Abtract - Qualitative Research Summation - Lactation Study UPMC

This study was developed to both measure effiacy of an educational intervention to improve outcomes for lactation intitaion and adherence as well as postpartum perspectives on lactation and newborn feeding plans.

This study proved positive results in identifying clinical oversight in assessing the patient's mental health medical history. This may position Doulas as a tier 1 intervention in working collaboratively with mental health practitioners postnatally in identifying and mitigating postpartum depression. Regarding patient outreach and the potential to extend/expand services, the zip code distribution of respondents receiving CHIP services incites the proposal for geographically-clustered outreach and an environmental survey of existing social barriers for our services.

Although no respondents answered positively for illicit drug use, alcohol or smoking, we find that our positionality in having built an intimate relationship with a potential client may result in divulging information not previously captured.

The BSI identified the need for a holistic examination of the standardization of postnatal discharge processes. Regarding the postnatal self-care processes and treatment plan adherence for high-risk patients, the inclusion of postnatal Doulas is advised as an intervention. This contributes tremendously to the long term viability and sustainability of our existing Doula program and the potential to increase both utilization and clinical presence. This allows DDI to be recommended for permanent inclusion as complementary co-care.

Discussion

Birthing people of color are disproportionately affected by the most common causes of maternal morbidity and mortality7. While Doula support during pregnancy, labor, and birth has been demonstrated to improve outcomes, people of color have less access to Doula services than their white counterparts8. Community-based Doula programs like the Diversifying Doulas Initiative (DDI) through the non-profit Patients R Waiting (PRW) work to increase access to Doula services for people of color. What sets PRW apart is our commitment to five unwavering standards.

1. Intentionality in the Improvement of Black Maternal Outcomes

DDI was the second act of a humble beginning for PRW. As an organic extension of the educational consortium of PRW, DDI reaches beyond clinical practice and integrates a community health education aspect into all public programming, internal training, and institutional professional development at no cost to the participant.

2. Diversifying the Perinatal Workforce: Leadership for Black Patients by Black Clinicians to Black Interventionists Through Re-Embracing the Apprenticeship Model

Many patients have reported the importance of cultural resonances as a decisive factor in their perceived quality of care. Within the education sector, culturally reflective educators statistically generate better performance and retention outcomes9. DDI’s unique apprenticeship Doula program for birthworkers not only is designed to adhere to these models, but also does so in homage to early American Black birthworkers- the cultural and political framework for the contemporary Black American Doula movement.

3. Integration of Doulas Into the Maternity Care Team Historically and culturally, Doula services and midwifery care were apprenticeships and served as both care and economic empowerment models among the women represented within the Diversifying Doulas program. The conscientious decision to employ an apprentice model as an act of reclamation and resistance operates two fold: 1) As broadly marginalized populations, these women were prohibited from both the practice and care of reproductive medicine, and 2) exclusive of their exploitation for experimentation or as a subhuman labor force. The recognition and inclusion of the types of knowledge inherent to these birth workers is not only respected, but germane to specialized types of care most needed by the targeted patient population.

4. Research Integration

As a pilot program, this action research study on the DDI Breastfeeding Support Initiative examined the benefits of and patient perspectives on types of integrated community health education and sociomedical support. This support examines both lactation plan adherence and identifies types of patient-admitted and/or clinically identified depression and anxiety within the perinatal cycle. As DDI lactation support continues to strive towards improving perinatal wellbeing and diversity representation, the strategic utilization of these findings provides an entree for future collaborative social programming.

5. Considerations for Future Study Amendments:

1. Secondary levels of questioning related to additional members of the household for smoking and or illicit drug use/dependency.

2. Situational discharge (i.e. living environments/situations) post -discharge to indicate housing instability/crowding/low quality or unsafe housing (e.g history of lead or poor water quality).

3. Situational questioning regarding inciting factors for stress in patients who answered positively to having preeclampsia or depression.