Doula Program for Incarcerated Women
Purpose: Provide services that have a positive impact on the birth experience and postpartum maternal-infant interaction of incarcerated women
Target Population: Pregnant women who deliver while incarcerated in the Cook County Jail
Results: Lower epidural and caesarean section rates for women participating in the program compared to overall rates for hospital
Every year more than 50 pregnant detainees at the Cook County Jail deliver their babies at John H. Stroger Jr. Hospital of Cook County. Giving birth during incarceration can be isolated and frightening for these women, who typicallv lack the maternal support systems of family and friends during pregnancy, labor and delivery. They receive little attention to their needs. After delivery they are quickly separated from their babies and returned to jail, making crucial mother-child bonding difficult.
The Cook County Bureau of Health Services developed its Doula Program for incarcerated Women in 2001.
Doula means: a caregiver experienced in childbirth who provides continuous physical, emotional, and informational support to a mother before, during, and after childbirth. Studies shown that when doulas are involved in childbirth, mothers experience fewer labor and delivery complications, fewer medical interventions such as cesarean section and use of anesthesia, more positive maternal-infant interaction, and less postpartum depression. In the programs first year, 50 patients received doula services, with a cesarean section rate of four percent (compared to a hospital rate of close to 2 percent) and an epidural rate of 33 percent (compared to a hospital rate of approximately 50 percent).
Pregnant women at Cook County Jail have overwhelmingly embraced the support of the doulas. They now receive prenatal education and doula visits, including the opportunitv to develop a birth plan. This tool enables women to understand and request specific comfort measures during labor and delivery. In their last trimester of pregnants; they attend a prenatal class with all of the doulas, where they learn about the role of the doula. The women provide information on prior pregnancies, medication preferences, and how they would like to interact with the baby immediately after birth. When a detainee goes into labor, the doula on rotation is notified and spends the entire labor and delivery providing support. A doula also visits the mother each day of her postpartum hospital stay. Maternal-infant bonding is especially important for women who have to endure a separation from their baby.
Most Cook County detainees return to the jail after the postpartum stay; and their babies are discharged to a family member or into foster care. The doulas work to solidify the bond, taking pictures of the mother and baby immediately after the birth, and visiting the mother at the jail. Much of this time is spent discussing the birth, and the doubt gives the mother a diary in which she can write a birth narrative and keep the pictures of her baby. The doula concept was not well known to the Cook County Department of Corrections (DOC) at the outset, so the Bureau held a series of meetings to explain the benefits of the program. To assure buy-in and to expedite program success, the Bureau distributed descriptions of services to be offered and key personnel contact information. Using five existing Bureau staff on a rotating volunteer basis as doulas eased the Department of Corrections’ security concerns.
DOC staff have become familiar with the doulas and are supportive of the program. Hospital labor and delivery staff have warmly received the doubts, and now expect all patients from the jail to have doula support. Many Bureau staff have expressed an interest in participating as volunteer doulas, and several have received doula training in the past year. The Bureau is now seeking funding to expand the program to women detained in alternative custodial programs.
Contact: Martha Gottlieb, Bureau Coordinator of Maternal and Infant Services