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The Chicago Doula Project

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Exclusivity and duration of breastfeeding. Enhanced quality of mother-infant interaction ... NCAST feeding scale 26.8% mothers in the 'clinically worrisome' range ... – PowerPoint PPT presentation

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Title: The Chicago Doula Project


1
The Chicago Doula Project
  • Susan Altfeld, Ph.D.
  • Senior Research Associate
  • Ounce of Prevention Fund
  • September 2000

2
Background
  • The Irving Harris Foundation
  • Funded early doula research in Guatemala and in
    Texas
  • Wanted to fund a project for adolescent mothers
    in Chicago

3
Doula
  • A woman experienced in childbirth who provides
    continuous physical, emotional, and informational
    support to the mother before, during and just
    after childbirth.
  • John H. Kennell, M.D. and Marshall H. Klaus, M.D.

4
Previous Doula Research Outcomes
  • Continuous doula support during labor is
    associated with
  • Fewer c-sections
  • Decreased need for pain medication
  • Shortened duration of labor
  • Greater maternal satisfaction with birth
    experience
  • Exclusivity and duration of breastfeeding
  • Enhanced quality of mother-infant interaction

5
Previous Studies
  • First births
  • Uncomplicated, singleton, full-term pregnancies
  • Hospital-based
  • Labor and delivery support only
  • Randomized clinical trials

6
The Chicago Doula Project
  • Chicago Health Connection
  • Ounce of Prevention Fund

7
Project SitesAlivio Medical CenterChristopher
HouseMarillac Social CenterFunding
PartnersThe Irving Harris FoundationRobert
Wood Johnson FoundationPrince Charitable
TrustsIllinois Department of Human Services,
Office of Family Health
8
From Academic Research to Community Practice
  • Program Design
  • Community-based
  • Nestled in a home visiting program for parenting
    teens
  • Trained and employed community women as doulas
  • Provided home visits and prenatal education and
    support groups during pregnancy
  • Supported teens during labor and delivery
  • Extended doula involvement from pregnancy until
    12 weeks after birth

9
  • How This Project Differed From Studies in the
    Literature
  • Women were not excluded because of complications
    or preexisting conditions
  • Women with previous births were not excluded
  • It was not a random assignment
  • It extended the doula relationship
  • It included intensive doula training
  • Doulas were paid, permanent doula positions

10
Evaluation Design
  • Quantitative
  • Qualitative

11
Quantitative Data
  • Doula notes hospital medical records for each
    birth
  • Birth certificate data from State of Illinois
  • Questionnaires - depression screening (CES-D)
  • Ounce of Prevention Fund Stargate client database
  • NCAST feeding protocol for maternal-child
    interaction
  • Doula training questionnaires

12
Qualitative Data
  • Doula group interviews (training)
  • Doula group interviews (project recommendations,
    impact)
  • Program director interviews (project
    implementation, impact, recommendations)
  • Participant focus groups and individual interviews

13
Participant DemographicsAgen262 mean16.8
years (s.d.1.4)
14
Participant DemographicsEthnicity
15
Quantitative Outcomes
  • Cesarean sections
  • Epidural analgesia
  • Breastfeeding
  • Mother-infant interaction

16
Why Study Cesarean Sections?
  • Morbidity and mortality associated with surgical
    birth
  • Costs
  • c-section12,896
  • vaginal birth5,569
  • Compare outcomes with previous research

17
Project OutcomesCesarean Section Rates
18
Why Study Epidural Rates?
  • Association with prolonged labor c-section
  • Association with infant feeding difficulties
  • Cost
  • Previous research

19
Project OutcomesEpidural Rate
20
Why Study Breastfeeding?
  • Infant health
  • Maternal health
  • Psychosocial

21
Project OutcomesBreastfeeding
22
Project OutcomesBreastfeeding
23
Mother-Infant Interaction(n71)
  • NCAST feeding scale 26.8 mothers in the
    "clinically worrisome" range
  • Extended model dyads scored higher than those
    from shorter model sites
  • No statistically significant difference between
    doula sample and NCAST teen database sample

24
Qualitative Outcomes
  • Program outcomes
  • Enhanced program quality, provide more
    comprehensive care to participants
  • Doula as "buffer", health care advocate
  • Doula as trusted source of information and
    support ("friend", "mother", "sister")
  • Relationship-based intervention"

25
For more information contactsaltfeld_at_comcast.net
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