266190 Challenges of sustaining a community-based doula program: Lessons learned from listening to doulas

Monday, October 29, 2012

Cynthia Salter, MPH , Family Medicine, The Birth Circle Doula Agency, Pittsburgh, PA
Irene Frederick, MD, FACOG , Family Medicine, UPMC, Pittsburgh, PA
Dara Mendez, MPH, PhD , Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
Stacey Atwell-Keister, MFA , Family Medicine, UPMC, Pittsburgh, PA
Abstract: Community-based doulas are emerging as an innovative and effective addition to the maternity care team for mothers with complex needs. Community Doulas, recruited from the communities they serve, provide culturally appropriate pre-natal and childbirth education; active support during labor and delivery; and breastfeeding and parenting support during the post-partum period. They function as community health workers during the birth year and assist mothers in navigating the health care system.

We examine the growth of a community doula program that provides services free-of-charge to underserved mothers in Pittsburgh, including the challenges of securing funding through federal grants, local foundations, and a unique collaboration with a medical assistance Managed Care Organization. We describe the process of recruiting and training paid doulas, assess training requirements for supplementing DONA International doula training, discuss the community doula job structure that has emerged and the infrastructure that has developed to support doulas in this demanding work.

An interactive panel of program staff members, including community doulas, will analyze results from doula focus groups, describing their calling to doula work and their strategies for combating burnout, including the unforeseen high incidence of secondary trauma that doulas experience after some births. The panel will identify lessons learned about communication needs for a program staffed with part-time field workers, describe the logistics of on-call staffing, and the challenges in accurately documenting doula work to maximize service quality, as well as collect data for program management and evaluation; for accounting/billing; and for doula supervision and support.

Learning Areas:
Diversity and culture
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Program planning
Provision of health care to the public

Learning Objectives:
-Identify ways in which doulas assist women to navigate the health care system -Describe challenges faced by community doulas in managing job responsibilities, including on-call requirements for births and identify potential programmatic provisions for support. -Discuss the communication challenges for a program staff by part-time field workers and identify successful strategies for overcoming. -Describe the various uses of paperwork, including client continuity of care; data collection for program management and evaluation; billing, doula support and evaluation. -Discuss the dangers of burn-out for doulas in demanding work with high-needs mothers, as well as the satisfaction that sustains them, and how programs can help.

Keywords: Community Health Promoters, Maternal Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator on a federal grant focusing on the design and implementation of community doula services, and am currently a program director. My interest has been in the development of community-based health programs that employ community members as peer educators or health workers.
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.