The Chicago Doula Project

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The Chicago Doula Project

• Susan Altfeld, Ph.D.
• Senior Research Associate
• Ounce of Prevention Fund
• September 2000

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Background

• The Irving Harris Foundation
• Funded early doula research in Guatemala and in
  Texas
• Wanted to fund a project for adolescent mothers
  in Chicago

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Doula

• A woman experienced in childbirth who provides
  continuous physical, emotional, and informational
  support to the mother before, during and just
  after childbirth.
• John H. Kennell, M.D. and Marshall H. Klaus, M.D.

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Previous Doula Research Outcomes

• Continuous doula support during labor is
  associated with
• Fewer c-sections
• Decreased need for pain medication
• Shortened duration of labor
• Greater maternal satisfaction with birth
  experience
• Exclusivity and duration of breastfeeding
• Enhanced quality of mother-infant interaction

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Previous Studies

• First births
• Uncomplicated, singleton, full-term pregnancies
• Hospital-based
• Labor and delivery support only
• Randomized clinical trials

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The Chicago Doula Project

• Chicago Health Connection
• Ounce of Prevention Fund

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Project SitesAlivio Medical CenterChristopher
HouseMarillac Social CenterFunding
PartnersThe Irving Harris FoundationRobert
Wood Johnson FoundationPrince Charitable
TrustsIllinois Department of Human Services,
Office of Family Health
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From Academic Research to Community Practice

• Program Design
• Community-based
• Nestled in a home visiting program for parenting
  teens
• Trained and employed community women as doulas
• Provided home visits and prenatal education and
  support groups during pregnancy
• Supported teens during labor and delivery
• Extended doula involvement from pregnancy until
  12 weeks after birth

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• How This Project Differed From Studies in the
  Literature
• Women were not excluded because of complications
  or preexisting conditions
• Women with previous births were not excluded
• It was not a random assignment
• It extended the doula relationship
• It included intensive doula training
• Doulas were paid, permanent doula positions

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Evaluation Design

• Quantitative
• Qualitative

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Quantitative Data

• Doula notes hospital medical records for each
  birth
• Birth certificate data from State of Illinois
• Questionnaires - depression screening (CES-D)
• Ounce of Prevention Fund Stargate client database
• NCAST feeding protocol for maternal-child
  interaction
• Doula training questionnaires

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Qualitative Data

• Doula group interviews (training)
• Doula group interviews (project recommendations,
  impact)
• Program director interviews (project
  implementation, impact, recommendations)
• Participant focus groups and individual interviews

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Participant DemographicsAgen262 mean16.8
years (s.d.1.4)
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Participant DemographicsEthnicity
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Quantitative Outcomes

• Cesarean sections
• Epidural analgesia
• Breastfeeding
• Mother-infant interaction

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Why Study Cesarean Sections?

• Morbidity and mortality associated with surgical
  birth
• Costs
• c-section12,896
• vaginal birth5,569
• Compare outcomes with previous research

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Project OutcomesCesarean Section Rates
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Why Study Epidural Rates?

• Association with prolonged labor c-section
• Association with infant feeding difficulties
• Cost
• Previous research

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Project OutcomesEpidural Rate
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Why Study Breastfeeding?

• Infant health
• Maternal health
• Psychosocial

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Project OutcomesBreastfeeding
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Project OutcomesBreastfeeding
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Mother-Infant Interaction(n71)

• NCAST feeding scale 26.8 mothers in the
  "clinically worrisome" range
• Extended model dyads scored higher than those
  from shorter model sites
• No statistically significant difference between
  doula sample and NCAST teen database sample

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Qualitative Outcomes

• Program outcomes
• Enhanced program quality, provide more
  comprehensive care to participants
• Doula as "buffer", health care advocate
• Doula as trusted source of information and
  support ("friend", "mother", "sister")
• Relationship-based intervention"

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For more information contactsaltfeld_at_comcast.net