Community-based Doulas

From direct community-based doula care to Medicaid policy implementation and pilots, there has been a growing awareness and demand for doula services. Explore the field of doula work through policy, practice, and advocacy.

Celebrating and Understanding Community-Based Doulas

Eboni Williams CD (DONA) & Amber Penderegraph-Leak – BirthMatters

TRACKS: Community-based Doulas; Southeast

What is a Community-Based doula? (My definition) A CHW who provides culturally congruent informational support and care to birthing people in their community. The CHW meets each client where they are and saturates them with community resources.

Understanding there is a difference in doula care:

Clarification about various doula services and structures, according to HealthConnect One.

Community-based doula: A CHW with perinatal training who provides services through home visits during pregnancy and postpartum and continuous labor support at the birth site.

Birth doula: A labor support person who is trained in providing continuous physical, emotional, and informational support to a mother and her family during the birth process.

Postpartum doula: A trained support professional who provides information, assistance, and support for baby care and postpartum adjustment.

Administrative and payment models:

Community-Based Doula: Doulas are salaried employees whose services are provided at no cost to the participant. Programs are often paid for by grants or philanthropy.

Private-practice doula: An independent doula who offers doula services to families for a fee that patients pay directly to the doula.

Hospital-based doula: A doula service that is offered as part of a hospital’s labor and delivery unit.

Why Community-Based Doula Week?

Community-Based Doulas do so much and give so much to each client. We go into each relationship not knowing what to expect and we show up authentically, in a non-judgemental light. Not only are we a service to the expectant birthing person, but we are a support system and service to the entire family. We experience these families in many different ways and we are a part of their most sacred space: their birth space. We continue to show up for our clients after birth and help them navigate motherhood and the many changes of their new life. These are just a few examples of the amazing work that CBDs are doing. Each CBD deserves to be celebrated and recognized for all of the selfless work that they do in each of their respective communities.

“Everyone has a day or a week in which they are celebrated or they celebrate others. CBDs deserve a whole week to be honored and celebrated for their unmatched hard work.” -Eboni Williams

How can we celebrate and what is the future of CBDW?

During the first kickoff of CBD week, BirthMatters and Health Connect One came together and created a social media kit to bring awareness and to honor all of the amazing community-based doulas. They also hosted a live chat, a Twitter chat, and a conference which got a lot of positive feedback and solidarity. There was a lot of support and love shown throughout the US. My hope is we can celebrate and honor all of the amazing CBDs worldwide. Also, I hope that we are able to have a bigger celebration for next year’s CBDW.

Learning Objectives:

What is a Community-Based Doula?
What is Community-Based Doula Week?
Why should we celebrate Community-Based Doulas?

Navigating Category 4s during Covid: Lessons learned about infant feeding during emergencies from in Louisiana from Hurricanes Laura & Ida

Tyra Gross, PhD, MPH & Malaika Ludman – Birthmark Doulas

TRACKS: Disaster Preparedness, Data, Research and Storytelling, Community-based Doulas; Southwest

Breastfeeding is the safest infant feeding option during emergencies, according to the World Health Organization (WHO), Centers for Disease Control & Prevention (CDC), and other health authorities. Since the onset of the COVID-19 pandemic, Louisiana has experienced two Category 4 hurricanes. Hurricane Laura struck Southwest Louisiana on August 27, 2020 and Hurricane Ida struck Southeast Louisiana a year later on August 26, 2021. The New Orleans Breastfeeding Center (NOBC) mounted an emergency response to support pregnant and parenting people with children under 2 years affected by these storms as part of their Infant Ready emergency preparedness program. During Hurricane Laura, doulas and other staff did infant feeding assessments at an evacuee resource center. This also included mounting a free 24-hour perinatal emergency hotline in the wake of the storm. Callers were also supported through follow-up texts. For Hurricane Ida, NOBC partnered with Mom2Mom to train them to staff the perinatal hotline while NOBC staff and their families sheltered in place or evacuated to safety. Since Louisiana has some of the lowest breastfeeding rates in the United States, efforts to improve breastfeeding can promote resilience for future emergencies. NOBC received a pilot grant in partnership with Xavier University of Louisiana to research infant and young child feeding during emergencies in a low-breastfeeding population in Louisiana. To date, we have analyzed field notes from almost 100 hotline calls, analyzed 70+ infant feeding assessments from Hurricane Laura, and conducted interviews with families, birth workers and local stakeholders about their experiences navigating these storms. Experiencing a severe natural disaster during a pandemic compounded stress for mothers and their families. Most had to put COVID-19 pandemic concerns on the backburner as they tended to more pressing issues such as lack of food, water, utilities and property damage. Infant feeding assessments revealed a low rate of breastfeeding. Formula was the number one supply requested through the hotline for both disasters. Callers faced breastfeeding challenges such as mastitis, nipple pain and latching issues, plugged ducts, relactation, combination feeding, and weaning. Given the increasing frequency and intensity of natural disasters due to climate change, we are confident our project provides important lessons on IYCFE for communities beyond Louisiana.

