Establishing a Community-Based Doula Program

Background Information

Doulas Care was founded in 1999 by Patty Brennan, as a grassroots, community-based, volunteer doula program serving families in Southeastern Michigan. It was the premier charitable program of the non-profit Center for the Childbearing Year (CCY) through 2007. Under Patty’s leadership, the program attracted numerous community partners and experienced rapid growth. In 2004, Doulas Care was awarded the DONA International Founders’ Award for Excellence in a Doula Group. In 2008, the program spun off from CCY as an independent non-profit organization, while CCY evolved into a for-profit business.

Program Concept

Win-Win

Doulas Care was conceived, from the beginning, as a win-win proposition. Women who had recently completed doula training and were eager to get to births were matched with low-income expectant mothers who desired doula support. The new trainees were thereby provided with a ready opportunity to complete professional certification requirements, while moms who might otherwise face birth alone or with inadequate support, were provided with support from a mentor — a trained volunteer doula from their own community. Since many of the volunteers were themselves low income, the opportunity to become a professionally trained and certified doula proved to be a career development strategy and pathway to gainful employment.

The Community Model

The community-based model of care was a fundamental aspect of the program from the outset. The very first program grant ever written succeeded in gaining scholarship funds for low-income women to take doula training. As a payback for training, scholarship recipients agreed to provide free doula services to five women in their community. Bi-lingual doulas were recruited to serve non-English-speaking immigrant families, and a doula proficient in sign language also participated with the program. Our success, over the years, in building a culturally diverse volunteer base and clientele was phenomenal.

Unlike hospital-based programs, the independent, community-based doula program emphasizes the primacy of the doula-client relationship. Program volunteers endeavor to work collaboratively with medical team members, but the doula’s first loyalty is to her client. In hospital-based models, on the other hand, the doula is an employee of the hospital. Potentially, the employer-employee relationship may trump the doula-client bond. Furthermore, if the hospital doula program is established with research funding, then the program is at risk of going down once the research is completed. In this scenario, the research is primary (along with the researcher’s job), while the doulas and the families being served are secondary. Because of these potential pitfalls, a community-based approach was deemed to be more consistent with the ideal role of the doula and more sustainable in the long-run.

As an outreach program, client brochures are distributed widely to service providers, in target communities, through direct mailing and exhibiting at community baby fairs and similar venues. Participating providers who serve as referral sources include midwives, physicians, public health personnel, hospital-based social workers, community clinics, childbirth educators, and so on. Women who could potentially benefit from the emotional, physical, educational, and logistical support of a doula are given a brochure and encouraged to enroll in the program.

Making the Match

Over time, as funding streams were developed, a part-time Volunteer Coordinator was hired to take calls from women seeking services. The Coordinator conducts a brief phone interview to check income eligibility and gather information about the woman’s needs and preferences. The Coordinator then consults the volunteer database and sets about the task of matching the woman with a doula. Once the match is made, the doula contacts the woman directly and begins to establish a relationship. The Coordinator remains available to the doula to help problem solve any issues that may arise in the course of providing services.

Program Services Overview

Birth Doulas provide a minimum of three prenatal visits, attendance at the birth, three postpartum visits, and phone consultations as needed. If the client has special needs, transportation to enable access to prenatal care or childbirth classes might be included in the service package. Referrals are provided to care providers and community agencies for needs beyond the doula’s expertise or scope of practice.

Postpartum Doulas provide a minimum of two two-hour visits per week for a period of two weeks. In many cases, additional hours are provided, with the overall goal of engendering confidence in the mother and gradually weaning her from dependence on doula support. In special circumstances, such as families with multiples, single moms with toddlers who may also be post-cesarean, families with premature or sick babies, or moms suffering from severe postpartum depression, care may be extended up to three months. Sometimes a team of doulas is organized to provide additional hours of care in high-need circumstances.

Volunteer Training

Birth doulas serving with the program are trained by an approved DONA International trainer and curriculum. The 16-hour training fulfills one step in the DONA birth doula certification process. Completion of a basic childbirth education curriculum and reading list are pre-requisites for training.

Postpartum doulas serving with the program are also trained by an approved DONA International trainer and curriculum. The 27-hour training fulfills one step in the DONA postpartum doula certification process. Completion of a basic breastfeeding curriculum and reading list are pre-requisites for training.

In addition, a two-part Volunteer Orientation program was developed. Part I enrolls qualified doulas as volunteers in the program and addresses scope of practice, policies, and procedures. Part II expands the role of the doula as a community outreach worker and provides training on perinatal risk factors and related topics. Issues such as domestic violence awareness, cultural competency, medical risks, substance abuse, and the needs of teen mothers are covered. While these topics are not included in the core DONA curricula, program evaluation results over time demonstrated that many volunteers felt unprepared to meet the unique needs of the population served by the program.

