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The Impact of and Care on the Birth Outcomes of Vulnerable Populations Ami W. Hanna, B.A., C.D., Department of Health Services University of Washington | School of | Maternal & Child Health Program

Definitions: vs. Effects of Doula and Midwifery Care on Socially-Determined Health Impacts3 Healthier Families, Lower Costs Doula and midwifery care are associated with a are trained professionals who provide Doulas reduction in costs due to medical intervention continuous physical, emotional, and during labor and delivery and adverse birth informational support to a birthing person outcomes such as preterm birth and low birth before, during and after a to help weight. them meet their birthing goals. This is a non- 1 clinical role. Based on this relationship, doula and - Midwives are healthcare providers who deliver attended births tend to produce healthier babies and give continuous prenatal, perinatal, families while keeping healthcare costs low. and to birthing people. Midwives also offer “well-woman” gynecological Full insurance reimbursement for these services care. This clinical role emphasizes a low- would result in a net cost reduction for state- intervention, patient-centered style of practice.2 level Medicaid programs.10,11 Effects of Continuous Care on Perinatal Health4,5 Combatting Health Disparities Recommendations Parental Benefits 1. Continued Research • Higher likelihood of spontaneous vaginal birth In the U.S., women of color – particularly Black women – are up to 4x • Causal links between continuous care and • Shorter labor times more likely to lose an or die of -related causes.6 Poor positive birth outcomes should be studied • Smaller chance of Cesarean section women are more vulnerable to health risks and have a greater chance of among more diverse cohorts of study • Reduced use of labor pain medication having a preterm or underweight infant.7 subjects. • Reduction in instrument-aided vaginal birth • Smaller likelihood of a negative birth Doula and midwifery care can mitigate some risks associated with giving experience 2. Policy & Public Awareness birth in low-income populations and populations of color. 8,9 • Lower rate of post-partum mood disorders • Policymakers should lower barriers to doula and midwifery access through Infant Benefits By addressing the need for social support, health literacy, and self- Medicaid reimbursement, cooperation • Higher 5-minute Apgar scores advocacy, doulas and midwives can serve as a “buffer” between clients • with hospital systems, and robust public Higher birthweights and socially-determined forces such as poverty and racial discrimination.3 • More likely to initiate & maintain information campaigns about the benefits • Smaller chance of experiencing complications of continuous birth support. References 1 What is a Doula. DONA International. https://www.dona.org/what-is-a-doula/. Accessed May 19, 2019. 2 What is a Midwife? Midwives Alliance of North America. https://mana.org/about-midwives/what-is-a-midwife. Published January 2, 2010. Accessed May 19, 2019. 3 Kozhimannil KB, Vogelsang CA, Hardeman RR, Prasad S. Disrupting the Pathways of Social Determinants of Health: Doula Support during Pregnancy and Childbirth. J Am Board Fam Med. 2016;29(3):308-317. doi:10.3122/jabfm.2016.03.15030 4 National Partnership for Women & Families. Continuous Support for Women During Childbirth: 2017 Cochrane Review Update Key Takeaways. J Perinat Educ. 2018;27(4):193-197. doi:10.1891/1058-1243.27.4.193 5 Steel A, Frawley J, Adams J, Diezel H. Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review. Health & Social Care in the Community. 2015;23(3):225-241. doi:10.1111/hsc.121126 Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm. Published August 7, 2018. Accessed May 19, 2019. 7 Infant Mortality | Maternal and Infant Health | | CDC. https://www.cdc.gov/rproductivehealth/maternalinfanthealth/infantmortality.htm. Published August 3, 2018. Accessed May 19, 2019. 8 Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016;4:CD004667. This poster project was supported by Grant #T76 MC00011 from doi:10.1002/14651858.CD004667.pub5 9 Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth outcomes. J Perinat Educ. 2013;22(1):49-58. doi:10.1891/1058-1243.22.1.49 10 Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien M. Doula Care, Birth Outcomes, and Costs Among Medicaid the Maternal and Child Health Bureau, Health Resources and Services Administration. Beneficiaries. Am J Public Health. 2013;103(4):e113-e121. doi:10.2105/AJPH.2012.301201 11 Brownell MD, Chartier MJ, Nickel NC, et al. Unconditional Prenatal Income Supplement and Birth Outcomes. . 2016;137(6):e20152992. doi:10.1542/peds.2015-2992