Article Figures & Data
Figures
- Figure 1.
Conceptual model of the pathways between social determinants of health and birth outcomes and the role of non-medical support.
Tables
Characteristics Participants, n (%) Race/ethnicity African American 5 (38.5) African 4 (30.7) Native American 2 (15.4) White 2 (15.4) Parity First pregnancy (nulliparous) 6 (46.2) Experienced mother (parous) 7 (53.8) Doula with current pregnancy Yes 10 (76.9) No 3 (23.1) Voluntarily disclosed high-risk medical status Yes 5 (38.5) No 8 (61.5) 5 Themes from the Good Birth Framework Definition of Theme Social Determinants of Health Categories: Traditional and Vulnerable Domains (Predisposing Factors) Personal/Family/Community Resources (Enabling Factors) Exemplary Quotations Agency How a woman makes choices and the ability she has to make choices and be in control ∙ Social and community context (social structure: social networks)
∙ Health and health care (health beliefs: values, attitudes, knowledge)
∙ Psychological resources∙ Social support and cohesion, culture, self-help skills, ability to negotiate system, competing needs, information sources, social services resources
∙ Access to health care services, health literacy, perceived barriers to care, regular sources of care, health services resources1. “I think it [having a doula] helps prepare you mentally; like it's gotten me more in the mind-set of, you know … the confidence throughout the pregnancy knowing that like I can do this… .”
2. “And it's [a doula is] someone that can help you with education, learn about yourself and the baby, but also ensure that what you want is heard.”
3. “My husband and I are taking childbirth classes but we still feel need for a doula. You can't remember everything and having experienced person around is important. Especially if we want to avoid a c-section… .”Personal security How safe a woman feels in her environment and with the people in her life ∙ Social and community context (social structure: social networks)
∙ Health and health care (health beliefs: values, attitudes, knowledge)
∙ Psychological resources∙ Social support and cohesion, culture, self-help skills, ability to negotiate system, competing needs, information sources, social services resources
∙ Access to health care services, health literacy, perceived barriers to care, regular sources of care, health services resources4. “… Having people there who make me feel good and feel like I can do it, not making me feel anxious, or scared, or, you know, like, ‘Oh … it's going to be really hard,’ more like [a] positive outlook on it, which I think a doula really has helped… . You know, so just using her and the techniques to kind of cope with labor… .”
5. “Cultural differences are a big deal too. If I have choices then I will want someone with my culture to make me feel comfortable and understand what we do.”
6. “… I talk to the doctor, I see the doctor and I'm calling the doula right after that. What does that mean? Like, I'm scared … And she's like, ‘Oh, no don't be’ … It's very comforting to know that you have somebody [who] has your back and explaining everything.”Respect How engaged a woman is in the decision-making process and the sense of dignity she has from the level of respect for herself and the way others treat her ∙ Social and community context (social structure: social networks)
∙ Health and health care (health beliefs: values, attitudes, knowledge)
∙ Psychological resources∙ Social support and cohesion, culture, self-help skills, ability to negotiate system, competing needs, information sources, social services resources
∙ Access to health care services, health literacy, perceived barriers to care, regular sources of care, health services resources7. “Having someone that is not only knowledgeable, but can put things I guess in layman's terms, but also in a way that you understand it and respects your culture … your well-being, your upbringing and things about you that you like to make sure that the baby is okay too.”
8. “[A doula] can help you make pregnancy plans if you don't have someone. Your doula can make sure it is being followed. Like if you say you don't want an epidural and she can make sure that the anesthesiologist doesn't come to do that.”
9. “When you call the doctor then the doctor don't have time[, the] doula takes time with you. When you are staying at home the doula helps with stress… .”Knowledge How prepared a woman is for childbirth based on the information she receives and being informed about what is happening to her body and around her ∙ Social and community context (social structure: social networks)
∙ Health and health care (health beliefs: values, attitudes, knowledge)
∙ Psychological resources∙ Social support and cohesion, culture, self-help skills, ability to negotiate system, competing needs, information sources, social services resources
∙ Access to health care services, health literacy, perceived barriers to care, regular sources of care, health services resources10. “[The] doula was coming on all my appointments with me and I was like, I don't speak medical terminology, like what just happened? And she'd break it down and [be] like, ‘It's okay.’”
11. “I also had like a class, like we got together with other pregnant moms and had like, discussions and education and actually healthy food. So it was kind of cool because you're seeing other moms, but then also having my doula talk about more than just what was going on with me, but talk about being a mom and changes and family and different things like that… . So, in that sense, I think that doulas provide a lot of education.”
12. “My reasons for wanting a doula [are] because I don't have nobody right now and if I go into labor, I didn't pay attention to my breathing class, I don't know the techniques or how to calm down.”
13. “… They [doulas] refer you to classes and the breastfeeding classes, birthing classes, any class you can think of that has to do with pregnancy, they have a referral for it.”Connectedness How alone a woman feels versus having people in her life she can trust. ∙ Social and community context (social structure: social networks)
∙ Health and health care (health beliefs: values, attitudes, knowledge)
∙ Psychological resources∙ Social support and cohesion, culture, self-help skills, ability to negotiate system, competing needs information sources, social services resources
∙ Access to health care services, health literacy, perceived barriers to care, regular sources of care, health services resources14. “I definitely think doulas are helpful like with mental—especially with stress because even if you're not alone, sometimes you may feel alone. You might not want to talk to anyone else except for the person that actually wants to talk about babies.”
15. “I'm really stressed out and worry about things a lot and [a] doula is there to support you and help you through stressful moments. [A] doula won't judge you or say anything bad about you—[she is] there to be supportive and tell you how it is—if this is going to happen and if this will hurt and what I'm supposed to feel when this happens. [She] communicates with you and helps you along the way… .”
16. “It's good to have a doula because the doctors will say this and your family may say this, but the doula is mindful of who you are.”
17. “I think it makes perfect sense. You want someone [a doula] who knows why you are doing things with the same culture. If they don't understand your culture then you have to educate them.”
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