Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health

Abstract

Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.

Teenage Childbearing, Reproductive Justice, and Infant Mental Health

“…The model has been described in a variety of sources, including a book (Abramson, Isaacs, & Breedlove, ) and a documentary film (Alpert & Suffredin, ). Randomized controlled trials of the community doula model have shown positive impacts of the intervention on breast‐feeding as well as early mother–infant interaction (Edwards et al., ; Hans, Edwards, & Zhang, ; Hans et al., ).…”

Peer support for disadvantaged parents: a narrative review of strategies used in home visiting health interventions in high-income countries

“…Personal vulnerability was usually in the form of low family income [32][33][34][35][36][37], even though only one of the studies reported recruitment based on an absolute income limit, defined as 200% of federal poverty level [37]. Another type of personal vulnerability was social risk, which included several types of socioeconomic and interpersonal risk factors.…”

“…Recruitment by disadvantaged socioeconomic groups were based on ethnicity [32][33][34][35][40][41][42][43] and age [32][33][34][35]42]. The ethnic minority groups in question were Hispanics [40,41,43], Koreans [40], Native Americans [42] and African Americans [32][33][34][35]. McLeish and Redshaw used HIV diagnosis rather than ethnicity as a basis for recruitment, but the large majority of their participants were immigrant women with a Sub-Saharan African background [44].…”

“…The same supporter also contacted the women within 2 d of discharge from the birth clinic to offer further support. Similar strategies were used in two other studies [35,42] where young pregnant women were referred to the program by other maternal health intervention programs, health clinics, schools and public health departments. One of these studies also reported recruitment through word of mouth in the study area [42].…”

Features and impact of trust-based relationships between community health workers and low-income pregnant women with chronic health conditions: A focus group study

“…Despite the potential benefits of CHW intervention, there is a paucity of research on how CHWs can help pregnant women with chronic conditions have healthier pregnancies, with much of the research in this area focusing exclusively on doula support. Several states have expanded Medicaid coverage for doula services [19][20][21] based on research documenting benefits of continuous labor care for pregnant and postpartum women [22,23]. Although doulas and CHWs both provide support to women during pregnancy, doula services are typically confined to active labor and the immediate postpartum period [24].…”