supporting the perinatal experience with a doula presenter angie whatley, rn university of arkansas...
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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
This program reflects the AHEC’s mission:
connecting healthcare professionals to communities
promoting better health outcomes
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
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
decreases negative birth statistics and outcomes in the community
initiates Mother-Friendly Services
Healthcare Dollars
Maternity care holds a major position in the health care system
$ 86 billion in 2007
In 2007 there were 4.3 million births
Cesarean Birth was the most common operating room procedure
(Levit, Wier, Stranges, Ryan, & Elixhauser,2009)
Goals for Care
provide support physically and emotionally throughout pregnancy, labor, birth and postpartum periods
care processes should protect, promote, and support physiologic childbirth
access to evidence-based, nonpharmacologic and pharmacologic strategies for pain management and relief
Goals After Giving Birth
provide strong support for breastfeeding
provide strong support for mother-baby attachment that includes parenting skills
the immediate hours after birth mothers and babies shouldbe encouraged to have skin to skin contact with minimal disruptions to promote early attachment, bonding and the initiation of breastfeeding
provide adequate help to cope with the challenges after birth, including emotional and physical changes
provide practical support at home as needed to cope with increased demands, fatigue and help to develop confidence as a new mother
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)
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
• 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
Tips for the success of a doula program
This brings out the unity of the medical
community
Teams must be interdisciplinary to examine
the viability of doula care in a facility
CommunityServices
ProviderServices
Social Services
Hospital Services
Client
Dealing With Conflict
instituting change
develop a multidisciplinary team or committee to address issues
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
Funding Sources
• Department of Health and Human Services
• March of Dimes
• United Way
• Blue Cross and Blue Shield
• HRSA
• CDC
Research Questions
volunteer doulas?
free evidenced-based childbirth classes?
birthing centers?
hospital participation?
Support for this type of program?
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
• Supplies for Program
• Mileage Reimbursement
• Marketing and Advertising
• Administration Cost
• Credentialing or Identification
Look at Target Population
Who are you going to provide service to
Target at risk clients in early pregnancy
Skills a Doula Brings
• Massage
• Breathing
• Support and Encouragement
• Trust
• Communication
• Knows positioning to advance and progress
baby through the birth canal
The Effects of Doula Support and RelaxationMuscle relaxation through massage,aromatherapy music therapy, guided
imagery, progressive relaxation techniquesor positioning
Stress Stress
Catecholamines
StressTensionAdrenaline –
which can slowor stop labor
Efficiency of Oxytocin which
Efficacy of contractions
Enhance Labor
25 % Shorter laborDecreased need for medications/induction/augmentation50% less Cesareans40% less forceps/vacuum assisted births
breastfeeding after 6 weeks parent satisfaction self-confidenceand self-esteem
National Organizations that have Certification Programs
CAPPA DONA ICEA ALACE
The cost for certification ranges from $300 - $500 through these organizations
Blue & You Perinatal Support Program Grant Provided:
• Trainings
• Marketing
• Advertising fees
• Home Visits reimbursement
• Mileage reimbursement
• Administrative Cost
Compensation Costs
• Trainer
• Food - Snacks/lunch at workshops
• Materials/Books/Supplies
• Certification Packets/Exam Fees per organization
•Compensation for 30 births ($300)
•Prenatal/Postpartum Visits ($25)
•Travel for visits (.50/mile)
•Administration Cost ( $10,000)
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
Grant Services Included
• Childbirth classes
• Labor Doula Services
• Breastfeeding services
• 2 prenatal home visits
• 2 postpartum home visits
• 24 hour contact with a doula
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
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
36 Births to date
23 Vaginal Births – 64%
• 7 Natural – 30 %
• 12 epidurals after 6 cm
• 2 Augmented with Pitocin
• 20 Inductions - 86 %
• 4 instrumental/Forceps births – 17 %
3 had epidural
Birthweights over 8 #
Grant Outcomes
12 Cesarean Births – 33%
• 3 Scheduled – previous Cesarean Birth
• 4 Fetal Distress
• 1 Failed VBAC
• 1 Frank Breech
• 2 Malpresentation/CPD
• 1 – PIH/Gestational Diabetes
SummaryMothers who used doulas experienced:
• Continuous labor support and comfort• Prolonged need for epidural and some reduction
of epidurals; less use of IV pain medications• More positive birth outcomes• Less postpartum depression• Increase breastfeeding success for longer
periods−Increased bonding promote healthier lifestyle
behaviors
Birth – Life-changing experience
This is a time of great opportunity to promote and improve health, because women and families often are greatly motivated to improve their lives at this time
Internet Resources
• www.cappa.net
• www.birthsource.com
• www.childbirthconnection.com
Book
Doula Programs (Paulina Perez & Deaun Thelen)
How to Start and Run a Private or Hospital-Based
Program with Success – Edition 1 & 2
Case Presentation
19 y.o. first pregnancyFOB not supportiveBirth at the Medical CenterTeaching Hospital using residents unfamiliar with Doula services
References
Harper, Barbara. (1994) Gentle Birth Choices
Simkin, Penny & Ancheta, Ruth.(2005) The Labor Progress Handbook 2nd Ed.
Women’s Health Issues 20 (2010). Blueprint for Action Steps Toward a High-Quality, High-Value Maternity Care System; S18-S49; November 2009
Milbank Report. Evidenced based Maternity Care “What It Is and What It Can Achieve”. (2008)