Doulas Supporting Teens
by Jessica Atkins

[Editor's note: This article first appeared in Midwifery Today Issue 92, Winter 2009/2010.]

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[Photo by Shea Hardy]

Destiny was scared and pregnant at 15 years old. She was not attending school regularly and lacked stable housing; Destiny’s future was uncertain. She started attending prenatal classes and met with a doula early on. She showed up to class every week and had a true interest in learning about her developing baby and changing body. Destiny’s belief and confidence in her ability as a birthing woman and as a mother began to flourish over time. It became clear that she would not only birth her son, but herself as a mother and woman. After giving birth, Destiny is no longer a scared 15-year-old with an uncertain future; she is a woman—confident, empowered and extremely dedicated to her baby boy. She attends high school, lives in an apartment of her own and is scheduled to graduate next year. Destiny’s success story is one shared by over 200 vulnerable teen parents served by an Oregon doula program since 2003.

According to Oregon’s Lane County Public Health, at 9.5 deaths per 1,000 births (compared to the national rate of 6.9), infant mortality is a serious issue that needs addressing.(1) Promising agencies, such as the Lane County Birth and Wellness Collective, are making headway in addressing this issue and many other issues that teen parents face, through prenatal and parenting education programs and doula support. Founded in 2003, Doulas Supporting Teens (DST)—a program of the Collective—was created to address the needs of pregnant and parenting teens in the Lane County area, with a focus on education and support throughout the first year of parenting.

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[Photo by Shea Hardy]

The concept of a doula is not new. A woman caring for other women during childbirth is an ageless tradition common to many cultures. DST brings this traditional support system for birthing women to teen parents. A doula serves as a source of evidence-based information; she assists parents in gathering information and learning about healthy options. Another important role of the doula is providing continuous emotional support, physical comfort measures and trust in the woman’s ability to birth her baby. Research proves that continuous support in labor improves birth outcomes and positive perceptions of the birth experience and has long-lasting positive health benefits for mothers and babies.(2)

Myths are rampant when it comes to teen pregnancy and only serve to promote isolation from support and education. The truth is that many teen parents do not set out to become pregnant, their motivation is not to live on welfare and they truly do care about their children. Birth can be a transformative experience for a teenager. Through DST, parents are both educated and nurtured and as a result, many achieve healthy lifestyle changes and personal goals.

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[Photo by Iris Bicksler]

DST is operated by two Oregon women with a passion for helping pregnant teens grow and develop into outstanding parents. Directors Iris Bicksler and Shea Hardy recognize a need and have a vision. Iris’s passion for serving teen mothers came at age 19, after attending the birth of her teenaged friend and witnessing judgments and poor treatment that left a lasting impression. “Birth is inspiring; it should be something special,” she says. That experience inspired her to help women achieve what they want in their own birth experiences. “I want to show women what their options are; then support them 100% in their choices.”

Shea always dreamed of being involved in service to women, yet a women’s services program that focused on birth had never crossed her mind until she met a doula. After completing doula training and volunteering with teens at a local high school, she experienced firsthand what doula support can do for teen parents. “People were excited about support for teen parents,” Shea stated. “We needed to recruit more volunteer doulas.”

Soon after, DST was created with the explicit purpose to support and educate young parents through respectful age- and situation-appropriate methods and the knowledge that a positive birth experience can be beneficially transformative for parents with long-lasting implications for their children. Goals of the organization include increasing knowledge of pregnancy physiology and nutrition; promoting the health benefits of breastfeeding; encouraging high school completion and further education; working toward higher cessation rates of smoking and lower rates of alcohol and illicit drug use; and connecting to community resources that lead to increased access to health care, as well as demonstrating a decreased rate of pregnancy-related illness and infant mortality and morbidity.

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[Photo by Iris Bicksler]

The program is currently meeting or exceeding these goals. With a cesarean section rate of 12.9%, which is about 60% lower than the national average, low birth weight at 4.8%, compared to the Oregon average of 6.1%(3) and a breastfeeding initiation rate of 99%, DST is affecting health in many beneficial ways for Oregon’s teen parents, as well as saving money for taxpayers and insurance companies (the majority of DST’s clients are on the state-funded Oregon Health Plan). Reducing costly interventions is one way that DST is saving money; promoting long-term health benefits, such as breastfeeding and achieving personal success goals, is another. The directors are optimistic about the futures of their participants. Many have graduated from high school and gone on to college. Several have become doulas and give back to DST in that capacity.

Kayla was a DST client in 2005. The experience of having a doula was so powerful that she decided to become a doula herself. Since completing her doula training, Kayla has supported numerous families. In 2006, she joined DST’s board of directors. Currently, she is pursuing a degree through Lane Community College.

The DST doulas provide more than emotional and physical comfort; they are acting as mentors for healthy parenting and forming meaningful bonds. For many of these teen parents, this is the first time they have had a caring adult in their lives who listens to them, provides useful suggestions and respects their individual choices. Doulas are required to complete birth doula training and be mentored by a senior DST doula. They must also demonstrate a passion and high degree of commitment to serving teen parents and their particular needs.

