Evaluating the impact of a community-based doula program on childbirth outcomes among low-income women

Background. Doulas offer an innovative option to address complex health problems during the childbearing year. Building on the value of home visiting programs and community outreach worker models a community based doula program provides trained volunteer doulas who offer social, emotional and educational support to low income childbearing women and their families. The community-based doula model has been described as an extended intervention that begins in early pregnancy “develops a trusting relationship over time, intensifies support around the birth itself, and extends into the postpartum period.” Methods. To evaluate the outcomes of a community based volunteer doula program, Doulas Care, two evaluation forms were developed. One form is used by the doulas to capture client birth information and the other is an evaluation form completed by the client. Data was entered into SPSS and descriptive statistics were performed. Comparisons to local and state maternity care outcomes were made. Results. There were 470 paired surveys in the data set. Care practices during prenatal visits, labor and post partum are identified, including average use of 4.6 different comfort measures during labor, lower epidural use at 46%, lower use of continuous electronic fetal monitoring (70%), lower preterm birth rate 4.7% and lower cesarean birth rate at 23.2% compared to state or county rates. Conclusions. Strengths and weaknesses of this community-based volunteer doula program model are identified along with the associated health outcomes. This model can be replicated in other communities to reach at risk childbearing women to promote improved health outcomes.