Learning Objectives:

Review the current research on infant and young child feeding in emergencies (IYCFE)
Identify family-centered supports needed to respond to populations with low breastfeeding rates in an emergency
Describe Birthmark Doula Collective’s Infant Ready emergency preparedness program

Diversifying Birthwork, Improving Breastfeeding Outcomes

Esther McCant, CD, CLC, HBCE – Metro Mommy Agency

TRACKS: Black Founder’s Corner, Data, Research and Storytelling, Community-based Doulas; Southeast

How to increase breastfeeding rates by diversifying birth work amongst community-based doulas.

PURPOSE: Birth outcomes and breastfeeding outcomes are largely connected and the work of doulas is often left out of the conversation about increasing breastfeeding rates. The limitations of some doulas to provide adequate breastfeeding support stem from a lack of continuing education, professional development, and mentorship to pursue lactation instruction as a means to improve infant health. I would like to highlight how going beyond the typical “serve one-parent/family at a time” model of birth work can benefit the doula and the community when it comes to breastfeeding.

METHOD: Surveys from local birth workers and Metro Mommy Agency (MMA)’s previous clients will be completed to understand the role of the doula to increase breastfeeding outcomes. Questions will center doulas and client understanding of community breastfeeding resources, community involvement, professional development resources utilized to care for families, stories of successes, lessons learned, and awareness of local community initiatives.

RESULTS: Pending case-study of MMA clients and doula survey results. Current data from MMA show that more than 75% breastfeed beyond 6 months with high exclusivity.

CONCLUSION: We can increase breastfeeding rates by diversifying birth work amongst doulas. Integration into the maternal-child-health initiatives in South Florida through networking and diversifying birth work increased the org’s reach and experience in supporting families. Through attendance at community meetings, MMA had been able to stay in step with community initiatives, offering a unique insight to breastfeeding advocates and stakeholders to increase community education. MMA has been able to guide the conversation and create new means of support for mentees, increasing their skills at identifying breastfeeding issues, sharing resources, and outsourcing/referring out when necessary.

Learning Objectives:

Identify 3 ways in which community-based doulas can increase breastfeeding within their community.
State 3 actionable steps that community-based doulas can do to improve breastfeeding in the first 2 weeks of postpartum.
Describe 3 ways that partnership and collaboration advance the goals of increasing breastfeeding in any community.

Healthy Start Supplement: Community-Based Doulas

Rochelle Logan, DrPH, MPH, CHES & Simone Esho, MPH – Health Resources and Services Administration/Maternal and Child Health Bureau

TRACKS: Community-based Doulas; National

The Maternal and Child Health Bureau’s (MCHB) Healthy Start (HS) program works to improve health outcomes before, during, and after pregnancy, and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes (e.g., low birthweight, preterm birth, maternal morbidity and mortality). The HS program provides grants to high-risk communities with infant mortality rates at least 1.5 times the U.S. national average and high rates of other adverse perinatal outcomes. HS grant recipients serve women, their infants and children under 18 months, and their families through various models such as home visiting, Centering Pregnancy, and Centering Parenting. In an effort to provide additional support to HS participants, the Healthy Start Supplement: Community-Based Doulas was launched in 2021. Doula support has been found to improve outcomes for mom and infant including increased spontaneous vaginal birth, shorter duration of labor and decreased instances of Cesarean birth. Doulas serve as advocates for pregnant mothers to ensure that they are listened to, respected and receive the best care possible. Thus far, 32 HS sites have received a one-time supplemental award of $125,000 to recruit, facilitate training and certification, compensate and retain doulas. Doulas will provide services to HS women during the periods of pregnancy, birth and at least three (3) months postpartum. MCHB’s Division of Healthy Start and Perinatal Services solicited a Request for Information to the 25 grant recipients who received the first round of funding, in order to gauge the progress towards implementation. Four major themes that we are learning from HS sites as a result are the use of needs assessments, collaboration, cultural responsiveness and innovation.??

Learning Objectives:

Describe the purpose and design of the Healthy Start Supplement: Community-Based Doula program.
Identify four major themes from the field that healthy start programs are using to successfully implement community-based doula programming.