Shared Decision Making Through Doula Supported Group Education for ESL Families

Grant Application

Jeanette E. South-Paul, MD, Department of Family Medicine, University of Pittsburgh School of Medicine and UPMC, and Megan Shope, MPH, CHES, CD(DONA), The Birth Circle Doula Program, UPMC Department of Family Medicine

Proposed Innovation

Resettlement in a new culture brings unique challenges, especially for pregnant women with limited English proficiency (LEP). Unfamiliar hospital and birth practices in the United States can make labor and delivery particularly stressful for immigrants and refugees, who report a lack of care providers who understand and support cultural practices. The result can be a less than positive birth experience for pregnant women and their families.

In Pittsburgh, which has a growing immigrant and refugee population, no formal childbirth education classes had been provided in any language other than English. Through this innovative program, the Birth Circle Doula Program of UPMC’s Department of Family Medicine was expanded to provide prenatal group classes and postpartum support sessions to Bhutanese and Latina mothers in Nepali and Spanish.

Improvements

Information gathered from focus group meetings with former Birth Circle patients from the Bhutanese and Latina communities was used to develop training programs for providers and labor/delivery staff with basic information about various cultures and their view of childbirth, the role of family members, and the medical team.

In addition, four 6-week childbirth classes were held at the Squirrel Hill Health Center and the Latino Family Center. These sessions for expectant mothers and their families were conducted in Spanish and Nepali by a member from each of the target communities — who were hired as Community Facilitators — and a Birth Circle doula. Monthly postpartum support groups were also offered in each language. This model created a safe space for mothers to ask questions, share experiences, and learn together.

Outcomes

The project demonstrated that providing group education in the expectant mother’s native language enhances understanding and empowers her ability to act as a key player in her medical decisions. Doula support throughout labor and delivery also enhances the birth experience for the mother, her family, the Magee Womancare Birth Center staff, providers, and community members.

The project team successfully conducted group education classes and collaborated with multiple partners to enhance the program. The Beckwith Foundation funding proved critical in securing the Nepali and Spanish-speaking doulas, which allowed important information to be disseminated to this vulnerable population in both Allegheny and Westmoreland counties. In addition, the team presented the project at multiple national conferences and hopes it will serve as a national model.