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Patty’s Blog: “Doula Programs” posts
Infant Mortality Data
Doula program grant writers are always in need of current information and data on infant mortality. Here are two interesting recent articles about infant mortality:
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Healthy Native Babies Project
Doula programs serving Native Americans now have a new tool for SIDS prevention. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has released for distribution the new Healthy Native Babies Project Workbook Packet. The workbook packet includes updated versions of the workbook and toolkit along with “Healthy Action for Native Babies” handout. These materials have all been revised, based on feedback from training sessions held from 2006 through 2009. The workbook is a comprehensive and up-to-date guide for health professionals, social workers, community organizers, and anyone working in Native communities. The easy-to-read, informative text outlines the facts of SIDS, how to reduce the risk, strategies for reaching communities, and action steps. The toolkit disk allows individuals to design culturally appropriate and regionally specific materials, such as posters, flyers, postcards, and brochures. In addition, there are phrases translated into Native languages as well as photographs of Native families taken across the country to assist communities in delivering customized outreach materials.
The workbook packet can be ordered, free of charge, by calling 800-370-2943 or ordering online at http://www.nichd.nih.gov/publications/pubs_details.cfm?from=&pubs_id=5733.
A facilitator’s packet, with training guides, presentations and activities, and an online self-study module will be available in 2012 to provide additional resources to those working in Native communities.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Healthy Start and Infant Mortality Prevention
Doula program visionaries should look into the possibility of partnering with federal Healthy Start programs in order to address issues of common concern. The National Healthy Start Association (NHSA), the membership association for the federal Healthy Start programs, promotes the development of community-based maternal and child health programs, particularly those addressing the issues of infant mortality, low birthweight, and racial disparities in perinatal outcomes. As Healthy Start celebrates 20 years of improving infant mortality rates in the communities served, NHSA has released the following new resources:
- Saving Our Nation’s Babies: The Impact of the Federal Healthy Start Initiative chronicles the birth of Healthy Start and NHSA and contains profiles and photographs for over 80 Healthy Start projects.
- Social Emotional Development of Young Children: Resource Guide for Healthy Start Staff focuses on the influence of early childhood experiences and skills on life-long trajectories of health and productivity. Topics include understanding brain development, social emotional development, the life course, and how Healthy Start staff can help parents promote their children’s social and emotional development. The guide was designed with three unique covers as a way to address diversity within communities.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
U.S. Needs to Do More About Newborn Death, Study Suggests
Grant writers seeking to fund doula programs can make use of data related to infant mortality when making their case. The number of newborns who died in the first four weeks of life declined worldwide from 4.6 million in 1990 to 3.3 million in 2009, according to a recent report by researchers from the World Health Organization (WHO). However, researchers said the U.S. “isn’t making progress like other countries,” with a newborn death rate higher than 40 other countries at 4.3 for every 1,000 live births. The study, covering 20 years and all 193 WHO Member States was led by researchers from WHO, Save the Children, and the London School of Hygiene and Tropical Medicine. The estimates are based on more data than ever analyzed before and extensive consultations with countries. The study shows detailed trends over time and forecasts potential future progress. Read the full report here.
In 20 years, the U.S. reduced its newborn mortality rate 26 percent, slower than the global average. More than 19,000 newborns still die each year. The U.S. now trails 40 other countries when it comes to risk of newborn death. In 1990, the U.S. had the 28th lowest risk. It is now tied for 41st place with Qatar, Croatia, and United Arab Emirates. All have a newborn death rate of 4.3 per 1,000 live births.
“There are areas of the United States where access to prenatal and preventive care is a real problem. It puts the mother at a disadvantage and contributes to premature births and death rate,” says the study’s author Dr. Joy Lawn of the non-government organization Save the Children.
The study says the leading causes of newborn death worldwide are preterm delivery, asphyxia and severe infections. More than a half million babies in the United States, one in every eight, are born premature each year.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Disparity in African-American Infant Deaths
Doula programs that serve high-risk women can be a helpful intervention to address disparities in birth outcomes.
“Any state you look at, you see the same disparities, and race is the strongest predictor of disparities,” says Dr. Deborah Ehrenthal, of Christiana Care Health System in Delaware. “So we see higher rates of infant mortality, higher rates of preterm delivery.” Black women are about 60 percent more likely than white women to deliver babies early and black infants are about 230 percent more likely than white infants to die before their first birthdays. Read the article.
A program that’s showing signs of progress in reducing low birth weight and infant deaths among African-Americans is getting a major vote of confidence. The W. K. Kellogg Foundation has awarded a $4.5 million grant to a program in Grand Rapids called Strong Beginnings.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Breastfeeding Protective Against SIDS
A recent meta-analysis of 288 studies confirms that exclusive breastfeeding helps protect against Sudden Infant Death Syndrome (SIDS). The research was published in the journal Pediatrics. The authors’ concluded that “Breastfeeding is protective against SIDS and this effect is stronger when breastfeeding is exclusive. The recommendation to breastfeed infants should be included with other SIDS risk-reduction messages to both reduce the risk of SIDS and promote breastfeeding for its many other infant and maternal health benefits.”
