Transcript Community Doula Program

CityMatCH Conference, September 2005
Teen Pregnancy “Promising Practice” presentation
“Mothering the Mother”…
What does it mean?
Co-Author: Nadia Stein, President
Presenter: Nathalie Paravicini,
Executive Director
A March of Dimes “Comenzando Bien” Agency
Why Focus on Teens
 In Houston, in the year 2000, only 55% of
young Latinas graduated from High School
(Making the Grade on Women’s Health, National Women’s
Law Center, 2001)
In the areas we serve, up to 19.5% of babies are
born to teenagers and 60.4% of mothers have
less than a high school diploma (St Luke's
Episcopal Health Charities' Community Health Index website,
2002 Data)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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Why Focus on Teens
 In Houston, in the year 2000, only 55% of
young Latinas graduated from High School
(Making the Grade on Women’s Health, National Women’s
Law Center, 2001)
 In the areas we serve, up to 19.5% of babies
are born to teenagers and 60.4% of mothers
have less than a high school diploma (St Luke's
Episcopal Health Charities' Community Health Index website,
2002 Data)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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Public Health Implications
Low birth weight accounts for 10% of all health
care costs for children (4/10 costliest
hospitalizations, regardless of age, are related
to infant care) (MOD, Prematurity Campaign,
2000 report)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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Public Health Implications
Low birth weight accounts for 10% of all health
care costs for children (4/10 costliest
hospitalizations, regardless of age, are related
to infant care) (MOD, Prematurity Campaign, 2000 Report)
9.6% of babies born to teens are low birth weight
(13.9% for Black teens) (National Vital Statistics, Dec
2003 Report)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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Public Health Implications
Low birth weight accounts for 10% of all health
care costs for children (4/10 costliest
hospitalizations, regardless of age, are related
to infant care) (MOD, Prematurity Campaign, 2000 Report)
9.6% of babies born to teens are low birth
weight (13.9% for Black teens) (National Vital
Statistics, Dec 2003 Report)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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A Much Wider Problem
The situation is emblematic of wider problem:
The rate of premature births jumped 29%
since 1981 (MOD, Prematurity Campaign, 2000 Report)
“48% of Americans struggle with low health
literacy” (AMA, 2003 report).
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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A Much Wider Problem
The situation is emblematic of wider problem:
The rate of premature births jumped 29%
since 1981 (MOD, Prematurity Campaign, 2000 Report)
“48% of Americans struggle with low health
literacy” (AMA, 2003 report).
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
8
A Much Wider Problem
The situation is emblematic of wider problem:
The rate of premature births jumped 29%
since 1981 (MOD, Prematurity Campaign, 2000 Report)
“48% of Americans struggle with low health
literacy” (AMA, 2003 Report)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
9
A Much Wider Problem
 Our challenge is to “translate scientific knowledge into
street knowledge” (Vice Admiral Richard Carmona, US
Surgeon General, 2004 address, Houston, Texas)
 To change health behavior health practitioners must
• Build Trust
• Repeat the Message at appropriate intervals over a
substantial period
• Be prepared to change the message path and
appearance as people take current ones for
granted
(Mrs. Elliott Churchill, MS, MA, Division of International
Health, CDC Atlanta Georgia, 2005)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
History and Development
A concept rooted in practical experience
The “primordial” story-teller meets the “modern” businesswoman
Founder Nadia Stein’s personal history:
• One of the first Doulas of the US study, became Jr. Project
Coordinator
• Learned from each other, asked questions to medical students and
staff
• Subsequent 20 years of private practice and extensive reading
Executive Director Nathalie Paravicini, a Mother-Daughter team:
• Unique combination of complementary skills and experience
• Studied Microbiology, biochemistry and business
• Shared 20 years of experience and learning within the family
Framed by experience in scientific studies
• Rigorous informational data-tracking background
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
History and Development

Continuous Emotional Support
During Labor in a US Hospital, John
Kennel, MD; Marshall Klaus, MD; Susan
McGrath, PhD; Steven Robertson, PhD;
Clark Hinkley, MD, JAMA. 1991; 265:21972201.
70
60
50
40
30
20
10
0
Study
Control
.
s
an rceps ation emp
i
r
Fo edic nal T
es a
Ca
M ater
M
S
C
C. Sect. (% of all deliveries)
8
18.1
Forceps (% vag. deliveries)
8.3
26.9
Epidural (% of all deliveries)
11.4
60.8
Mat. Temp. (% of sepsis
eval.)
