The Wisconsin Guild of Midwives Doulas of Color Project
The Wisconsin Doulas of Color Project in conjunction with the Wisconsin Guild of Midwives and the Wisconsin Chapter of the March of Dimes is hosting a free DONA doula (Labor support) training August 19-21, for Women of Color willing to serve in and around Dane County. 15 spots are available, several have already been filled. First come first serve, so reserve your spot today!!
Wisconsin has one of the worst racial disparities in birth outcomes in the nation (WI Council on Children & Families 2013). According to the Wisconsin Department of Health Services, infants born to African American women are 3 to 4 times more likely to die in their first year of life than white infants. Much recent literature argues that racial disparities in birth outcomes are rooted in the physiological impacts of the lifelong stress of racism on African American maternal bodies. (Lu and Halfon 2003; Lu et al 2010; Giscombé and Lobel 2005; Harrell et al 2011). The profound lack of culturally appropriate maternity care providers exacerbates the difficulties that women of color have in establishing trusting relationships with providers and maintaining essential continuity of care. To date, the Milwaukee and Madison communities combined have fewer than 8 doulas of color and only one out-of-hospital midwife of color.
Doula care has been shown to dramatically reduce adverse birth outcomes to socially disadvantaged women who are at increased risk of poor outcomes (Gruber, Cupito & Dobson, 2013). Kozhimannil, Hardeman, Attanasio, Blauer-Peterson, and O’Brien (2013) found that women on Medicaid who received prenatal education and childbirth support from trained doulas were 40.9% less likely to have a cesarean than Medicaid recipients nationally. This same study also showed that the preterm birth rate decreased from 7.3% to 6.1% when mothers had doula support. A study by Breedlove (2005) found that disadvantaged African American teens reported high rates of satisfaction, empowerment, stress relief, and parenting competence. She found that community-based doulas’ sensitivity to culture, assistance in navigating socio-demographic barriers, and emphasis on goals made a significant and lasting difference for the young mothers.
The Full Circle Doula Training was a collaborative project between the Wisconsin Guild of Midwives (WGOM) and the International Center for Traditional Childbearing, Inc. (ICTC) a Portland Oregon-based organization of African and African-American midwives, dedicated to training midwives and doulas of color and ending racial disparities in maternal and infant health. The training was funded in large part through a community grant through the March of Dimes, and held at Venice William’s Body and Soul Healing Arts Center in Milwaukee, November 6-9, 2014, with 23 participants in attendance. The Wisconsin Guild of Midwives gave full (N=17) and partial (N=1) scholarships to 18 women of color from Madison and Milwaukee and is in the process of fostering their organization into sustainable collectives. The project is designed to build mother mentorship networks and to increase access to culturally appropriate birth services in order to reduce adverse birth outcomes in the African American communities in our state.
This training and the empowerment of women exposed to this model of care introduces families to alternatives in childbirth and parenting, teaches self and community advocacy to reduce unnecessary interventions in birth, promotes earlier entry into services including midwifery care, builds provider-client trust, and profoundly impacts the life course of these women and their children. WGOM also intends to use this training to establish a culturally-accessible, low-cost route of entry to a midwifery model of birth work, laying the groundwork for women of color to consider midwifery as a profession and to be fully supported in that choice.
The Wisconsin Guild of Midwives (WGOM) is a 501C6 volunteer organization, founded in 1975, representing Licensed Midwives and Certified Nurse Midwives who practice in the out-of-hospital setting. The Guild has a commitment to partnering with allied organizations to engage in birth-related social justice efforts, especially in communities with clear health outcome disparities.
We are now in Phase 4 of the program, which follows the training with continued program support, formation of doula collectives and ongoing publicity and outreach in the MCH community. This phase also includes WGOM outreach to, and recruitment of, participants for additional midwifery training.
Short term project outcomes include the establishment of 2 urban doula collectives comprised of a total of 15 women of color and grounded in the midwifery model of care and strengthened collaborative relationships between WGOM and several women of color-led breastfeeding and health access advocacy groups and other MCH organizations through partnership and co-sponsorship of this project.
Long term project outcomes include sustained access to culturally appropriate doula care for communities of color in our urban core, increased visibility and public access to racially concordant midwifery care in communities of color as some women pursue further midwifery training, reduced cesarean rates, reduced preterm birth and LBW rates, increased breast feeding rates, and a decreased incidence of maternal and infant mortality in African American communities in our state. These outcomes are measurable and founded on prior research into the efficacy of doula care in reducing adverse outcomes in at-risk populations, as described above.
Evaluation and data collection will take place for 2 years, concluding with a program impact evaluation conducted by WGOM. Program monitoring will also be achieved through ongoing, bimonthly contact with doulas and through formal follow-up evaluations with participants at six months, 1 year, and 2 years, post-training. WGOM will report the following after the 2-year mark: number of doulas in active practice; number of clients served; maternal/infant birth outcomes; and number of trainees pursuing further birth-related education. Qualitative measurements will also be included in this report.
