Trainings
• Materials
• Reimbursement fees
• How to structure payments for services

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• Supplies for Program
• Mileage Reimbursement
• Marketing and Advertising
• Administration Cost
• Credentialing or Identification

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Look at Target Population

• Who are you going to provide service to
• Target at risk clients in early pregnancy

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Doula Training/Certification
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Doula Trainings
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Skills a Doula Brings

• Massage
• Breathing
• Support and Encouragement
• Trust
• Communication
• Knows positioning to advance and progress baby
  through the birth canal

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The Effects of Doula Support and Relaxation
Stress
Stress
Muscle relaxation through massage, aromatherapy
music therapy, guided imagery, progressive
relaxation techniques or positioning
Catecholamines
Efficiency of Oxytocin which Efficacy of
contractions
Adrenaline which can slow or stop labor
Stress
Tension
25 Shorter labor Decreased need for
medications/induction/augmentation 50 less
Cesareans 40 less forceps/vacuum assisted births
Enhance Labor
self-confidence and self-esteem
parent satisfaction
breastfeeding after 6 weeks
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National Organizations that have Certification
Programs

• CAPPA
• DONA
• ICEA
• ALACE
• The cost for certification ranges from 300 -
  500 through these organizations
  

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• Our Program
• Grant Funding
• Received
• 31, 385

Blue Cross/Blue Shield Blue You Foundation
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Blue You Perinatal Support Program Grant
Provided

• Trainings
• Marketing
• Advertising fees
• Home Visits reimbursement
• Mileage reimbursement
• Administrative Cost

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Compensation Costs

• Trainer
• Food - Snacks/lunch at workshops
• Materials/Books/Supplies
• Certification Packets/Exam Fees per organization

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• Compensation for 30 births (300)
• Prenatal/Postpartum Visits (25)
• Travel for visits (.50/mile)
• Administration Cost ( 10,000)

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Administrative Costs

• Childbirth Class Materials
• Consultation fees
• Books for lending library
• Identification tags or uniforms for doulas
• Trainer fees for workshops and continuing
  education classes to keep up credentials

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Grant Services Included

• Childbirth classes
• Labor Doula Services
• Breastfeeding services
• 2 prenatal home visits
• 2 postpartum home visits
• 24 hour contact with a doula

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Reimbursement for Doula Services

• Doulas 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

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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

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Grant Outcomes

• 428 persons touched by the grant in 2009

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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

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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

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Outcomes

• 2 Premature births
• 37.2 Weeks PROM
• 35 Weeks PROM
• No transfers to NICU

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Summary

• Mothers 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

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

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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

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Case Presentation
Conflict Situation
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Case Presentation
16 y.o. first pregnancy Mother of teen blind FOB
incarcerated
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Case Presentation
19 y.o. first pregnancy FOB not supportive Birth
at the Medical Center Teaching Hospital using
residents unfamiliar with Doula services
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References

• Harper, Barbara. (1994) Gentle Birth Choices
• Simkin, Penny Ancheta, Ruth.(2005) The Labor
  Progress Handbook 2nd Ed.
• Womens 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)

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Questions