Session
Innovations in Maternity Health Services: Evaluating Maternal Health Programs, Providers and Place of Birth
APHA 2022 Annual Meeting and Expo
Abstract
Understanding Healthcare Providers’ Experiences with and Perceptions of Doulas
APHA 2022 Annual Meeting and Expo
Background: Despite increasing attention on doula care’s potential to improve birth experiences and decrease maternal health inequities, limited research has examined healthcare providers’ experiences with and perceptions of working with doulas.
Methods: As part of an evaluation of a community doula program in San Francisco, we interviewed physicians (n=11), certified nurse midwives (n=7), and registered nurses (n=10) who work in six hospitals and clinics where doula clients receive pregnancy-related care and give birth. We used reflexive thematic analysis to better understand providers’ experiences with doulas.
Results: A majority of participants described positive experiences working with doulas generally, with many indicating that doulas made their work easier by providing continuous support to clients, which allows participants to focus on clinical tasks and dedicate time to patients lacking support. Participants believed that doulas positively impact patient experience, particularly when they have established relationships with clients prior to childbirth and facilitate patient communication with care teams. Providers’ personal sense of accountability increased, with some participants stating that they provide more detailed explanations to patients when doulas are present. A minority of participants expressed concern about doulas interfering with care; notably, these participants also suggested racism and implicit bias do not impact pregnancy-related care in their units.
Conclusions: In this study, healthcare providers perceived doula support as positively impacting patient experience and provider work experience. Further, doulas shifted power dynamics within the clinical environment by introducing an additional layer of accountability.
Abstract
Evaluating rural maternal health programming by race and insurance status
APHA 2022 Annual Meeting and Expo
Background: Women who reside in rural areas face barriers to healthcare caused by geographic location, cost, and technology access. Racial and ethnic disparities coexist with disparity due to insurance status in rural communities. Implementing and utilizing technological advancements can aid digital equity and counter racial bias.
Methods: Healthy Start Communities that C.A.R.E. (HSCC) in collaboration with Connecting Kids to Coverage – Indiana (CKC-IN) increases access to care for reproductive-aged rural Indiana women. Perinatal navigators (PNs) and community health workers (CHWs) provide case management, access to perinatal care, resources, and education. Insurance navigators (IN) provide free-to-the-client, unbiased aid in digital health insurance applications, which allows for elimination of risk for failed attempts.
A mixed-methods approach was conducted to evaluate access to care to increase health equity. HSCC and CKC-IN primary data was utilized for quantitative and qualitative analysis to determine technology use and increased access to care. The Cochran-Mantel-Haenszel method was used to estimate the association between majority or minority identification and insurance status from initial enrollment to next HSCC service.
Results: HSCC referred 25% uninsured initially enrolled women to CKC-IN. Of those uninsured women, 19.8% were pregnant, 82.8% were Haitian, and 36.3% were Hispanic. 25% identify with a minority population. Of those screened during the next HSCC encounter, 50 women had received health insurance navigation through CKC-IN.
Conclusions: Implementation of PNs, CHWs, and INs have contributed to increased access to perinatal care particularly for women identified in minority populations. Staff utilization of new technology has bridged gaps in health insurance in rural Indiana communities.
Abstract
Doorways to Health: Taking an implementation science approach to improve maternal healthcare access and quality
APHA 2022 Annual Meeting and Expo
Background: Several evidence-based programs (EBPs) have been developed to address the root causes of maternal health disparities, such as inadequate access and/or low-quality care. However, there is currently a lack of information on programmatic elements that should be adjusted when EBPs are implemented in new, diverse settings.
Methods: We engaged in an equity-centered design process from June to November 2021 to develop the “Doorways to Health (D2H) for Mothers of Color program to meet this need. Several implementation science frameworks (e.g., RE-AIM) informed the program design, operations, and evaluation plan. Multi-sector stakeholder interviews also informed our approach, with an emphasis on centering the experience of black mothers/families.
Results: D2H was launched in January 2022 and will run through December 2023 to support four local teams across the nation implementing maternal health EBPs (e.g., Family Connects, Maternal Safety Bundles) to improve perinatal health equity for underserved Black women. D2H aims to close gaps in maternal health outcomes by locally implementing EBPs, centering the voices of black women, and driving local, state, and federal policy change. D2H teams form a collaborative learning community where each team shares effective local implementation strategies, and the group has developed a shared measurement framework to track outcomes across diverse locations.
Conclusions: D2H leverages implementation science frameworks to enhance existing EBPs and improve access and quality of care for Black mothers. Sharing our program design, measurement framework, and preliminary results can inform the work of other communities across the nation working to advance perinatal health equity.
Abstract
Implementation of a multi-hospital doula program for Black and Indigenous obstetric patients
APHA 2022 Annual Meeting and Expo
Background
Pregnant people of color experience higher rates of unplanned cesarean sections, which significantly contribute to obstetric morbidity and mortality, nationally, regionally, and locally. We aimed to develop an accessible doula care program with longer-term goals of reducing inequities in Cesarean delivery rates.
Methods
We surveyed Black and Indigenous pregnant persons to identify barriers to accessing a doula. Data was collected from four sites across a large Boston area multi-hospital system. We then developed a pilot program to address these barriers and partner nulliparous patients with public insurance with doulas.
Results
From survey responses (n=40), we identified lack of knowledge, cost, and local supply of doula services as barriers to accessing doulas. To address these barriers, we designed a lottery program where four nulliparous Black or Indigenous patients with public insurance were selected per month. We developed educational materials for patients and providers, built an internal system to identify eligible patients, and acquired funding to strategically partner with doula agencies. Eligible patients were notified by their primary OB/GYN team and if interested, were enrolled in the lottery. Doulas were partnered with pregnant people through prenatal, peripartum, and postpartum care.
Conclusions
We identified lack of knowledge, cost, and inability to access doula services as barriers to patient access for doula support, which is an evidence-based intervention to reduce the likelihood of cesarean birth. Implementation of an internally-funded pilot doula matching program was feasible, and could provide the basis for broader access to interventions designed to reduce birth disparities.