Abstract
Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.
Highlights
Home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts
The American Academy of Pediatrics (Task Force on Sudden Infant Death Syndrome 2016) recommends that infants be placed in supine sleep positions in their own beds in order to reduce the risk of sleep-related infant deaths, infants born to young, low-income mothers have a relatively high risk for prone placement and for co-sleeping (Colson et al 2009; Caraballo et al 2016)
Most early-childhood home-visiting programs begin working with families during pregnancy or soon after birth, relatively few evaluations have examined maternal and child health outcomes at birth or during the newborn period
Summary
Home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. MIECHV legislation did not prioritize specific maternal and newborn health outcomes, the U.S Department of Health and Human Services’ national health blueprint, Healthy People 2020 (Office of Disease Prevention and Health Promotion 2014), identifies such priorities: mother health at birth and postpartum (including attendance at childbirth preparation classes, reduction in Caesarean deliveries, reduction in maternal postnatal medical complications, and reduced postpartum depression), infant morbidity and mortality (including reduction in infant deaths, low birthweight and preterm birth), and infant care (including increased breastfeeding and increased proportion of infants put to sleep on their backs). The American Academy of Pediatrics (Task Force on Sudden Infant Death Syndrome 2016) recommends that infants be placed in supine sleep positions in their own beds in order to reduce the risk of sleep-related infant deaths, infants born to young, low-income mothers have a relatively high risk for prone placement and for co-sleeping (Colson et al 2009; Caraballo et al 2016)
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