183499 Does the Evidence Support the Effectiveness of Group Prenatal Care and Doula Care for Improving Pregnancy Outcomes?

Tuesday, October 28, 2008: 11:10 AM

Susan C. Vonderheid, PhD, RN , Maternal Child Nursing, University of Illinois at Chicago, Chicago, IL
Rieko Kishi, RN, MW , Maternal Child Nursing, University of Illinois at Chicago, Chicago, IL
Kathleen F. Norr, PhD , Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL
Carrie Klima, CNM, PhD , Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL
BACKGROUND: Innovation is needed to improve the quality of maternity care and to reduce racial/ethnic disparities. This integrated review examined two promising innovations for improving pregnancy outcomes: group visit prenatal care (Group-PNC) and doula care. SAMPLE/METHOD: Studies had to examine at least one target outcome: Group-PNC: birth weight (BW) or prematurity; DoulaCare: length of labor (LOL) or mode of delivery. Online and manual searches located 15 original Group-PNC and 12 doula studies (3 meta-analyses, 9 original randomized trials). Study quality and suitability to examine effectiveness of the intervention were evaluated. Study ratings by two authors achieved high reliability (1.00 for Group-PNC, 0.90 for doula). RESULTS: Group-PNC: Five studies examined BW; two found significantly better outcomes for Group-PNC, two found trends of fewer LBW infants for Group-PNC, and one had few LBW infants but no comparison group. Five studies reported preterm birth rate or gestational age (GA). The only randomized trial and one other study found significantly fewer preterm births for Group-PNC, one study found no difference, one study reported a higher GA but statistical significance was not reported, and one study had a low preterm birth rate but no comparison group. DoulaCare: Seven out of nine studies found doulas were associated with lower cesarean section rates. All five studies that examined LOL found shorter LOL in doula groups, but the difference was significant in only three studies. CONCLUSION: Group-PNC and doula care offer two alternatives to routine maternity care that show potential for improving pregnancy outcomes and reducing racial/ethnic disparities.

Learning Objectives:
1. To identify the characteristic features and outcomes of two innovations for childbearing women: group visit prenatal care and doula care. 2. To evaluate the evidence base for these two innovations given the results and methodological strengths and limitations of published studies. 3.To discuss the implications for health care providers and maternal child health researchers of the evidence base for these two innovations.

Keywords: Access to Health Care, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have 10 years experience conducting research that examines maternal-child services. Specifically, I have conducted research that evaluates the quality of services (content of care and satisfaction), and the organizational factors affecting service delivery in community health centers. As faculty I teach and advise masters and doctoral students on their program of study and research. I have published 11 articles, and presented at numerous conferences-both invited and peer reviewed.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Women's reproductive and perinatal health: interventions and evidence for reducing racial and ethnic disparities
See more of: Maternal and Child Health