Supporting the Perinatal Experience With a Doula

1. 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

3. This program reflects the AHEC’s mission: • connecting healthcare professionals to communities • promoting better health outcomes

4. 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

5. 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

6. decreases negative birth statistics and outcomes in the community initiates Mother-Friendly Services

7. Infant MortalityPreterm BirthsLow Birth WeightsMaternal Deaths Birth Statistics

8. Healthcare Dollars Maternity care holds a major position in the health care system $ 86 billion in 2007

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

10. Goals for Care provide support physically and emotionally throughout pregnancy, labor, birth and postpartum periods care processes should protect, promote, and support physiologic childbirth

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

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

13. Goals After Giving Birth provide strong support for breastfeeding provide strong support for mother-baby attachment that includes parenting skills

14. 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

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

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

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

18. How can a Doula Program help achieve these goals?

19. Doula ? Labor Assistant

20. 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)

21. Doula/client Relationship

22. Doula-Client Relationship • Trust • Communication • Encourage education • Support • Confidentiality • Advocate

23. 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

24. Tips for the success of a doula program • 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

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

26. Choosing the Right Program • Community Based • On Call Program • Continuum Care Program

27. Dealing With Conflict • instituting change • develop amultidisciplinary team or committee to address issues

28. 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

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

30. Research Look at your area resources

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

32. 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

33. Cost • Trainings • Materials • Reimbursement fee’s • How to structure payments for services

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

35. Look at Target Population Who are you going to provide service to Target at risk clients in early pregnancy

36. Doula Training/Certification

37. Doula Trainings

38. Skills a Doula Brings • Massage • Breathing • Support and Encouragement • Trust • Communication • Knows positioning to advance and progress baby through the birth canal

39. 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

40. National Organizations that have Certification Programs • CAPPA • DONA • ICEA • ALACE The cost for certification ranges from $300 - $500 through these organizations

41. Our Program Grant Funding Received $ 31, 385 Blue Cross/Blue Shield Blue & You Foundation

42. Blue & You Perinatal Support Program Grant Provided: • Trainings • Marketing • Advertising fees • Home Visits reimbursement • Mileage reimbursement • Administrative Cost

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

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

45. 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

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

47. 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

48. 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

49. Grant Outcomes 428 persons touched by the grant in 2009