Beginning in 2017, the United Way Great Rivers HUB began tackling the problem of health disparities around childbirth in the La Crosse County area.
The HUB hired community health workers (CHWs) to assist families at risk of poorer maternal and child health outcomes due to high social needs, such as poverty, mental health issues, discrimination, substance misuse and other health factors.
The initial results were good, with 40 births showing birth weights and outcomes that matched the county’s average percentages.
“Because all of these births were in a high-risk population, to have the birth weights and birth outcomes in line with the general county population is a success in itself,” said Lindsey Purl, Great Rivers HUB director for the Great Rivers United Way.
Still, the group felt that it could make further progress if the CHWs were also trained as doulas, enabling them to deliver more comprehensive care to the families. In September 2022, the HUB applied for and received a Wisconsin Partnership Program (WPP) Maternal and Child Health grant to begin training the first two CHWs/doulas.
“The WPP grant allowed us to show our proof of concept, that doulas can improve maternal and child health and outcomes,” said Purl.
The first two CHWs/doulas, who work for the Family and Children’s Center of La Crosse, also developed the core curriculum that is still used by all the doulas in the program.
The program continues to expand its work and impact through additional funding and successful collaborations. Thanks to an additional grant, the program now has four CHW/doulas who serve La Crosse County. Neighboring Monroe County saw the program’s success and decided to write a grant to have a community health worker cross-trained as a doula. As a result, a fifth CHW/doula will join the group at the end of 2024, working with the Families First of Monroe County.
The CHWs/doulas collaborate with local health systems, including Gundersen Health System and Mayo Clinic Health System, insurers such as United Healthcare and Quartz Health Plan, and government agencies.
Purl recalled a meeting with some local health care providers where some skepticism about working with doulas was expressed. But by the end of the presentation, Purl said, the providers were impressed about how doulas can promote maternal and health for at-risk families.
Most of the CHWs/doulas spend their workdays in the community. They visit mothers and babies at home, accompany them to medical appointments, and, if requested, attend births.
“Our standard of care is to attend at least two prenatal appointments, but often they will attend more than that,’’ Purl said. “They help navigate medical discussions and advocate for the clients’ birth plans.”
After the new families return home, in-home visits continue. In their role as doulas, the CHWs/doulas may help fold laundry or wash dishes, hold the newborn so mom can take a shower, and do screenings for prenatal depression. They often attend the well-baby visits and ensure that other children in the home receive preventive care.
The model we follow is holistic care, working on both social determinants of health and on clinical issues such as prenatal care coordination.
- Lindsey Purl
As community health workers, CHWs/doulas ensure families have sufficient food, money for heat and rent, and transportation to medical appointments. They are also trained to connect families with local agencies that can provide additional support.
“The model we follow is holistic care, working on both social determinants of health and on clinical issues such as prenatal care coordination,’’ Purl said. “It’s a dual role in which doulas can focus on child development and screening.”
