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CityMatCH Conference, September 2005 Teen Pregnancy “Promising Practice” presentation

CityMatCH Conference, September 2005 Teen Pregnancy “Promising Practice” presentation. “Mothering the Mother”… What does it mean? Co-Author: Nadia Stein, President Presenter: Nathalie Paravicini, Executive Director A March of Dimes “Comenzando Bien” Agency. Why Focus on Teens.

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CityMatCH Conference, September 2005 Teen Pregnancy “Promising Practice” presentation

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  1. CityMatCH Conference, September 2005Teen Pregnancy “Promising Practice” presentation “Mothering the Mother”… What does it mean? Co-Author: Nadia Stein, President Presenter: Nathalie Paravicini, Executive Director A March of Dimes “Comenzando Bien” Agency

  2. Why Focus on Teens • In Houston, in the year 2000, only 55% of young Latinas graduated from High School (Making the Grade on Women’s Health, National Women’s Law Center, 2001) In the areas we serve, up to 19.5% of babies are born to teenagers and 60.4% of mothers have less than a high school diploma (St Luke's Episcopal Health Charities' Community Health Index website, 2002 Data) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  3. Why Focus on Teens • In Houston, in the year 2000, only 55% of young Latinas graduated from High School (Making the Grade on Women’s Health, National Women’s Law Center, 2001) • In the areas we serve, up to 19.5% of babies are born to teenagers and 60.4% of mothers have less than a high school diploma (St Luke's Episcopal Health Charities' Community Health Index website, 2002 Data) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  4. Public Health Implications • Low birth weight accounts for 10% of all health care costs for children (4/10 costliest hospitalizations, regardless of age, are related to infant care) (MOD, Prematurity Campaign, 2000 report) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  5. Public Health Implications • Low birth weight accounts for 10% of all health care costs for children (4/10 costliest hospitalizations, regardless of age, are related to infant care) (MOD, Prematurity Campaign, 2000 Report) 9.6% of babies born to teens are low birth weight (13.9% for Black teens) (National Vital Statistics, Dec 2003 Report) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  6. Public Health Implications • Low birth weight accounts for 10% of all health care costs for children (4/10 costliest hospitalizations, regardless of age, are related to infant care) (MOD, Prematurity Campaign, 2000 Report) • 9.6% of babies born to teens are low birth weight (13.9% for Black teens) (National Vital Statistics, Dec 2003 Report) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  7. A Much Wider Problem The situation is emblematic of wider problem: • The rate of premature births jumped 29% since 1981 (MOD, Prematurity Campaign, 2000 Report) “48% of Americans struggle with low health literacy” (AMA, 2003 report). CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  8. A Much Wider Problem The situation is emblematic of wider problem: • The rate of premature births jumped 29% since 1981 (MOD, Prematurity Campaign, 2000 Report) “48% of Americans struggle with low health literacy” (AMA, 2003 report). CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  9. A Much Wider Problem The situation is emblematic of wider problem: • The rate of premature births jumped 29% since 1981 (MOD, Prematurity Campaign, 2000 Report) • “48% of Americans struggle with low health literacy” (AMA, 2003 Report) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  10. A Much Wider Problem • Our challenge is to “translate scientific knowledge into street knowledge”(Vice Admiral Richard Carmona, US Surgeon General, 2004 address, Houston, Texas) • To change health behavior health practitioners must • Build Trust • Repeat the Message at appropriate intervals over a substantial period • Be prepared to change the message path and appearance as people take current ones for granted (Mrs. Elliott Churchill, MS, MA, Division of International Health, CDC Atlanta Georgia, 2005) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  11. “Promising Practice”History and Development • A concept rooted in practical experience • The “primordial” story-teller meets the “modern” businesswoman • Founder Nadia Stein’s personal history: • One of the first Doulas of the US study, became Jr. Project Coordinator • Learned from each other, asked questions to medical students and staff • Subsequent 20 years of private practice and extensive reading • Executive Director Nathalie Paravicini, a Mother-Daughter team: • Unique combination of complementary skills and experience • Studied Microbiology, biochemistry and business • Shared 20 years of experience and learning within the family • Framed by experience in scientific studies • Rigorous informational data-tracking background CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  12. “Promising Practice”History and Development • Continuous Emotional Support During Labor in a US Hospital, John Kennel, MD; Marshall Klaus, MD; Susan McGrath, PhD; Steven Robertson, PhD; Clark Hinkley, MD, JAMA. 1991; 265:2197-2201. CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  13. “Promising Practice”History and Development • A concept rooted in practical experience • A healthy, healing and marvelous body • A truly integrated approach • Based on actual needs