The Community Doula Program empowers pregnant women from culturally diverse backgrounds by matching them with doulas who assist in a safe and supportive birthing process. The program began as a pilot proposal for InterCommunity Health Network CCO two-and-a-half years ago, with the help of Program Champion Dr. Missy Cheyney, a Medical Anthropologist at Oregon State University and a Certified Professional Midwife with 20 years of experience. The pilot received a grant from IHN-CCO in 2018, launching the Community Doula Program.
“The program is here to help women get a birth that is closer to the birth they want,” said Dr. Cheyney. “Three-percent of women have doulas, and these are often college educated white women.” The program has sought to bring doula services to women who typically would not have access to a doula.
The target population for the CDP is pregnant women in Benton, Linn, and Lincoln counties. These women are identified as priority populations by the Oregon Health Authority and include: racially and ethnically diverse women, homeless or under-homed women, women under the age of 21, women who speak limited to no English, medically high-risk women, and women with little to no family support.
Birth doulas build trusting relationships with pregnant women and provide support throughout the last weeks of pregnancy and during labor and birth. The program uses social and cultural matching to connect doulas with mothers.
“We want our clients to feel connected to their doulas and be able to think, ‘this person could be a part of my family,’” said Dr. Cheyney.
The program relies on referrals from maternity care coordinators or other community partners. “At the beginning of the project, the CDP would get a referral about once a month,” said Dr Cheyney, “but now we get a referral about every day.”
After the referral, the doulas schedule to meet with the women for a home visit at around 30 weeks of pregnancy. A doula completes two home visits before the birth, going over paperwork and determining an ACE (Adverse Childhood Experience) score. The doula can provide transportation to the birth, and is present for the labor and the birth. There are then two post-partum home visits with the women to support them and to help connect them to resources they may need in their community.
There were three main goals set by the CDP proposal: to find and recruit 30 community members either with previous doula experience or those from priority populations who wish to become doulas and be culturally matched to the families served (this includes bilingual Spanish and Arabic doulas); to provide doula care to 200 women during the funding period; and to improve outcomes through the one-on-one support given by doulas.
The program accomplished well beyond its recruitment goal, receiving 81 women for doula training. These women came from different backgrounds with a variety of skills. At present, there are 68 doulas working with the program, trained in trauma-informed care, cultural competency, and helping women through the grieving process if a baby is stillborn.
“These doulas are committed to healthcare in Oregon. Some of them came in with little to nothing, to becoming leaders within the program. This is truly a community-led project,” said Holly Horan. Horan has worked with the CDP since 2018 as the project coordinator and with client referrals. She currently works in program evaluation and qualitative statistics.
According to the Centers for Disease Control and Prevention, the national average for cesarean births in 2017 was 32 percent. The CDP has had a much lower cesarean rate of only 13 percent, and planned cesarean births are included in this number. CDP has also achieved a rate of 100 percent of breastfeeding initiation with new mothers. This is astounding because the program serves demographics that often have high-risk pregnancies.
Cheyney said, “Most women want to try to breastfeed. We try to help them start this process by staying with them in the hospital until they are breastfeeding.”
Doulas are shown to empower the women they work with. “Having a doula in the room gives women the chance at a well-supported vaginal birth,” said Horan. “The doula’s presence in the room gives the respect that every woman deserves throughout the birth process.”
Next Steps, Needs
The CDP is innovative in the fact that it is a patient-centered project which is designed and implemented by former patients. A steering committee comprised of three doulas and four clients from the CDP created surveys for women who have participated in the program. They have also created and implemented protocol.
The IHN-CCO has granted the CDP an extension for their grant. During this time they would like to increase their intake of referrals, especially from Lincoln County, to train more doulas to serve between 200-300 women, so they can provide more data analysis about the program.
The CDP aims to get doulas paid a living wage by impacting policy in Oregon. At present, doulas are being paid by Medicaid at a rate of $50 per visit and $150 per birth. This totals to $350 per client. Doulas save medical costs by letting mothers know what to expect throughout the birthing process and advocating for women during birth. The program would like to see the payment increased, so there can be more full-time doulas in the workforce.
The program has a need for Spanish-speaking workers from all three counties. Bilingual doulas often serve as medical interpreters, as women are more comfortable speaking with their doula than with a translator who is often only available over the phone. These doulas require additional training to become certified medical translators, work for which they should be reimbursed.
On October 18, there will be a Doula Summit at Oregon State University.
“We have invited legislators, healthcare providers, insurance companies, and other doula pilot programs from all over the state,” said Cheyney. “The summit will help promote discussions about the future and commitment to giving women access to birth-doulas throughout the state of Oregon.”
In closing, Horan noted, “The community can help the Community Doula Program by sharing information about the program on social media. Community members can keep their eyes and ears open and ask about services. Eventually letters may need to be written to legislators, but that can wait.”