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[Photo by Iris Bicksler]

Though a successful model exists to address the disparity of needs for teen parents, the unfortunate fact is diminishing resources. Nonprofit organizations have had to become more creative in their efforts to sustain programs, and DST is no exception. Iris had to pull her energy from programmatic coordination to concentrate on creative fundraising efforts. Donations have slowed and funding opportunities have declined. As for many nonprofit programs across the nation, the economic downturn has had an impact. If their diligence does not pay off, DST risks turning away participants; mothers and babies will be the first to bear the impact.

Everyday Miracles, a community-based doula program in the Twin Cities, Minnesota, has served 239 teen parents in the past five years. The primary issues most teen parents face are stable housing and cuts in the financial assistance for daycare that allows them to continue their education and work. Several Medicaid insurance provider groups have partnered with Everyday Miracles to institute doula programs for their members. Third-party reimbursement helps, however it doesn’t entirely meet the need. Lately, diligent fundraising efforts take up the majority of the executive director’s attention.

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[Photo by Iris Bicksler]

The American Indian Family Center (AIFC) of St. Paul, Minnesota, hosts a community-based doula program that serves mothers from diverse communities, primarily teenaged Medicaid recipients. The Center was recognized this year with an award for its service to teen parents, for “improving the quality of life for young people around the issues related to adolescent sexual health promotion, adolescent pregnancy prevention and adolescent parent support,” by the Minnesota Organization on Adolescent Pregnancy, Parenting and Prevention. AIFC states that issues for teen parents include lack of family support, lack of positive parenting skills and lack of resources. Like the other programs, the doula program is mostly grant-funded, though Medicaid reimburses some of the educational services. The future of the program has been threatened, as legislation has re-prioritized funding that the center counts on for its doula program.

Chicago Health Connection (CHC), a federally-funded program held up as the model maternal-child health organization, states that the measurable cost savings of community-based doula programs includes the thousands of Medicaid dollars saved by an averted c-section or epidural (with additional cost savings possible due to reduced length of hospital stay) and the public health savings from increased breastfeeding, totaling anywhere from $300 to $1400 per child and $500 per family. CHC is making a difference in the lives of numerous Chicago teen parents and their infants. Rachel Abramson, director of Chicago Health Connection, was quoted recently, “Every woman needs that kind of support around birth, but in terms of resources and need, it’s particularly critical for women who are underserved, who face a lot of challenges in their lives.”(4)

Recommendations of the Cochrane Review, the most exhaustive review of evidence-based research, states, “Continuous support during labor should be the norm, rather than the exception. All women should be allowed and encouraged to have support people with them continuously during labor.”(5)

Susan Lane, DONA State Representative for Minnesota, is working diligently with this evidence to gain recognition for the valuable and cost-saving support that doulas provide. She has been involved in introducing legislative action in an effort to obtain third-party payment for doulas since 2003 and is seeing results.

DST sees a potential to serve teen parents with worthwhile programs while saving taxpayers money immediately and in the long term, but challenges exist to sustaining the program. Without third-party reimbursement from Medicaid and private insurers, the future of doula programs looks bleak. Nevertheless, Shea and Iris are trying to remain optimistic. With programs that show real, tangible and cost-effective results that have long-lasting impact for a whole society, we have to ask why it is not a very significant priority.

For more information on getting involved or donating, please call Doulas Supporting Teens at (541) 344-1091 or visit them online at www.doulassupportingteens.org.

To learn more about getting involved in legislative action, look to your local and state representatives. Call them, write to them and take part in civic engagement.

If gaining third-party reimbursement for doulas interests you, please contact DONA International at 3PRChair@DONA.org.

Jessica Atkins has been a doula for two decades and is a writer and nonprofit consultant. She lives in the hill country outside of Austin, Texas, where she shares her passion for birth with the community of doulas, midwives and families.

References:

  1. Hendrickson, Sarah. 2007. Infant Mortality in Lane County; Using the Perinatal Periods of Risk Approach to Look at Local Fetal and Infant Mortality. Power Point presentation by Lane County Public Health Services to CityMatCH, University of Nebraska Medical Center, 18 Jul, in Omaha, Nebraska.
  2. Klaus, Marshall H., John H. Kennell and Phyllis H. Klaus. 2002. The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth. Cambridge, Massachusetts: Perseus Publishing.
  3. “Low birthweight: Oregon, 1996–2006.” March of Dimes Peristats Web site. http://www.marchofdimes.com/peristats/level1.aspx?dv=ms&reg=41&top=4&stop=43&lev=1&slev=4&obj=1. Accessed 13 May 2009.
  4. Wilgoren, Jodi. 2005. “Mothering the Mother” During Childbirth, and After. New York Times, 25 Sep. http://www.nytimes.com/2005/09/25/national/25doula.html. Accessed 14 May 2009.
  5. Hodnett, E.D., et al. 2007. Continuous support for women during childbirth. Cochrane Database Syst Rev (2): CD003766. DOI: 10.1002/14651858.CD003766.pub2.

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