3/4/2021

African American Infant & Maternal Mortality (AAIMM) Prevention Initiative Doula Program

MARCH 5,2021

Objectives

Share the work of the African American Infant and Maternal Mortality Prevention Initiative (AAIMM)

Provide overview of the AAIMM Doula Program

Discuss stress and PMADs specifically relating to foster youth

Collaborate to create a Village of Care for Black pregnant foster youth

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 1 3/4/2021

AAIMM Prevention Initiative

Aspirational Goal: to eliminate racism and reduce the effects of racism on Black women’s bodies.

Initiative Goal: to reduce the Black-White infant mortality gap in LA County by 30% over 5 years (2018-2023). • Reduce the maternal mortality gap in LA County (metrics TBA)

We are a Collaborative of Collaboratives

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 2 3/4/2021

What Is a Doula?

Doulas are professional childbirth companions. We provide physical and emotional support, education, and advocacy during pregnancy, labor and birth, and the postpartum period.

Why doulas?

Evidence shows that continuous support Access to continuous labor support from can decrease maternal deaths, preterm a doula is especially vital for birthing birth, risk of cesarean, use of people of color. Black women experience medications for pain relief and labor higher rates of death, poor birth augmentation, and length of labor. Doula outcomes, including higher rates of support can increase chance of a cesarean, preterm birth, low birth spontaneous vaginal birth, breastfeeding weight, preterm loss and infant death initiation/duration, and maternal (Thomas et al., 2017). satisfaction with birth experience.

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 3 3/4/2021

AAIMM DPH Doula Program

Experienced Doulas reside Virtual support as Black/African all over the needed due to American doulas county COVID-19

3 prenatal visits

Available to clients throughout pregnancy

Labor & birth support

3 postpartum visits

Foster Youth & Pregnancy Youth in foster care typically have an accumulation of factors that increase the risk of teenage pregnancy. By definition, almost all youth in foster care have experienced maltreatment and all have experienced some form of family disruption. In addition, youth of color, as well as those of very low socioeconomic status, are overrepresented in foster care. (Child Welfare Information Gateway, 2016)

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 4 3/4/2021

Youth in CA Foster Care Have Disproportionately High Pregnancy Rates

% females who report having been pregnant 60

50

40

30

Percentage 20

10

0 Age 17 Age 19 Age 21 Axis Title

General Youth Population (National) Foster Youth (CA)

DATA SOURCE: COURTNEY ET AL., FINDINGS FROM THE CALIFORNIA YOUTH TRANSITIONS TO ADULTHOOD STUDY. CONDITIONS AT AGE 17 ( 2014 REPORT) CONDITIONS AT AGE 19 (2016 REPORT) CONDITIONS AT AGE 21 (2018 REPORT)

Perinatal Mood and Anxiety Disorders (PMADs) Perinatal mood and anxiety disorders is an umbrella term that encompasses maternal mental illness during pregnancy and up to one year postpartum.

PMADs are common and treatable. They affect 1 out of 5-7 women.

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 5 3/4/2021

Perinatal Mood & Anxiety Disorders (PMADs) & Adolescent Foster Mothers OVERVIEW RISK FACTORS – RATES Not only depression Teens Not only postpartum Trauma Hx Adolescent mothers are more likely to be impoverished, in families or situations that Trauma survivors (Postpartum PTSD) are socially and economically disadvantaged. Social isolation ◦ Adversely affect maternal mental health, parenting, and behavior outcomes for their Poor | inadequate social support children Discord w/ partner Infant feeding - more likely to give infants water, cereal, juice; experience feeding difficulties; report being “unsatisfied” w/ breastfeeding

Considerations

BARRIERS THAT PREVENT ADOLESCENT INTERVENTIONS FOR THIS VULNERABLE MOTHERS FROM SEEKING SUPPORT POPULATION A lack of awareness of what depression/anxiety Providers should attempt and foster attachment feels like and how to seek help behaviors in the context of well child care & anticipatory guidance Lack of access (affordability, appropriate tx, availability) Positive and supportive relationships between the teen mom and FOB = protective factor for teen Resentment towards caregivers for lack parental mom & children. autonomy Mental health integration using models for Negative attitudes and misconceptions about collaborative care (e.g. Doulas) increase depression adolescent health outcomes. Higher risk for community and interpersonal violence exposure

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 6 3/4/2021

Thinking Styles: Perfectionistic tendencies Going Deeper: Rigidity Perinatal Anxiety Disorders Belief thoughts will truly create reality Lack of confidence in ability to solve problems

What does that look like? Constant worry/racing thoughts Overwhelmed/tearfulness/tension , Sleep disturbance Panic attacks 8-15% Difficulty leaving the house, controlling parenting style, ruminating thoughts on baby’s well being Poor coping skills

Low birth weight/lower APGAR scores/smaller size Miscarriage Pre-term delivery/other obstetric complications Why Does Heightened startle response Relationship w/ partner this Anxiety - decreased blood flow to placenta PTSD - avoidance of aftercare; impaired mother-infant bonding Breastfeeding - making up for “awful” arrival: atonement to Matter? baby; “one more” thing to be violated (mother’s breasts); birth trauma & insufficient milk supply Why Does Elevated risk of substance abuse Repeating cycles for foster youth – PMADs associated with this Matter insecure attachment in young children

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 7 3/4/2021

•Stress plays a major role in adverse birth outcomes among Black women and youth • Stress reflecting a lifetime of exposure to racism. • Stress growing out of instability and interactions with the court and How do health care systems. • Social isolation and inadequate support increase stress. •Doula care is a proven strategy to reduce stress, improve outcomes you fit for Black women and youth • Having doula support throughout pregnancy, birth, and the postpartum period can help reduce isolation commonly experienced by foster youth. • Doulas provide education to help birthing people make informed choices regarding their rights and the care they deserve. into the • Doula support has helped to increase breastfeeding initiation and duration rates among Black moms and babies. •We are working hard to make doula care a norm, a standard in care Village? for Black women •You can take the lead: • Support the overall AAIMM Initiative • Advocate for culturally congruent perinatal support for foster youth • Help connect your clients to doula support and other resources

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 8 3/4/2021

Client eligibility

 Clients must self-identify as Black/African American and be pregnant.

We accept clients countywide:  Medi-Cal eligible clients are priority, but clients with other insurance are accepted.

There is no gestational age requirement.

 Incentives provided to participating clients

Doula, agency, clinic, hospital, organization, and self referrals accepted

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 9 3/4/2021

MEET THE AAIMM DOULAS

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 10 3/4/2021

AAIMM Doula Program Contacts

Michelle L. Sanders, Doula, CLEC Nakeisha Perkins-Robinson, MA, LMFT [email protected] [email protected]

Ariana White, MSW, CLES Helen O’Connor, MSPH, MA, LES [email protected] [email protected]

www.blackinfantsandfamilies.org Instagram: blackinfantsandfamiliesla

Media Coverage

https://www.foxsoul.tv/clip/15116608/the-tammi-mac-late-show-maternal-mortality https://kjlhradio.com/the-kjlh-womens-health-expo/what-every-black-woman-should-know-to-have-a- healthy-and-joyous-birth/ https://www.nbclosangeles.com/news/local/los-angeles-doulas-free-county-black-women/2378319/ https://laist.com/2020/05/28/coronavirus-pregnancy-support-doulas-hospitals.php

Data Source: Courtney et al., Findings from the California Youth Transitions to Adulthood Study. Conditions at Age 17 ( 2014 report) Conditions at Age 19 (2016 Report) 11