Even Super Heroes Need Help!

How Policy Makers,

Home Visitors and Doulas Can Team Up to Support
Healthy Moms and Babies
2018 Maryland MIECHV Conference

Stacey Tuck, MS
Kaitlin Law, MS RN
Baltimore City Maternal and Infant Care
Nurse Family Partnership Program
 Today’s Session Objectives

• Discuss Maternal Mortality and Power dynamics when

dealing with health care system

• Shine hope through discussion policy and ground level

interventions

• Compare and contrast home visiting and doula work

• Highlight the B’more for Healthy Babies home visiting

and doula collaboration

• Share other resources related to doula work

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV Conference)
 Maternal Mortality

• The rate of maternal mortality is now worse in the US than it was 25 years
ago.

– US: 20.7
– Maryland: 23.5

• Of the 4,000,000 American women who give birth each year, about 700 suffer
fatal complications during pregnancy, while giving birth, or during the
postpartum period, and an additional 50,000 are severely injured.

• For Black women, the risk of death from pregnancy-related causes is three to
four times higher than for white women, and Black women are twice as likely
to suffer from life-threatening pregnancy complications.
 Stress, Racism, and Implicit Bias

• High rates of maternal mortality among Black women span income and education
levels, as well as socioeconomic status; moreover, risk factors such as a lack of access to
prenatal care and physical health conditions do not fully explain the racial disparity in
maternal mortality.

• Stress from racism and racial discrimination factors into hypertension and pre-
eclampsia, which are especially high in African American women.

• Pervasive racial bias and unequal treatment against Black women happen within the
health care system resulting in inadequate treatment for pain and dismissal of cultural
norms.
– Myths: Black patients have less-sensitive nerve endings and thicker skin than their
White counterparts.
 The Case for Home Visiting

• Reduces incidences of child abuse and neglect

• Decreases pre-term and low-birthweight births

• Improves school readiness for children and increases high

school graduation rates for mothers participating in the program.

• Cost-benefit analyses shows that high quality home visiting

programs offer returns on investment ranging from $1.75 to
$5.70 for every dollar spent because of reduced costs of child
protection, K-12 special education and grade retention, and
criminal justice expenses.
 The Case for Doulas

• Women who had doulas attending their births were four times less likely to have a low
birth weight (LBW) baby, two times less likely to have birth complications, and initiated
breastfeeding at a higher rate
• Strong association between doula care and healthy birth outcomes among women who
are low income, socially disadvantaged, or who experience cultural barriers to getting
care
• American College of Obstetricians and Gynecologists (ACOG) and the Society for
Maternal Fetal Medicine, endorsed doula work in 2014 as effective, cost containing
intervention

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/
http://onlinelibrary.wiley.com/doi/10.1111/birt.12213/full
 The Role of a Doula-”woman who helps”

Doula: a trained professional who provides continuous

physical, emotional and informational support to a mother
before, during and shortly after childbirth to help her achieve
the healthiest, most satisfying experience possible”
– Physical Support
– Emotional Support
– Partner Support
– Evidence Based Information and Advocacy
 Comparing Home Visiting and Doula Care

Home Visitor Birth Doula Postpartum Doula

Pregnancy Relationship initiated 1-2 prenatal visits Optional 1-prenatal visit to connect / get to
know mom’s goals / priorities / preferences
Monitor health / wellbeing of mother help develop a birth plan

Provide health education / anticipatory

guidance for labor/birth/parenting

Screen for perinatal mood disorders

Labor and Delivery Provide anticipatory guidance Continuous emotional presence No involvement

Possibly review birth plan prior to labor Practical physical support

Assist the support person
Provide emotional support postpartum to Protect the labor “space”
process birth experience Advocate for client to receive or avoid
interventions.
Stay with the mother after delivery of baby
Breastfeeding Support woman to reach her long-term Assist with initial skin to skin / “Golden Provide hands on support with establishing
breastfeeding goal by: Hour” / Breast crawl milk supply and initial latch
-Providing prenatal education / guidance
-Link/refer to lactation services /WIC services Provide trouble shooting guidance in
-Provide hands on support postpartum and immediate postpartum
beyond
- provide trouble shooting guidance May have additional lactation training (either
throughout postpartum formal such as CLC or IBCLC or informal
such as peer – counselor)
Length of 2.5-5 years depending on program Late pregnancy to immediate postpartum “4th Trimester” – 3 months
relationship
Provide Resources YES YES YES
and Referrals
 Comparing Home Visiting and Doula Care
Home Visitor
Example of Service Home visits biweekly
initiated in mid-pregnancy (before 28 weeks)
through child’s 2nd birthday
implementing evidence based curriculum
Availability / On Day time / work week only
Call
Postpartum Continue home visits throughout entire
postpartum period
- screen for perinatal/postpartum mood
disorder
- education / assist with understanding
baby cues
- breastfeeding assistance
- monitor postpartum “danger signs” in
mother
Birth Doula
1 to 2 prenatal appointments
o Get to know each other
o review basic labor / child birth
education
o review client’s birth plan and
priorities
Continuous presence for duration of hospital
labor/delivery
1 follow up visit in hospital or in home w/in
10 days of delivery (emotional support,
process labor/delivery/birth experience,
immediate breastfeeding support)
• 1 to 3 scheduled daytime prenatal and
postpartum visits.
• “On Call” 2 weeks +/- due date
• Present for entire duration of in
hospital labor/delivery
1 postpartum visit to provide closure of
relationship and allow for client to process
birth experience
Postpartum Doula
1 prenatal appointment to connect / get to
know each other
Choose between daytime support vs night
time support.
Daytime support example:
- six 3-hour visits to be scheduled anytime in
the first three months postpartum
Nighttime support example:
- three nights of overnight support over the
first 1-2 weeks postpartum
See above for night / daytime example
schedules.
-Basic newborn care / assistance
-Light Housekeeping assistance
-Assist with newborn care while client
showers, naps, etc
- meal prep
- assist with childcare of older children
- breastfeeding assistance
- assist with understanding baby cues
- screen for postpartum mood disorder
*bold are also role of HV