Doulas and doula programs, with an aim to reducing infant mortality, should be promoting breastfeeding and increasing breastfeeding support for all new mothers. This article can serve as evidence-based justification, when making the case to funders of doula programs, that doulas can play a role in the prevention of SIDS.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: The National Cost of Unintended Pregnancies
More funding angles for those interested in maternal and infant health in the U.S., including doula program managers. Put your ideas, interventions, and educational initiatives into action and make the case!
Reports reveal national cost of unintended pregnancies. Two new studies taking different methodological approaches arrive at the same conclusion: unintended pregnancy costs U.S. taxpayers roughly $11 billion each year. Both estimate that the potential public savings from reducing unintended pregnancy in the U.S. would be huge.
“The Public Costs of Births Resulting from Unintended Pregnancies: National and State-Level Estimates,” by the Guttmacher Institute, relied on data from 2006 to estimate costs for each state, which were then added together to arrive at a national total. The study found that two thirds of births resulting from unintended pregnancies (more than one million births!) are publicly funded, and the proportion tops 80% in a couple of states. The cost of those births, and the potential gross saving from helping women to avert them, is estimated at $11.1 billion.
A breakdown by state, using 2006 data, shows that of Michigan’s 127,500 births that year, 55,500 were publicly funded and 62% of those publicly-funded births resulted from unintended pregnancies. “At a time when policymakers everywhere are looking for ways to cut costs under Medicaid, these findings point clearly to a way to achieve that goal by expanding access to health care, not cutting it,” said author Adam Sonfield. “Investing in publicly-funded family planning to help women avoid unintended pregnancy has a proven track record. In the absence of the services provided at publicly-funded family planning centers, the costs of unintended pregnancy would be 60% higher than they are today.”
“Unintended Pregnancy and Taxpayer Spending,” by the Brookings Institution, estimated the cost of unintended pregnancy by counting 2001 national estimates of the outcomes of publicly-financed unintended pregnancies (births, abortions, miscarriages, and need for infant medical care) and multiplying those counts by the average cost per outcome. The estimates of the cost to taxpayers of providing medical services to women who experience unintended pregnancies and to the infants who are born as a result of such pregnancies range between $9.6 and $12.6 billion per year (average $11.3 billion). The estimates of the public savings that would result if these unintended pregnancies were prevented range from $4.7 billion to $6.2 billion per year (average $5.6 billion).
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Treatment of mothers’ depression benefits children
Doula program managers are always looking for funding angles. It shouldn’t be too hard to make the case for doulas, because there are so many gaps in services and unmet needs. And there is great potential for new moms and their families to benefit from doula care.
For example, a recent article in the Wall Street Journal highlights the importance of treating depression in mothers. The article cites a study in the American Journal of Psychiatry which showed that treating a mother’s depression has long-lasting benefits for her children’s mental health. When a mother’s depression is treated successfully, her children show decreases in problem behaviors and symptoms. More than 400,000 infants are born to depressed mothers each year in the U.S., and children under age one are especially vulnerable to parents’ depression. Approximately one in eight women are likely to develop depression at some point in their lives, with the greatest incidence in the childbearing years. It is estimated that 24% of women become depressed during or after pregnancy. The American Academy of Pediatrics has urged pediatricians to screen all new mothers for signs of postpartum depression.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
We continue with our strategies for limiting liability associated with running a doula program.
- Support the doulas with administrative boundary setting. It is important to establish clear and systematic expectations for both volunteers and clients. Deliver a consistent message to clients regarding available services, limits to services, and the timeframe for services. This can be accomplished through: (a) a descriptive brochure (written at a third-grade level of literacy and also translated into Spanish) that clients receive from their care provider or other referring agency, (b) a verbal explanation during the initial phone enrollment interview with the program coordinator, and (c) a reiteration in writing, sent out in the form of a Welcome Letter and Client Contract (see more below). Doulas should be informed of the steps staff members are taking to set boundaries on their behalf and are mandated to work within the specified parameters as a condition of participation with the program, as noted above.
- Create a doula contract. Doulas are mandated to work within the specified scope of practice and other program-specific parameters as a condition of participation with the program and sign a contract to that effect.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Risk Management Strategies
To wrap up our discussion of risk management strategies for doula programs, the following steps are key to limiting liability:
Design and implement a program evaluation process. Program administrators will need to gather feedback from both the doulas and their clients and closely monitor that feedback. If a pattern emerges with a “problem” doula, it should be promptly reviewed with the doula and resolved. Doulas with repeated negative feedback, demonstrated poor judgment, or reliability
issues will need to be barred from participating with the program.
Identify high-risk incidents as they occur. A clear-cut support system for the doulas must be established, and response to potentially high-risk incidents must be made a priority. Doula program administrators should put a mechanism in place enabling doulas to notify them, as soon as possible, in the following instances:
- Any time there is a poor birth outcome
- Any incident in the home involving personal injury, when the doula is present
- Any incident involving emergency hospitalization of the mother or baby, before or after delivery, if the doula is present or in any way involved
- Any incident involving anger or rage on the part of the client
- Any incident in which the doula is witness to illegal behavior
- Any incident in which the doula feels that her personal safety is at risk
- Any incident in which the client’s response seems unreasonable or out of proportion to the stimulus
- Any incident in which the hospital’s patient advocate is called to intervene
- Anytime the doula feels scared or lost in trying to manage a client scenario
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.