Continuing education programs are offered at regular intervals throughout the year — often using expert speakers in the community — in an effort to address the ongoing training needs of doula volunteers. Topics include breastfeeding support skills, grief counseling, setting boundaries with clients, optimal nutrition for pregnancy, effects of sexual abuse on childbearing, and more. Continuing education contact hours are provided for these sessions as a volunteer benefit and to help certified doulas meet re-certification requirements.

Sustainability

Grants

The community-based volunteer doula program model is likely to be primarily (though it should not be wholly) a grant-funded program. As a public health intervention, it is both innovative and proactive. With its focus on prevention strategies, the model is not a hard sell to the right funder. Numerous foundations on local, state, and national levels, identify priority areas for support that are a natural fit with doula programs (i.e., women’s health, women’s career development, prematurity and infant mortality, mental health, promotion of community volunteerism, family health initiatives, etc.). Learn to write a competitive grant proposal and you will get funded!

Funders for Doulas Care included:

  • Michigan Women’s Foundation
  • W.K. Kellogg Foundation
  • March of Dimes
  • James A. and Faith Knight Foundation
  • Blue Cross/Blue Shield of Michigan
  • Pfizer Corporation
  • Ann Arbor Area Community Foundation
  • Ypsilanti Area Community Foundation
  • Ann Arbor Thrift Shop

Fundraising

First the bad news: fundraising never stops! This is simply a fact of life in the non-profit sector. Few grants will cover overhead costs such as rent or salaries for full-time employees in the organization. Persistent cultivation of community supporters is essential to survival of the program. The need for focused leadership on your team to drive fundraising efforts cannot be over emphasized.

Now the good news: again, you have an easy case to make. Everybody gets it that a new mother coming home with twins is going to need some extra help or she will likely fall prey to severe sleep deprivation, depression, or complications such as hemorrhage or infection. If she is just a few days post surgery and has a toddler to boot, the situation becomes more dire. Throw into the mix the fact that she is the non-English-speaking wife of a foreign graduate student, lacking in family or community support, or an abandoned single mother, and you have hospital social workers frantically scrambling for community support resources. You see what I mean? It does not take a great leap of imagination to make the case for financial support. Doulas DO make a difference! But fundraising can NEVER be put on the back burner.

Revenue-Generating Ideas

A charitable doula program can be underwritten by offering programs that generate a revenue stream such as childbirth preparation and other programs for parents, as demonstrated by the model established by the Center for the Childbearing Year. The Center also offers DONA doula trainings for a fee, in addition to grant-funded scholarships.

The addition of a sliding-scale fee-for-service component to the volunteer program is another revenue-generating idea. Some folks may narrowly miss meeting income-eligibility requirements, but still not be able to pay the full service fee of an independent doula. Rather than turning these folks away, invite them to participate and pay for services!

And whatever else you can dream up!

Replicating the Model

If you and your group are interested in establishing a community-based volunteer doula program, why re-invent the wheel? This award-winning program model can be replicated in your community.

Consultant Services

Inquiries Welcome!

I have had numerous inquiries over the years from folks seeking to establish similar volunteer programs throughout the United States and Canada, and I have tried to be generous with my time in the interest of moms and babies everywhere. However, I am no longer able to answer broad, open-ended questions such as “how did you do it?”. I do welcome your inquiries, and I am prepared to answer a handful of specific questions at no charge. In addition, I am in the process of writing a book and developing a package of materials that will, no doubt, prove helpful for anyone interested in the development of doula programs. Once all materials are available commercially, I will post it here. If you would like to receive personal notification as soon as it becomes available, please email me and I will add you to my list.

First Steps:  Procure Seed Money

If you are in the initial stages of considering establishing a community-based doula program, or perhaps even founding your own non-profit, and you want my advice, I have a recommendation for you. The first step is to identify enthusiastic supporters in your community who will provide Seed Money for your project. One or two major private donors will do, for starters. Your target goal should be a minimum of $10,000–$20,000.

If you feel absolutely daunted by this prospect, and you are not willing to go out now and raise money for this idea, if you are not committed to becoming a fundraiser, if you think you can do this in a vacuum, by yourself, without help, if you’re a dreamer, not a doer — then do yourself a favor and give it up before you start. However, if the vision in your mind and the fire in your belly compel you forward, and you succeed in raising the necessary Seed Money, that will be a promising beginning! Give me a call and I will be delighted to share my expertise with you to take you to the next level.

Existing Programs

If you already have a doula program up and running, please see a list of available services under Grantwriting or Establishing a 501(c)(3) Non-Profit to learn more about ways that I can help.

Patty Brennan is a consultant, professional grant writer, and program development specialist. She can help you sidestep hard lessons learned and launch your program. She can save you time and money. Email patty@center4cby.com or call 734-663-1523.

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