33.3
70.0
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
12
“Promising Practice”
History and Development
A concept rooted in practical experience
A healthy, healing and marvelous body
A truly integrated approach
• Based on actual needs of pregnant women and couples
regardless of socio-economic background
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
13
“Promising Practice”
History and Development
A concept rooted in practical experience
A healthy, healing and marvelous body
A truly integrated approach
• Based on actual needs of pregnant women and couples
regardless of socio-economic background
• Starts from the point of view of a healthy body, a body (and mind)
with an immense capacity for healing, especially during pregnancy
and birth.
as opposed to intervening from the point of view of illness,
specifically “defensive medicine vs preventive medicine” (Dr. John C.
Nelson, Obstetrician and 2004-2005 President of the AMA)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
14
“Promising Practice”
History and Development
A concept rooted in practical experience
A healthy, healing and marvelous body
A truly integrated approach
• Based on actual needs of pregnant women and couples
regardless of socio-economic background
• Starts from the point of view of a healthy body, a body (and mind)
with an immense capacity for healing, especially during pregnancy
and birth.
as opposed to intervening from the point of view of illness,
specifically “defensive medicine vs. preventive medicine” (Dr. John C.
Nelson, Obstetrician and 2004-2005 President of the AMA)
• Integrates the person as a whole, the body-mind-spirit
Nutrition affects the mind; the mind affects digestion and hormonal
releases, trust and confidence allows us to release the power within
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Results
2003 2004
Participating moms
529
619
Births,
participating moms
215
330
9
14
4.2%
4.2%
Low Birth-Weight
Babies
CDP’s Rate of Low
Birth Weight Babies
National Rate for
Hispanic Women
6.5%
In addition, the CDP
experiences a high rate of
long-term breastfeeding
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Approach
One Mission, Two Objectives
The Mission the Community Doula Program is to educate
and nurture expectant youth in disadvantaged
neighborhoods, by cultivating a network of peer Doulas
from the communities served.
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
17
“Promising Practice”
Approach
One Mission, Two Objectives
The Mission the Community Doula Program is to educate
and nurture expectant youth in disadvantaged
neighborhoods, by cultivating a network of peer Doulas
from the communities served.
1. Our primary objective is to
improve the overall health of
mother, child and her family
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
18
“Promising Practice”
Approach
One Mission, Two Objectives
The Mission the Community Doula Program is to educate
and nurture expectant youth in disadvantaged
neighborhoods, by cultivating a network of peer Doulas
from the communities served.
1. Our primary objective is to
improve the overall health of
mother, child and her family
2. Our second objective is to
cultivate a network of trained,
peer Doulas, thereby developing
a network of knowledgeable role
models
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
19
“Promising Practice”
Approach
One Mission, Two Objectives
The Mission the Community Doula Program is to educate
and nurture expectant youth in disadvantaged
neighborhoods, by cultivating a network of peer Doulas
from the communities served.
1. Our primary objective is to
improve the overall health of
mother, child and her family
2. Our second objective is to
cultivate a network of trained,
peer Doulas, thereby developing
a network of knowledgeable role
models
For teens: increase the graduation
rate
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Approach
. What We Do – Six Integrated Services:
1. Pregnancy & nutrition, labor & birth, breastfeeding and
early baby development classes
2. One-on-one emotional support throughout pregnancy
and early motherhood
3. Labor support at the hospital
4. Hands-on breastfeeding counseling and support
5. Post-partum support and post-partum depression
assistance (in collaboration with other agencies)
6. Recruitment, training and mentoring of peer Doulas
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Approach
. What We Do – Three Distinguishing Characteristics:
1. In-depth content-integrated education spanning the
range of issues a young mother needs to be informed
about from nutrition, to pregnancy and labor,
breastfeeding and early child development
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
22
“Promising Practice”
Approach
. What We Do – Three Distinguishing Characteristics:
1. In-depth education spanning the range of issues a
young mother needs to be informed about from
nutrition, to pregnancy and labor, breastfeeding and
early child development
2. Integration of education and emotional support during
the entire perinatal period, particularly by way of labor
support at the hospital. This aspect is particularly
important for survivors of violence
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
23
“Promising Practice”
Approach
. What We Do – Three Distinguishing Characteristics:
1. In-depth education spanning the range of issues a
young mother needs to be informed about from
nutrition, to pregnancy and labor, breastfeeding and
early child development
2. Integration of education and emotional support during
the entire perinatal period, particularly by way of labor
support at the hospital. This aspect is particularly
important for survivors of violence
3. Training and mentoring of women from the community
itself, providing culturally-sensitive services and
creating a lasting multiplier effect within the
community
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Approach
Two Key Factor for Success:
.
