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Herriott AL, Etling S, Hans SL. Community-Based Doulas' Roles Within the Birth Support System: Young Black Mothers' Perspectives. J Midwifery Womens Health 2024; 69:33-40. [PMID: 37766383 DOI: 10.1111/jmwh.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/05/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Doulas have been found to be beneficial to pregnant adolescents during childbirth, but little is known about their role within the larger system of people providing birth support, including family and health care providers. The purpose of this study was to examine, from the perspectives of young mothers, the role of the doula within their broader birth support system. METHODS One hundred pregnant Black adolescents and young women (aged 13 to 21) who were provided perinatal community-based and racially concordant doula services at no cost to them were interviewed after the birth of their newborn, prior to hospital discharge. Interviews generated birth story narratives and responses to focused questions about their experiences of birth support. Thematic analysis was conducted to examine the role of the doula within the context of the broader system of birth support. RESULTS Doulas functioned in 2 primary ways within the birth support system by (1) providing tandem support alongside family and health care providers and (2) filling gaps in health care not provided by family and providers. Laboring adolescents sometimes described their family members and doulas working in tandem to provide multiple types of support such as comfort measures, coaching, and help with pushing. They also identified gaps in their care or support filled by the doula, in particular gaps due to family members' physical or emotional unavailability or health care providers' many responsibilities. DISCUSSION The findings highlight the ways in which doulas support pregnant adolescents during childbirth through their deft navigation of the existing support system. Well-being was enhanced by the inclusion of the doula in the birth support system. The findings align with existing research that underscores the valuable role doulas play in supporting individuals during childbirth, particularly for those most affected by processes of marginalization.
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Affiliation(s)
- Anna L Herriott
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
| | - Sophia Etling
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
| | - Sydney L Hans
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
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Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
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Nguyen A, Arteaga S, Mystic MI, Cuentos A, Armstead M, Arcara J, Jackson AV, Marshall C, Gomez AM. Supporting Birthing People and Supporting Doulas: The Impact of the COVID-19 Pandemic on a Community-Based Doula Organization in San Francisco. Health Equity 2023; 7:356-363. [PMID: 37351531 PMCID: PMC10282965 DOI: 10.1089/heq.2022.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 06/24/2023] Open
Abstract
Background Beginning in March 2020, health care systems in the United States restricted the number of support people who could be present during pregnancy-related care to reduce the spread of COVID-19. We aimed to describe how SisterWeb, a community-based doula organization that employs Black, Pacific Islander, and Latinx doulas in San Francisco, California, adapted to the COVID-19 pandemic. Methods As part of process and outcome evaluations conducted through an academic-community partnership, we interviewed SisterWeb doulas, mentors, and leaders in 2020, 2021, and 2022 (n=26 interviews). We identified preliminary themes using the Rapid Assessment Process and then conducted thematic analysis of data related to COVID-19. Results SisterWeb leadership remained committed to safeguarding doulas by shifting to virtual support until doulas were onboarded as benefitted employees. Doulas reported hospital policies impacted clients' pregnancy-related care. Initially, doulas adapted to virtual support by connecting with clients more frequently through phone and text. When permitted to meet in person, doulas adjusted to client preference. Finally, as the pandemic impacted doulas' well-being, they turned to mentors for emotional support. Discussion and Health Equity Implications This analysis contributes to a growing body of literature describing doulas' experiences during the pandemic. By shifting to virtual support, SisterWeb leaders prioritized the health, safety, and financial stability of doulas, who were members of communities disproportionately impacted by COVID-19. Our findings suggest that public health guidance, organizational COVID-19 precautions, and hospital policies hindered SisterWeb's goal of ensuring clients receive equitable medical care. In addition, we found that emotional support for doulas is vital to their work.