In addition to the two organizations who partnered to host this training, and the Wisconsin Chapter of the March of Dimes who made the program possible through a community grant, we have received statements and letters of support from the following individuals and organizations as well as further funding: Hershey Barnett-Bridges, RN, BSN, IBCLC, RLC, President of the African American Breastfeeding Alliance of Dane County; Dalvery Blackwell, BA, IBCLC, Program Director of the African American Breastfeeding Network of Milwaukee; Daniel Stattleman-Scanlan, RN Director of the Dane County Fetal Infant Mortality Review and Supervisor at Public Health Madison & Dane County; The Breast Feeding Coalition of South Central WI; Deanna Tharpe, African American doula and women’s health advocate for the March of Dimes, Milwaukee; Erin Tenney, Co-director Zaagichigaazowin TMIECHV Home Visiting Program at Red Cliff Community Health Center; Alice’s Garden and the Body and Soul Healing Center; All Black Everything, Wisconsin; Monique Liston, Director, University of Wisconsin, Milwaukee Women’s Resource Center; Susan R. Davidson, MD, MS, FACOG at Dean Medical Center Maternal Fetal Medicine and C. Danae Steele, MD, FACOG at Fox Valley Perinatology. All endorse this project, and several have made donations toward project implementation. We intend to use these relationships to support recruitment, to sustain participants as they form doula collectives, and to foster participant success in business as well as in pursuit of additional midwifery education if desired.
Visibility for this effort and for our funders will be provided through website recognition, local, state, and national media coverage, community partnerships and online networking and through the broad dissemination of the program data and findings to community partners and maternal child health interest groups and the media.
For more information or to get involved, please contact:
- Altfield S. (2003). The Chicago Doula Project Evaluation Final Report. Chicago, Ounce of Prevention Fund.
- Breedlove G. (2005). Perceptions of social support from pregnant and parenting teens using community-based doulas. J Perinat Educ 14(3):15–22.
- Giscombé C., and Lobel M. (2005). Explaining Disproportionately High Rates of Adverse Birth Outcomes Among African Americans: The Impact of Stress, Racism, and Related Factors in Pregnancy. Psychological Bulletin 131(5): 662-683.
- Gruber K., Cupito S., Dobson C. (2013). Impact of doulas on healthy birth outcomes. The Journal of Perinatal Education 22(1), 49-58.
- Harrell, CJ., Burford T.I., Cage B. N., Nelson, T. M., Shearon S., Thompson A., Green S. (2011). Multiple Pathways Linking Racism to Health Outcomes. Du Bois Review. 8:1,143-157.
- International Center for Traditional Childbearing. http://ictcmidwives.org/. Website. Accessed March 17, 2014.
- Kozhimannil K, Attanasio L, Hardeman R, O’Brien M. (2013). Doula Care Supports Near-Universal Breastfeeding Initiation among Diverse, Low-Income Women. J Midwifery Womens Health 58:378–382.
- Kozhimannil K, Hardeman R, Attanasio L, Blauer-Petersen C. Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries.(2013). Am J Public Health 103(4):e113-e121.
- Lu M., and Halfon N. (2003). Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal and Child Health Journal 7(1):13–30.
- Lu M., Kotelchuck M., Hogan V., Jones L., Wright K., Halfon N. (2010). Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach. Ethnicity and Disease 20:10 Suppl 2: s2-62–s2-76.
- Wisconsin Council on Children & Families. (2013). Race to Equity: A Baseline Report on the State of Racial Disparities in Dane County. Madison, WI.
The Guild is working with policy makers to establish a billing category thus providing a means for Licensed Midwives to become providers for women and families covered by Medicaid and Badger Care. The response has been very positive and this initiative has considerable support.
Wisconsin Critical Congenital Heart Disease Screening Demonstration Program:
Representatives from the Wisconsin Guild of Midwives are collaborating with the University of Wisconsin Medical Center and the State of Wisconsin Department of Health Services (DHS) to implement and study pulse oximetry screening for critical congenital heart defects in all settings, including the out-of-hospital (OOH) birth setting.
Death or re-hospitalization of infants due to a missed diagnosis of critical congenital heart disease (CCHD) occurs in approximately1:25,000 Wisconsin births. Pulse Oximetry (POX) screening can detect CCHD prior to the onset of symptoms and is currently performed in more than one third of babies born in Wisconsin. However, POX screening is not performed uniformly and its results are not linked to the Wisconsin Birth Defects Registry (WBDR) or systematically evaluated.
In this project we have provided caregivers in Wisconsin the necessary education, administrative assistance, and technical support needed to implement universal POX screening in all birth settings. Included in the study is an OOH screening protocol and data collection mechanism for all newborns born in the OOH setting. Given that midwives in this state care for many plain clothed families who potentially have an increased risk of having an infant with a congenital heart defect, as well as caring for families who do not elect routine ultrasound screening in pregnancy, inclusion in the study may detect infants with CCHD that may otherwise go undetected.
Licensed Midwives and Certified Nurse Midwives practicing in the OOH setting began receiving hand-held pulse oximeters to extend POX screening to home birth and birth center settings in January 2013. This is the only CCHD POX screening study nationwide that includes Licensed Midwives practicing in the home or birth center setting. If you have any questions, please feel free to email Marijke van Roojen, LM, CPM at firstname.lastname@example.org or visit the SHINE project website at http://www.wisconsinshine.org/home-births/