Community-based doula model

I wanted to share this from our luncheon.

Our speaker was Rachel Abramson, Executive Director of HealthConnect One in Chicago. She spoke about the kinds of results they have seen from community doula programs. The Open Arms Outreach Doula program is modeled after the program in Chicago.

Rachel said:

Let me tell you a bit about the community-based doula model, the foundation for Open Arms’ Outreach Doula program. This evidence-based model has been cited by the Center for American Progress as one of five important national evidence-based home visiting models. It began with a four-year pilot serving low-income African-American and Latina pregnant and parenting teens in Chicago from 1996 – 2000. With 254 mothers in the evaluation, we saw:

* 80% breastfeeding initiation rates, including 65% initiation rates at an agency with practically no breastfeeding in their home visiting program before the doula piece was integrated

* 8.1% c-section rates

* 11.3% epidural rates

* Increased pregnancy spacing for young teens

* Significantly enhanced maternal scores on the NCAST scale to rate videotapes of maternal-infant interaction

* Decrease in preterm births

* Cost savings including $750 per person in c-sections and epidurals not performed, approximately $500 per breastfed baby in savings on formula, and broader savings from shorter hospital stays and less illness among breastfeeding babies.

These outcomes have held up over time and with replication in a variety of underserved communities across the country. We have seen consistent high breastfeeding rates, consistently lower c-section and epidural rates, increased use of birth control, increased practice of skin-to-skin contact after birth, and lower preterm and low birth weight babies. There are now 40 community-based doula replication sites in 14 states, 6 of which are funded through the new HRSA Maternal and Child Health Bureau funding stream. We have rolled out this year a robust and user-friendly data collection system designed to continue the process of evaluating these programs and researching the outcomes and processes of community-based doula program.

These outcomes are so important. The birth outcomes that come from having a doula are outstanding - resulting in healthier moms and babies, lower health care costs and shorter hospital stays.

But the one that really caught my eye is the better parent-child interactions. That is the key - the lasting effect that will go on to improve lives for years to come. When a parent increases the quality of interaction with the child, all sorts of brain development happens, attachment happens, and the entire family is strengthened.

Describing Open Arms

I was at the board executive committee meeting today and we were discussing how we describe Open Arms. We do a lot in unique ways - sometimes it's hard to describe.

Many of the terms we use have specific meanings in the nonprofit community. We do home visits, we are community-based, and we provide doulas for the perinatal period (before, during and after birth). It's the combination of these things that provides the magic of what Open Arms is. But each of the terms is limited - and our mission spans all of them.

We do home visits - but most home visitation services don't attend births, so we are unique in that way. We attend births, but we do a lot of our work before and after the birth through our home visits and the scope is broader than what traditional, private-pay doula services provide. And, our community-based work ensures that the services we provide are culturally-relevant and anchor the family in the larger community that will continue support for years to come - something generally not done by either home visitation services or doula work.

And what comes out of this unique combination? We have a wide range of impacts - supported family, fewer interventions during birth, shorter hospital stays, increased breastfeeding, parent education, community support, increased support for early learning, lower postpartum depression, increased bonding....

We hope that the impact of support services at a pivotal time will last for many years. One of the things we discussed today is that our outcomes follow studies done nationally - we know that - for example, our breastfeeding rate is well over 90% and our c-section rate is more than half of the general Seattle population. But we need to apply statistical analysis to our data so that we will be able to say for sure what our outcomes are. We hope to get this kind of analysis underway this year. We also hope to follow our clients over the past 11 years (which can be hard with a mobile population) and find out what the long-term impact really is. We think we know, but we want to quantify it.

We'll keep you updated as this progresses.