Supporting Women with a History of SUD/OUD through Pregnancy and Beyond using Doula Support

Full Description: Authors: Arielle Narva, Amirah Grasty, My-Phuong Huynh, Nick Claxton, Stacey Kallem
Background & Need: In Philadelphia, rates of maternal opioid use/dependence and neonatal abstinence syndrome (NAS) quadrupled from 2002 to 2016. The elevated rates for both have persisted, along with a significant rise in opioid related deaths. This is a public health priority because infants exposed to substances in utero are more likely to be born preterm and of low birth weight compared to all other live births. Doulas are non-medical professionals who provide continuous emotional and educational support throughout perinatal period. The Doula Support Program (DSP) developed by the Philadelphia Department of Public Health Division of Maternal, Child & Family Health (MCFH) was designed to address the crises of SUD/OUD and NAS. Pregnant people with SUD/OUD have historically been mistreated and stigmatized, but incorporating doulas as part of a continuum of providing health care for this population can mitigate stigma and promotes better outcomes for mothers with SUD/OUD and their babies. Trauma-informed programs like the DSP with prolonged, comprehensive postpartum support are crucial for engaging these parents and families.
Program

Description: MCFH created the DSP in July 2019 to serve pregnant and postpartum women with substance use disorder (SUD), including opioid use disorder (OUD). Support is provided throughout the perinatal period and up to one year postpartum. The doula’s role includes prenatal and continuous support throughout labor and delivery, referrals to resources and help navigating medical and social service systems. Doulas build and sustain an emotional connection of trust and nonjudgement with the participant, which has proved critical for participants in meeting their parenting and recovery goals.
Accomplishments: The DSP had a successful launch during the COVID-19 pandemic despite several challenges, including restrictions at birthing facilities and revising its program model to include virtual support. As of November 2021, 33 individuals received doula services. Most program participants identified as non-Hispanic/Latinx (79%), Black/African American (61%), between ages 20-34 (72%), and insured by Medicaid (94%). Nineteen of the 33 participants had a doula attend their birth. Participants had an average of 6 prenatal visits and 9 postpartum visits. In an anonymous online satisfaction survey, one respondent said “My doula has helped me out the most during a tough time in my life. She's been very supportive.”
Lessons Learned: The DSP is an innovative approach to supporting a very stigmatized and marginalized population. Doulas play a critical role as a bridge between pregnant/postpartum women and the multitude of social service systems, medical and SUD care plans and providers they must navigate, and the DSP has gained critical perspective of the unique challenges this population faces, and how to support them effectively.

Abbreviated Description: In Philadelphia, rates of maternal opioid use/dependence and neonatal abstinence syndrome (NAS) quadrupled from 2002 to 2016. The elevated rates for both have persisted, along with a rise in opioid related deaths. Infants exposed to substances in utero are more likely to be born preterm/low birth weight compared to all other live births. The Doula Support Program (DSP) developed by the Philadelphia Department of Public Health, Division of Maternal, Child & Family Health (MCFH) was designed to address the crises of SUD/OUD and NAS. Pregnant women with SUD/OUD have historically been stigmatized. Incorporating doulas as part of a continuum of care for this population can mitigate stigma and promote better outcomes for these mothers and their babies.