 Investment in QUALITY of service, in-depth and integrated
Integrated content, Intellectually challenging classes, designed for
low literacy (ie experiential), importance of community-setting to
promote interaction, learning from each other and support
networks
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Approach
Two Key Factor for Success:
.
 Investment in QUALITY of service, in-depth and integrated
Integrated content, Intellectually challenging classes, designed for
low literacy (ie experiential), importance of community-setting to
promote interaction, learning from each other and support
networks
 Great investment in training of the Doulas:
- Recruitment from within the program
- 64 hours of didactic material
- 3-6 months of hands-on mentoring with experienced Doulas
- 2-3 births at the hospital with an experienced Doula
TOTAL: 9-12 months of training
Followed by monthly Continuing Education sessions
In a non-hierarchical organizational structure focused on personal
growthCityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Barriers and Support
Barriers to implementation:
1. Complex needs of low-income families, especially childcare and
transportation
2. Lack of support from the family, especially husbands in light of
changing dynamics
3. Acceptance by healthcare providers to the presence of Doulas,
letting women labor uninterrupted and providing for more
freedom of movement
4. A cost-saver may conflict with increasing profits
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Barriers and Support
Barriers to implementation:
1. Complex needs of low-income families, especially childcare and
transportation
2. Lack of support from the family, especially husbands in light of
changing dynamics
3. Resistance by healthcare providers to the presence of Doulas,
letting women labor uninterrupted and providing for more
freedom of movement
4. A cost-saver may conflict with increasing profits
How to overcome barriers:
1. High-quality training and preparation of women and Doulas
2. Early institutional support from healthcare institutions because of
decreased healthcare costs
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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“Promising Practice”
Barriers and Support
Key supporters
 Baylor College of Medecine, Dr. Clark Hinkley (former Dr. of
Ob/Gyn), Dr. Cabrera-Meza (Director International Neonatology,
Texas Children’s Hospital), Dr. Garcia-Pratt (Professor of Pediatrics
and Neonatology and Director of Nurseries, Ben Taub Hospital),
and others
 The March of Dimes and other key foundations afterwards
 City of Houston and Harris County Hospital District (Ben Taub)
 Midwifery Section of Baylor College of Medicine
 Various service providers (addressing domestic violence, housing,
behavioral health and other needs)
 The media (Houston Chronicle, Telemundo, Univision and others)
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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A Peer-to-Peer, In-Depth
Integrated Approach
The perinatal period is a unique moment that affects the entire life of
the baby and mother. This moment addresses an integrated and
extensive spectrum of knowledge and skills that need to be
addressed together as a whole. When the mother has a positive
experience, we observe stronger and healthier family ties
It is a transforming moment that touches the entire person; women
are particularly sensitive and vulnerable. Any approach must
focus on empowerment from within, cultivating the person,
instead of only providing basic information, for systemic longterm impact
Women of the community, particularly the Doulas, play a key role
for the long-term impact on public health and the community’s
well-being. They are the experts on the community.
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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A Peer-to-Peer, In-Depth
Integrated Approach
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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EXTRA SLIDES
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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Addressing the Needs
of Healthcare Providers
In a stressed system with:
•
•
•
•
Increased competition at hospitals
cost reductions
need for more qualified personnel
increased demands and less resources
A well-prepared Doula offers:
• A knowledgeable patient, healthier
pregnancies
• Easier work-load, shorter births,
improved outcomes in the delivery
room
• Improved early baby and mother
care
• Higher CityMatCH
rates ofConference
long-term
September 2005, "Promising Practice":
breastfeeding"Mothering the Mother... What Does it Mean?"
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Working with Doulas
For the Medical Staff
A mother who has chosen to have a Doula has made an informed
decision to have a closer bond with her child, less medications and less
interventions. That decision is to be supported and respected
The staff should avoid unnecessary interruptions of the mother and
should allow the mother to move during labor
No sugar water, no separation of the child and the mother,
no bottle-feeding (unless medically necessary)
For the Doula
Guides early labor, accompanies mom at the hospital,
helps with positions during labor
Models behavior, facilitates husband’s participation
Does not give medical advice, communicates mother’s
wishes, translates medical terms
Importance of in-depth training with hands-on
experience
CityMatCH Conference September 2005, "Promising Practice":
"Mothering the Mother... What Does it Mean?"
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