Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population

Mary-Powel Thomas,Gabriela Ammann,Ellen Brazier,Aletha Maybank,Philip Noyes

doi:10.1007/s10995-017-2402-0

Mary-Powel Thomas, Gabriela Ammann + Show 3 more

Open Access

https://doi.org/10.1007/s10995-017-2402-0

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Abstract

PurposeWomen of color in the United States, particularly in high-poverty neighborhoods, experience high rates of poor birth outcomes, including cesarean section, preterm birth, low birthweight, and infant mortality. Doula care has been linked to improvements in many perinatal outcomes, but women of color and low-income women often face barriers in accessing doula support.DescriptionTo address this issue, the New York City Department of Health and Mental Hygiene’s Healthy Start Brooklyn introduced the By My Side Birth Support Program in 2010. The goal was to complement other maternal home-visiting programs by providing doula support during labor and birth, along with prenatal and postpartum visits. Between 2010 and 2015, 489 infants were born to women enrolled in the program.AssessmentData indicate that By My Side is a promising model of support for Healthy Start projects nationwide. Compared to the project area, program participants had lower rates of preterm birth (6.3 vs. 12.4%, p < 0.001) and low birthweight (6.5 vs. 11.1%, p = 0.001); however, rates of cesarean birth did not differ significantly (33.5 vs. 36.9%, p = 0.122). Further research is needed to explore possible reasons for this finding, and to examine the influence of doula support on birth outcomes among populations with high rates of chronic disease and stressors such as poverty, racism, and exposure to violence. However, feedback from participants indicates that doula support is highly valued and helps give women a voice in consequential childbirth decisions.ConclusionAvailable evidence suggests that doula services may be an important component of an effort to address birth inequities.

Highlights

High school or less**p value for exact Fishers test (1-sided) at 95% confidence interval (1-tailed) calculated with SAS (version 9.4)
Women of color and those in areas of high poverty face persistent inequities in birth outcomes
In the United States, women of color— those living in areas of high poverty—experience disproportionately high rates of poor birth outcomes, including cesarean delivery, preterm birth, low birthweight, and infant mortality (Roth and Henley 2012; Hamilton et al 2015; Infant Mortality 2016)

Summary

High school or less

**p value for exact Fishers test (1-sided) at 95% confidence interval (1-tailed) calculated with SAS (version 9.4). Cesarean-section rate is statistically similar across both groups (33.5 vs 36.9%, p = 0.122); BMS participants have significantly lower rates of preterm birth (6.3 vs 12.4%, p < 0.001) and low birthweight (6.5 vs 11.1%, p = 0.001). In addition to collecting quantitative data, BMS conducts periodic follow-up telephone interviews with former clients, including both graduates and dropouts, using a semi-structured questionnaire. The follow-up interviews reveal high levels of satisfaction with the program: Of 244 clients surveyed between July 2010 and January 2015, 95.9% said they would recommend the program or use it in a future pregnancy, and 94.3% said they were “well-matched” with their doula. I trusted my doula more, and she gave all my options on the table so I could decide what was best for me, you know?” “She showed me she believed in me”

Conclusion

Findings

Compliance with Ethical Standards