Doula Support for Young Mothers: A Randomized Trial
Condition: Parenting; Breastfeeding; Depression, Postpartum
MeSH terms: Depression, Postpartum
Study type: Interventional

Summary: 
      The goal of this study was to evaluate the impact of a doula home visiting intervention on
      young, low-income mothers' birth outcomes, breastfeeding, postpartum depressive symptoms, and
      parenting, and on their children's development.
    

Detailed description: 
      The goal of this study is to evaluate a doula home visiting model -- sometimes called the
      "community doula model." This model differs from typical hospital based doula interventions
      in several ways. Doulas are providers from the same community backgrounds as their clients.
      Services are not just provided during labor and delivery, but throughout the final trimester
      and during the first weeks after delivery. Prenatal and postpartum services are provided in
      the homes of the mothers. The model was developed specifically for working with low-income
      mothers and with young mothers.

      A two-armed randomized controlled trial was conducted at the University of Chicago Hospitals.
      Participants were recruited through two out-patient obstetric clinics affiliated with the
      Hospitals. The clinics primarily served a low-income, African-American population, reflective
      of the families in the communities near to the hospital. The study was open to all young
      women receiving prenatal care at the clinics who met age and eligibility criteria. After
      providing informed consent and completing a baseline interview, participants were randomized
      into two groups. The experimental group, in addition to receiving regular clinical care,
      received weekly home visiting services from a doula and the support of a doula at the
      hospital during labor and delivery. Doulas worked with their clients until three months
      postpartum. The control group received standard clinical care and had access to social work
      case management.

      Four paraprofessional doulas delivered the study intervention. Before providing study
      services, doulas had been trained to provide childbirth education, labor support,
      breastfeeding education, and parent-child interaction support.

      Followup research assessments of the doula and control group mothers and infants were
      conducted during the first three days postpartum, at 4 months postpartum, at 12 months
      postpartum, and at 24 months postpartum. 80% of the sample was retained through the 24 month
      followup assessment. Follow up assessments involved interviews with the mothers, videotaping
      of mother-infant interaction, and behavioral assessment of the infants. Obstetric and newborn
      hospital medical charts were also reviewed.

      The study evaluated outcomes that have been the focus of prior studies of hospital-only doula
      services: use of obstetrical intervention in labor and delivery (anesthesia, surgical
      delivery), mother labor efficacy, breastfeeding, and maternal depression. A major
      contribution of this study is to explore longer term outcomes not evaluated in prior studies
      of doula intervention, particularly parenting and child development outcomes. The study
      evaluated multiple dimensions of parenting including parenting behavior (sensitivity,
      stimulation), parenting efficacy, parenting attitudes, and parenting stress. Child
      development outcomes included cognitive development and early behavior problems.
    

Intervention name(s): Doula
Intervention type(s): Behavioral
Intervention description(s): This intervention included doulas providing weekly home visits during the last trimester of pregnancy and up to three months postpartum. Home visits focused on prenatal health, preparation for childbirth, breastfeeding education, and developing a relationship with the baby. Doulas also were present in the hospital during labor, delivery, and postpartum providing emotional support, non-medical comfort measures, and breastfeeding counseling.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Doulas; Parenting; Breastfeeding; Pregnancy in Adolescence