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Haiman MD, Johnson KA, Horan H, Bradley LJ, Albright DL. Addressing Gaps and Saving Lives: Doulas' Role in Addressing Substance Use and Mental Health Challenges Among Pregnant and Postpartum Clients-A Scoping Review. Matern Child Health J 2024; 28:246-252. [PMID: 37948022 DOI: 10.1007/s10995-023-03832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Doulas are a potential resource for addressing substance use and mental health challenges that pregnant and postpartum individuals experience. We sought to review peer-reviewed literature that examines Doulas' role in addressing these challenges to highlight the need for more research in this area. METHODS We conducted a scoping review (2001-2021) to identify articles that examine the way in which Doulas address maternal substance use and mental health challenges in their clients. The articles were reviewed by two members of the research team. RESULTS Nine articles describing Doulas' role in addressing substance use and mental health challenges were identified. Six described Doulas' role in addressing mental health, five of which saw positive mental health outcomes due to Doula involvement. One additional article recommended Doulas be considered in the future to address mental health challenges. While the minority of articles addressed substance use (n = 2), it was reported that Doulas were a positive addition to interdisciplinary teams addressing substance use challenges with pregnant individuals. CONCLUSIONS While the literature showed that Doulas can improve substance use and mental health outcomes among pregnant or postpartum individuals, a significant gap remains in research, practice, and peer-reviewed literature addressing this issue.
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Affiliation(s)
- Madison D Haiman
- Steve Hicks School of Social Work, The University of Texas, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Karen A Johnson
- School of Social Work, The University of Alabama, Box 870314, Tuscaloosa, AL, 35487-0314, USA
| | - Holly Horan
- Heersink School of Medicine, The University of Alabama at Birmingham, 619 19th ST South, Birmingham, AL, 35249, USA
| | - Lilanta Joy Bradley
- Department of Community Medicine and Population Health, The University of Alabama, 1138 NE Medical Building, 211 Peter Bryce Blvd, Tuscaloosa, AL, 35401, USA
| | - David L Albright
- Department of Political Sciences, The University of Alabama, Tuscaloosa, AL, USA.
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Mazel S, Alexander K, Cioffi C, Terplan M. Interventions to Support Engagement in Addiction Care Postpartum: Principles and Pitfalls. Subst Abuse Rehabil 2023; 14:49-59. [PMID: 37424702 PMCID: PMC10327918 DOI: 10.2147/sar.s375652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
There is a fundamental disconnect between the optimal management of addiction in general and care delivery in pregnancy and postpartum. Addiction is a chronic condition requiring some degree of management across the life course. Yet, in the US, reproductive care is episodic and centers more on pregnancy than at other stages of the reproductive life course. Pregnancy is prioritized in access to insurance as almost all pregnant people are Medicaid eligible but access ends at varying points postpartum. This results in a structural mismatch: the episodic management of the chronic condition of addiction only within gestational periods. Though people with substance use disorder (SUD) may access care in pregnancy, treatment attrition is common postpartum. Postpartum is a time of increased vulnerabilities where insurance churn and newborn caretaking responsibilities collide in a context of care withdrawal from the health system and health providers. In part in consequence, return to use, SUD recurrence, overdose, and overdose death are more common postpartum than in pregnancy, and drug deaths have become a leading cause of maternal deaths in the US. This review addresses interventions to support engagement in addiction care postpartum. We begin with a scoping review of model programs and evidence-informed interventions that have been shown to increase continuation of care postpartum. We then explore the realities of contemporary care through a review of clinical and ethical principles, with particular attention to harm reduction. We conclude with suggestions of strategies (clinical, research, and policy) to improve care postpartum and highlight potential pitfalls in the uptake of evidence-based and person-centered services.
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Affiliation(s)
- Shayna Mazel
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - Camille Cioffi
- Center on Parenting and Opioids, Prevention Science Institute, University of Oregon, Eugene, OR, USA
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Turner D, Lindsey A, Shah P, Sayyad A, Mack A, Rice WS, Mosley EA. "Doulas shouldn't be considered visitors, we should be considered a part of [the] team": doula care in Georgia, USA during the COVID-19 pandemic. Sex Reprod Health Matters 2022; 30:2133351. [PMID: 36448944 PMCID: PMC9718548 DOI: 10.1080/26410397.2022.2133351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Doula support improves maternal-child health outcomes. However, during the COVID-19 pandemic, hospitals restricted the number of support people allowed during childbirth. An academic-community research team conducted 17 in-depth interviews and structured surveys with doulas in metro-Atlanta, Georgia, USA from November 2020 to January 2021. Surveys were analysed for descriptive statistics in Stata v. 14, and interviews were analysed in Dedoose using a codebook and memo-ing for thematic analysis. All 17 doulas reported COVID-19 changed their practices: most were unable to accompany clients to delivery (14), started using personal protective equipment (13), used virtual services (12), and had to limit the number of in-person prenatal/postpartum visits (11). Several attended more home births (6) because birthing people were afraid to have their babies in the hospital. Some stopped seeing clients altogether due to safety concerns (2). Many lost clientele who could no longer afford doula services, and some offered pro bono services. Most doulas pointed to restrictive hospital policies that excluded doulas and disallowed virtual support as they felt doulas should be considered a part of the team and clients should not be forced to decide between having their doula or their partner in the room. COVID-19 has severely impacted access to and provision of doula care, mostly due to economic hardship for clients and restrictive hospital policies. At the same time, doulas and their clients have been resourceful - using virtual technology, innovative payment models, and home births.
