UAMS doula toolkit piloted at Mercy Hospital in Rogers

The University of Arkansas for Medical Sciences has launched a toolkit to help integrate doulas into hospitals and lower both infant and maternal mortality rates. So far, the program has been implemented at Mercy Hospital in Rogers. Ozarks at Large's Eva Mundo reports.

The toolkit is being used to nurture collaboration between clinical nurses and doulas to expand support for women and families throughout pregnancy. Hannah McHardy is the senior director of research programs at the UAMS Institute for Community Health Innovation. As a former doula herself, she says this initiative was introduced as part of the state's commitment to expand access to doulas and improve maternal and infant outcomes.

"So I have been a doula and I've been a registered nurse, a labor and delivery nurse, and so I love being able to have a foot in one world to better understand. Doulas just do a fabulous job of really walking alongside the journey of pregnancy, birth and postpartum with families. It's really just a fantastic support. And it's not that nurses and doctors don't want to invest that amount of time with their clients. It's just that the systemic situation is that you don't have time all the time as a nurse or a doctor to really sit down and thoroughly educate your patients and go through all of the things that can come up really normally in a pregnancy and birth and postpartum."

McHardy says that UAMS conducted a study on 110 health care professionals across the state to better understand sentiments around doula practices. And despite nearly 90% of respondents who acknowledge the benefits to doula services, not a lot of them felt confident that they understood a doula's training and background.

"So that became the work, and part of building this toolkit in collaboration with clinical providers and doulas and community members, was really just to help create more of a path of collaboration between those, so that we have this net circling around our families as they're going through this time of pregnancy and childbirth."

Doulas provide non-clinical care, guidance and support to moms. They help access medical care and resources needed for a healthy pregnancy, like housing or food. Through the initiative, McHardy says they have partnered with local doulas and Doula Alliance of Arkansas to connect providers from across the state to families.

"The way we designed the toolkit was really to be adapted to what makes sense for that hospital, that community, the doulas and the community. And so what it's looked like so far in the hospital that's piloted is training the staff in better understanding what is a doula's role and scope and how to collaborate and really utilize doulas as another value add-on in the clinical setting to support moms and families. And then for doulas, we also did a training to better understand the clinical perspective and how to integrate well into that clinical role. A lot of it just comes down to understanding each other's scopes, where they overlap, where they are really different, and then how to communicate and collaborate really effectively. And it's been easy, because everybody understands that we're all reaching for the same goal. We are all trying to help moms and babies have better outcomes and make sure families feel supported. And so it's really just bringing everyone together to align on how to best do that."

Whitney Hardy is a doula and the owner of Bentonville Birth Services, which employs around 10 doulas. She says the toolkit allows both nurses and doulas to receive similar training and work towards more seamless collaborations for births, with a better mutual understanding of the other's background. Hardy says the biggest change from the toolkit is that doulas are now allowed into operating rooms when patients go for C-sections.

"We've also noticed just more familiarity and a sense of feeling welcomed onto the labor and delivery floor, because we have a badge that says this is a Mercy-oriented doula. And even though doulas are always technically welcome to come to the hospital with their clients, there is something about when you belong to a hospital, having your hospital say, these are doulas that have gone through a training program, that we understand their scope and role, they understand our perspective, and we are really committing to working together. So that has an impact on everyone that we talk with on the floor. They're like, oh, hi, you're a doula here. They were already pretty friendly to doulas, but we do see more collaboration and more access because of the toolkit."

Hardy says the initiative has allowed doulas to debunk common misconceptions that typically make people hesitant to opt into their services. For example, many people don't know that doulas help moms and families throughout their entire pregnancy, not just during labor. And it's also widely thought that doulas only work with unmedicated births, which is also not true. 

“And so that can be a reason why people hesitate to reach out, which is why we want to say over and over again that our job is to get to know the family and center their goals and help them from that perspective. We're not trying to help them have any particular kind of birth, except one that is empowering and supported, whatever that looks like for them."

Initially, doulas are brought into the hospital and taught the ways that Mercy plans to use the toolkit to facilitate doula care. There was a second training where doulas were brought in to talk to clinical nurses about their services and answer questions. Hardy says the program has also fostered feedback between clinical nurses and doulas on things like communication from nurses and any concerns from patients after births.

"Expectations, I think, were mixed in the beginning. Definitely a lot of high hopes for what we could accomplish, but then also wondering, you know, what will we do when there are conflicts that come up? And I think it's going to take time for us to have that feedback go back and forth between the doulas and the medical team. But I've been really happy so far with what the toolkit has accomplished. I hope we continue to build on it by having further opportunities to train and have contact with the clinical team, because I think that will just continue to build relationships that improve patient care and outcomes."

UAMS worked with the New York City Department of Health and Mental Hygiene, building off its Doula Friendliness Toolkit, to assess a hospital's doula policies and find areas of improvement. While the program is in its beginning stages, it is expected to expand to other hospitals and promote doula integration statewide.

"The toolkit provides an excellent framework, and I'm excited that many hospitals across the state are going to be able to adopt it. A toolkit itself is only as powerful as the goodwill of the people that participate in it. So I think anyone who works in maternal health is very passionate about what they do. And we also really need people who can be team players and who can be collaborative, because that's what is going to help move the needle for the women of Arkansas."

In February, UAMS announced it had enrolled another 25 doulas in training across 14 counties, boosting their numbers to around 75 doulas across Arkansas by the end of the year.

Eva Mundo is one of our student reporters this year with Ozarks at Large, focusing on maternal and women's health in Arkansas. Funding for her reporting is supported by the Women's Giving Circle with the University of Arkansas.