How Doula Care Can Advance the Goals of the Affordable Care Act: A Snapshot From New York City

Strauss, Nan; Giessler, Katie; McAllister, Elan

doi:10.1891/1058-1243.24.1.8

Cited by 23 publications

(21 citation statements)

References 23 publications

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“…Women with doula support are less likely to deliver by cesarean and report greater satisfaction with their birth experiences . However, doula services are costly and usually not covered by health insurance, limiting access . Additionally, doulas tend to be upper‐middle‐class and white, so racial/ethnic minority women may have difficulty finding a doula that shares their language or cultural background, even if cost is not a barrier .…”

Section: Discussionmentioning

confidence: 99%

Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status

Attanasio

Kozhimannil

Kjerulff

2017

Birth

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Objectives Researchers documenting persistent racial/ethnic and socioeconomic status disparities in chances of cesarean delivery have speculated that women’s birth attitudes and preferences may partially explain these differences, but no studies have directly tested this hypothesis. We examined whether women’s prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. Methods Data were from the First Baby Study, a cohort of 3,006 women who gave birth to a first baby in Pennsylvania between 2009 and 2011. We used regression models to examine 1) predictors of prenatal attitudes toward vaginal delivery, and 2) the association between prenatal attitudes and actual delivery mode. To assess moderation, we estimated models adding interaction terms. Results Prenatal attitudes toward vaginal delivery were not associated with race/ethnicity or socioeconomic status. Positive attitudes toward vaginal delivery were associated with lower odds of cesarean delivery (AOR=0.60, p<0.001). However, vaginal delivery attitudes were only related to delivery mode among women who were white, highly educated, and privately insured. Conclusions There are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Furthermore, our findings suggest that white and high- socioeconomic status women may be more able to realize their preferences in childbirth.

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Section: Discussionmentioning

confidence: 99%

Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status

Attanasio

Kozhimannil

Kjerulff

2017

Birth

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“…12,14,15 Benefits of doula support are significant between racial and ethnic minority groups who experience a disproportionate burden of adverse outcomes. 6,[16][17][18][19] Although about 6% of women laboring in the United States work with doulas, a much larger percentage of women who have heard about doulas would like to work with one but cannot 6 because of barriers such as cost, availability, and access to racially, culturally, and linguistically diverse doulas. [19][20][21] Gaps in the literature include how and why individual maternity care practitioners decide to utilize, encourage, or discourage doula care.…”

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confidence: 99%

Hospital‐based maternity care practitioners’ perceptions of doulas

Neel

Goldman

Marte

et al. 2019

Birth

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Introduction A birth doula provides continuous informational, physical, and emotional support during pregnancy, labor, and immediately postpartum. Existing data on the benefits of doulas, especially for low‐resource, high‐need patients, do not address how and why individual practitioners decide to recommend this model of care. This project aims to describe best practices of integrating doulas into hospital‐based maternity care teams to facilitate access to this evidence‐based service for improving maternal health outcomes. Methods Semi‐structured interviews using open‐ended questions were conducted in person with 47 maternity care practitioners—OB/GYNs, family medicine physicians, RNs, and nurse‐midwives—across three hospitals. Interview analysis was conducted using the Template Organizing Style qualitative analysis approach. Results Results demonstrated varied support for doula care given practitioners’ experiences. Positive experiences centered on doulas’ supportive role and strong relationships with patients. Some conflicts between practitioners and doulas may stem from a cross‐cultural divide between mainstream obstetric/physician culture and a natural birth “counter culture.” Suggestions to facilitate good working relationships centered on three overlapping themes: mutual respect between doulas and hospital staff, education about doulas’ training, and clarification of roles on maternity care teams especially among staff with overlapping roles. Conclusions Among maternity care practitioners, some frustration, anger, and resentment persist with respect to work with doulas. Adequate staff training in the doula model of care, explicit role definition, and increasing practitioner exposure to doulas may promote effective integration of doulas into hospital maternity care teams.

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“…Benefits may include improved maternal and neonatal health outcomes and potential health care cost savings. Such data may be instrumental to securing reimbursement for doula services by third‐party payers and would result in the increased accessibility of this unique care . Work is needed to explore the potentially significant impact doulas may have on advancing evidence‐based birthing practice and interprofessional approaches to health care.…”

Section: Discussionmentioning

confidence: 99%

Doulas in the Operating Room: An Innovative Approach to Supporting Skin‐to‐Skin Care During Cesarean Birth

Lanning¹,

Oermann²,

Waldrop³

et al. 2018

J Midwife Womens Health

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Introduction: Skin-to-skin care (SSC) immediately after birth is recommended for all women and their newborns. Barriers to SSC after cesarean birth lead to delays in initiation of this practice. The purpose of this quality improvement project was to implement an innovative approach with volunteer doulas to support initiation of SSC after cesarean for all clients.Process: Volunteer doulas in a well-established hospital-based program within an academic health center were trained to provide care during scheduled cesarean births in the operating and recovery rooms. Data on rate and time of SSC and client and nurse satisfaction were collected for a 12-week period.Outcomes: Sixty-six women received doula-supported care in the operating room. All medically stable woman-newborn couplets with complete data (N = 58) initiated SSC in the operating room and were included in the data analysis. Forty-eight women completed a feedback survey after birth. Scores indicated that clients agreed or strongly agreed that the doula was an important part of the birth experience. Feedback from labor and delivery nurses indicated highly positive attitudes about the importance of SSC and the presence of volunteer doulas. All nurses surveyed who had participated in doula care (n = 20) agreed or strongly agreed that they were satisfied with the doulas and that the doulas were prepared for this role.Discussion: This project demonstrates that volunteer doulas can be prepared to provide supportive care to clients during and immediately after cesarean birth. Doulas can play an integral role in supporting the initiation of SSC after cesarean birth and are perceived as an important member of the maternity health care team by clients and nurses.

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How Doula Care Can Advance the Goals of the Affordable Care Act: A Snapshot From New York City

Cited by 23 publications

References 23 publications

Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status

Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status

Hospital‐based maternity care practitioners’ perceptions of doulas

Doulas in the Operating Room: An Innovative Approach to Supporting Skin‐to‐Skin Care During Cesarean Birth

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