of pregnant women and couples • regardless of socio-economic background CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  14. “Promising Practice”History and Development • A concept rooted in practical experience • A healthy, healing and marvelous body • A truly integrated approach • Based on actual needs of pregnant women and couples • regardless of socio-economic background • Starts from the point of view of a healthy body, a body (and mind) with an immense capacity for healing, especially during pregnancy and birth. • as opposed to intervening from the point of view of illness, specifically “defensive medicine vs preventive medicine” (Dr. John C. Nelson, Obstetrician and 2004-2005 President of the AMA) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  15. “Promising Practice”History and Development • A concept rooted in practical experience • A healthy, healing and marvelous body • A truly integrated approach • Based on actual needs of pregnant women and couples • regardless of socio-economic background • Starts from the point of view of a healthy body, a body (and mind) with an immense capacity for healing, especially during pregnancy and birth. • as opposed to intervening from the point of view of illness, specifically “defensive medicine vs. preventive medicine” (Dr. John C. Nelson, Obstetrician and 2004-2005 President of the AMA) • Integrates the person as a whole, the body-mind-spirit • Nutrition affects the mind; the mind affects digestion and hormonal releases, trust and confidence allows us to release the power within CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  16. “Promising Practice”Results In addition, the CDP experiences a high rate of long-term breastfeeding CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  17. “Promising Practice”Approach One Mission, Two Objectives The Mission the Community Doula Program is to educate and nurture expectant youth in disadvantaged neighborhoods, by cultivating a network of peer Doulas from the communities served. CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  18. “Promising Practice”Approach One Mission, Two Objectives The Mission the Community Doula Program is to educate and nurture expectant youth in disadvantaged neighborhoods, by cultivating a network of peer Doulas from the communities served. • Our primary objective is to improve the overall health of mother, child and her family CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  19. “Promising Practice”Approach One Mission, Two Objectives The Mission the Community Doula Program is to educate and nurture expectant youth in disadvantaged neighborhoods, by cultivating a network of peer Doulas from the communities served. • Our primary objective is to improve the overall health of mother, child and her family • Our second objective is to cultivate a network of trained, peer Doulas, thereby developing a network of knowledgeable role models CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  20. “Promising Practice”Approach One Mission, Two Objectives The Mission the Community Doula Program is to educate and nurture expectant youth in disadvantaged neighborhoods, by cultivating a network of peer Doulas from the communities served. • Our primary objective is to improve the overall health of mother, child and her family • Our second objective is to cultivate a network of trained, peer Doulas, thereby developing a network of knowledgeable role models • For teens: increase the graduation rate CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  21. “Promising Practice”Approach . • What We Do – Six Integrated Services: • Pregnancy & nutrition, labor & birth, breastfeeding and early baby development classes • One-on-one emotional support throughout pregnancy and early motherhood • Labor support at the hospital • Hands-on breastfeeding counseling and support • Post-partum support and post-partum depression assistance (in collaboration with other agencies) • Recruitment, training and mentoring of peer Doulas CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  22. “Promising Practice”Approach • What We Do – Three Distinguishing Characteristics: • In-depth content-integrated education spanning the range of issues a young mother needs to be informed about from nutrition, to pregnancy and labor, breastfeeding and early child development . CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  23. “Promising Practice”Approach • What We Do – Three Distinguishing Characteristics: • In-depth education spanning the range of issues a young mother needs to be informed about from nutrition, to pregnancy and labor, breastfeeding and early child development • Integration of education and emotional support during the entire perinatal period, particularly by way of labor support at the hospital. This aspect is particularly important for survivors of violence . CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  24. “Promising Practice”Approach • What We Do – Three Distinguishing Characteristics: • In-depth education spanning the range of issues a young mother needs to be informed about from nutrition, to pregnancy and labor, breastfeeding and early child development • Integration of education and emotional support during the entire perinatal period, particularly by way of labor support at the hospital. This aspect is particularly important for survivors of violence • Training and mentoring of women from the community itself, providing culturally-sensitive services and creating a lasting multiplier effect within the community . CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  25. “Promising Practice”Approach • Two Key Factor for Success: • Investment in QUALITY of service, in-depth and integrated Integrated content, Intellectually challenging classes, designed for low literacy (ie experiential), importance of community-setting to promote interaction, learning from each other and support networks . CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  26. “Promising Practice”Approach • Two Key Factor for Success: • Investment in QUALITY of service, in-depth and integrated Integrated content, Intellectually challenging classes, designed for low literacy (ie experiential), importance of community-setting to promote interaction, learning from each other and support networks • Great investment in training of the Doulas: • Recruitment from within the program • 64 hours of didactic material • 3-6 months of hands-on mentoring with experienced Doulas • 2-3 births at the hospital with an experienced Doula • TOTAL: 9-12 months of training • Followed by monthly Continuing Education sessions • In a non-hierarchical organizational structure focused on personal growth . CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  27. “Promising Practice”Barriers and Support • Barriers to implementation: • Complex needs of low-income families, especially childcare and transportation • Lack of support from the family, especially husbands in light of changing dynamics • Acceptance by healthcare providers to the presence of Doulas, letting women labor uninterrupted and providing for more freedom of movement • A cost-saver may conflict with increasing profits CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  28. “Promising Practice”Barriers and Support • Barriers to implementation: • Complex needs of low-income families, especially childcare and transportation • Lack of support from the family, especially husbands in light of changing dynamics • Resistance by healthcare providers to the presence of Doulas, letting women labor uninterrupted and providing for more freedom of movement • A cost-saver may conflict with increasing profits • How to overcome barriers: • High-quality training and preparation of women and Doulas • Early institutional support from healthcare institutions because of decreased healthcare costs CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  29. “Promising Practice”Barriers and Support • Key supporters • Baylor College of Medecine, Dr. Clark Hinkley (former Dr. of Ob/Gyn), Dr. Cabrera-Meza (Director International Neonatology, Texas Children’s Hospital), Dr. Garcia-Pratt (Professor of Pediatrics and Neonatology and Director of Nurseries, Ben Taub Hospital), and others • The March of Dimes and other key foundations afterwards • City of Houston and Harris County Hospital District (Ben Taub) • Midwifery Section of Baylor College of Medicine • Various service providers (addressing domestic violence, housing, behavioral health and other needs) • The media (Houston Chronicle, Telemundo, Univision and others) CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  30. A Peer-to-Peer, In-DepthIntegrated Approach The perinatal period is a unique moment that affects the entire life of the baby and mother. This moment addresses an integrated andextensive spectrum of knowledge and skills that need to be addressed together as a whole. When the mother has a positive experience, we observe stronger and healthier family ties It is a transforming moment that touches the entire person; women are particularly sensitive and vulnerable. Any approach must focus on empowerment from within, cultivating the person, instead of only providing basic information, for systemic long-term impact Women of the community, particularly the Doulas, play a key role for the long-term impact on public health and the community’s well-being. They are the experts on the community. CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  31. A Peer-to-Peer, In-DepthIntegrated Approach CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  32. EXTRA SLIDES CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  33. Addressing the Needsof Healthcare Providers • In a stressed system with: • Increased competition at hospitals • cost reductions • need for more qualified personnel • increased demands and less resources • A well-prepared Doula offers: • A knowledgeable patient, healthier pregnancies • Easier work-load, shorter births, improved outcomes in the delivery room • Improved early baby and mother care • Higher rates of long-term breastfeeding CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

  34. Working with Doulas For the Medical Staff A mother who has chosen to have a Doula has made an informed decision to have a closer bond with her child, less medications and less interventions. That decision is to be supported and respected The staff should avoid unnecessary interruptions of the mother and should allow the mother to move during labor No sugar water, no separation of the child and the mother, no bottle-feeding (unless medically necessary) For the Doula Guides early labor, accompanies mom at the hospital, helps with positions during labor Models behavior, facilitates husband’s participation Does not give medical advice, communicates mother’s wishes, translates medical terms Importance of in-depth training with hands-on experience CityMatCH Conference September 2005, "Promising Practice": "Mothering the Mother... What Does it Mean?"

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