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Affiliation(s)
- Ashley Nguyen
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
| | - Marlee-I Mystic
- SisterWeb San Francisco Community Doula Network, San Francisco, California, USA
| | - Alli Cuentos
- SisterWeb San Francisco Community Doula Network, San Francisco, California, USA
| | - Marna Armstead
- SisterWeb San Francisco Community Doula Network, San Francisco, California, USA
| | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
| | - Andrea V. Jackson
- Department of Obstetrics, Gynecology and Family Planning, Maternal, Child, and Adolescent Health Program, University of California, San Francisco, San Francisco, California, USA
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California, 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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Doulas, Racism, and Whiteness: How Birth Support Workers Process Advocacy towards Women of Color. SOCIETIES 2022. [DOI: 10.3390/soc12010019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systemic racism is embedded in healthcare settings and is linked to high maternal mortality rates for Black women in US Society. Doulas, or birth support workers, are uniquely positioned to advocate for women of color going through the birthing process, but little is understood on how doulas come to terms with race, racism, and whiteness in maternal healthcare settings. Using qualitative in-depth interviews with 11 doulas in northeast Florida, this research study found that doulas’ advocacy for maternal justice leads to an intersection with racial justice through their support of minority women clients. Doulas shared stories of racial injustice when they compared their white and Black client experiences, leading to shifting strategies to address racism in maternal healthcare settings. Doulas also grappled with their connection to whiteness through their own identities and interaction with white and minority clients. Many doulas shared a need for anti-racism training and recruitment of Black doulas to meet the needs of women of color going through the birthing process.
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Oliver K, Raut A, Pierre S, Silvera L, Boulos A, Gale A, Baum A, Chory A, Davis NJ, D'Souza D, Freeman A, Goytia C, Hamilton A, Horowitz C, Islam N, Jeavons J, Knudsen J, Li S, Lupi J, Martin R, Maru S, Nabeel I, Pimenova D, Romanoff A, Rusanov S, Schwalbe NR, Vangeepuram N, Vreeman R, Masci J, Maru D. Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers. BMJ Open 2022; 12:e053641. [PMID: 34992113 PMCID: PMC8739539 DOI: 10.1136/bmjopen-2021-053641] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/28/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination. DESIGN Cross-sectional anonymous survey among front-line, support service and administrative healthcare workers. SETTING Two large integrated healthcare systems (one private and one public) in New York City during the initial roll-out of the COVID-19 vaccine. PARTICIPANTS 1933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers and administrative staff. PRIMARY OUTCOME MEASURES The primary outcome was COVID-19 vaccine receipt during the initial roll-out of the vaccine among healthcare workers. RESULTS Among 1933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among black (58%; OR: 0.14, 95% CI 0.1 to 0.2) compared with white (91%) healthcare workers, and higher among non-Hispanic (84%) compared with Hispanic (69%; OR: 2.37, 95% CI 1.8 to 3.1) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine (p<0.001). In a multivariable analysis, concern about being experimented on (OR: 0.44, 95% CI 0.31 to 0.6), concern about COVID-19 vaccine safety (OR: 0.39, 95% CI 0.28 to 0.55), lack of influenza vaccine receipt (OR: 0.28, 95% CI 0.18 to 0.44), disagreeing that COVID-19 vaccination is important to protect others (OR: 0.37, 95% CI 0.27 to 0.52) and black race (OR: 0.38, 95% CI 0.24 to 0.59) were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members and patients. CONCLUSIONS Our data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers' decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting black and Hispanic workers. Further research is urgently needed to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.
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Affiliation(s)
- Kristin Oliver
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anant Raut
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stanley Pierre
- NYC Health and Hospitals -Queens Hospital Center, Queens, New York, USA
| | | | - Alexander Boulos
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alyssa Gale
- Health Education, Mount Sinai Hospital, New York, New York, USA
| | - Aaron Baum
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashley Chory
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nichola J Davis
- NYC Health + Hospitals/Office of Ambulatory Care and Population Health, New York, New York, USA
| | - David D'Souza
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Freeman
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Crispin Goytia
- Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Hamilton
- NYC Health and Hospitals -Queens Hospital Center, Queens, New York, USA
| | - Carol Horowitz
- Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jessica Jeavons
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Janine Knudsen
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
- NYC Health and Hospitals/Bellevue Hospital Center, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sheng Li
- Department of Epidemiology, City University of New York, New York, New York, USA
| | - Jenna Lupi
- Office of Population Health, New York City Health and Hospitals, New York, New York, USA
| | - Roxanne Martin
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sheela Maru
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Deopartment of Obstetrics and Gynecology, NYC Health + Hospitals/Elmhurst, Queens, New York, USA
| | - Ismail Nabeel
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dina Pimenova
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Anya Romanoff
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonya Rusanov
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nina R Schwalbe
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Nita Vangeepuram
- Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Vreeman
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Masci
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- NYC Health + Hospitals/Elmhurst, Elmhurst, New York, USA
| | - Duncan Maru
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- NYC Health + Hospitals/Elmhurst, Elmhurst, New York, USA
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