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Affiliation(s)
- Daria Turner
- Master of Public Health Student, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Alyssa Lindsey
- Master of Public Health Student and Graduate Research Assistant, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Priya Shah
- Master of Public Health Student, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ayeesha Sayyad
- Master of Public Health Student, Georgia State University School of Public Health, Atlanta, GA, USA,Graduate Research Assistant, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Amber Mack
- Research and Policy Analyst, Healthy Mothers, Healthy Babies Coalition of Georgia, Atlanta, GA, USA
| | - Whitney S. Rice
- Assistant Professor, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth A. Mosley
- Affiliate Faculty Member, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA,Assistant Professor, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA.,Correspondence:,
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4
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Hubbard DK, Davis P, Willis T, Raza F, Carter BS, Lantos JD. Trauma-informed care and ethics consultation in the NICU. Semin Perinatol 2022; 46:151527. [PMID: 34895926 DOI: 10.1016/j.semperi.2021.151527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Trauma-informed care responds to our current understanding of the ways in which people's traumatic life experiences influence both their health and their interactions with the health care system. Many ethics consults arise because those past traumatic life experiences are not recognized and addressed. In this paper, we present a NICU case that led to an ethics consultation about end-of-life decisions for a dying baby. We illustrate the ways in which a trauma-informed approach helped doctors, nurses and ethics consultants to better understand and care for the mother and baby.
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Affiliation(s)
- Dena K Hubbard
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City.
| | - Patricia Davis
- Division of Psychosocial Services, Department of Social Work, Child and Family Therapy, Children's Mercy-Kansas City
| | - Tiffany Willis
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City; Division of Developmental and Behavioral Medicine, Department of Pediatrics, Children's Mercy-Kansas City
| | - Fajar Raza
- Pediatric Bioethics Center, Children's Mercy-Kansas City
| | - Brian S Carter
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City; Pediatric Bioethics Center, Children's Mercy-Kansas City
| | - John D Lantos
- Pediatric Bioethics Center, Children's Mercy-Kansas City
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Brown CC, Adams CE, George KE, Moore JE. Mental Health Conditions Increase Severe Maternal Morbidity By 50 Percent And Cost $102 Million Yearly In The United States. Health Aff (Millwood) 2021; 40:1575-1584. [PMID: 34606352 PMCID: PMC8759410 DOI: 10.1377/hlthaff.2021.00759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Perinatal mental health disorders are increasingly acknowledged as contributors to adverse maternal outcomes. We analyzed data from the Healthcare Cost and Utilization Project National Inpatient Sample (2016 and 2017) to estimate hospitalization cost, length-of-stay, and severe maternal morbidity associated with perinatal mental health disorders overall, as well as stratified by payer and by specific mental health category. We found that people with mental health disorders had $458 higher costs per delivery hospitalization and 50 percent higher rates of severe maternal morbidity compared with people without mental health disorders. We estimated increased annual delivery hospitalization costs of $102 million in the US among people with perinatal mental health conditions compared with those without. Furthermore, people diagnosed with trauma- or stress-related mental health disorders had even higher rates of hospitalization costs-$825 higher per delivery-and 87 percent higher rates of severe maternal morbidity compared with people without those diagnoses. These findings provide important information for perinatal mental health program feasibility and cost-effectiveness analyses and suggest the need for increased focus on trauma- and stress-related disorders.
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Affiliation(s)
- Clare C Brown
- Clare C. Brown is an assistant professor in the Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, in Little Rock, Arkansas, and a senior research fellow at the Institute for Medicaid Innovation, in Washington, D.C
| | - Caroline E Adams
- Caroline E. Adams was a health policy and research assistant at the Institute for Medicaid Innovation at the time this work was performed
| | - Karen E George
- Karen E. George is a clinical associate professor of obstetrics and gynecology at George Washington University, in Washington, D.C., and a senior women's health fellow at the Institute for Medicaid Innovation
| | - Jennifer E Moore
- Jennifer E. Moore is the founding executive director of the Institute for Medicaid Innovation and an assistant research professor in the Department of Obstetrics and Gynecology, University of Michigan Medical School, in Ann Arbor, Michigan
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Hall S, White A, Ballas J, Saxton SN, Dempsey A, Saxer K. Education in Trauma-Informed Care in Maternity Settings Can Promote Mental Health During the COVID-19 Pandemic. J Obstet Gynecol Neonatal Nurs 2021; 50:340-351. [PMID: 33493462 PMCID: PMC7836903 DOI: 10.1016/j.jogn.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2021] [Indexed: 12/11/2022] Open
Abstract
Globally, the pandemic has adversely affected many people's mental health, including pregnant women and clinicians who provide maternity care, and threatens to develop into a mental health pandemic. Trauma-informed care is a framework that takes into account the effect that past trauma can have on current behavior and the ability to cope and can help to minimize retraumatization during health care encounters. The purpose of this article is to highlight the pressing need for perinatal clinicians, including nurses, midwives, physicians, doulas, nurse leaders, and nurse administrators, to be educated about the principles of trauma-informed care so that they can support the mental health of pregnant women, themselves, and members of the care team during the pandemic.
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