Illinois Maternal, Infant, and Early Childhood Home Visiting (MIECHV): Doula Randomized Controlled Trial

Brief Summary

Detailed Description

The goal of this study is to evaluate the impact of doula enhanced evidence-based home visiting programs for young mothers in Illinois. Mothers in the intervention group receive home visits from doulas during pregnancy and in the first few weeks postpartum, and doulas provide mothers with support at the hospital during labor, delivery, and with early breastfeeding. Additionally, mothers in the intervention group receive prenatal and long-term postpartum home visitation services through an evidence-based home visiting program, such as Parents as Teachers and Healthy Families Illinois. Mothers in the comparison group receive a less intensive case management service. Four existing doula home visiting programs located in economically distressed communities in Illinois were selected for participation in the study. At each site, young pregnant women are recruited for participation in the study, provide informed consent, and complete a baseline interview in their homes during mid-pregnancy. At completion of the baseline interview, mothers are randomly assigned to either the doula home visiting intervention group or the case management comparison group. At 37 weeks of pregnancy, and at 3 weeks-, 3 months-, 13 months-, and 30 months, and 4 years postpartum, mothers are interviewed in their homes on topics including pregnancy, parenting, health, mental health, feeding practices, employment/education, and relationships. Additionally, at all postpartum visits, mothers are videorecorded interacting with their infants. At the 13 month, 30 month, and 4 year followup sessions, children of the study participants are administered developmental and behavioral assessments. Based on prior studies of doula services and the goals of doula enhanced home visiting programs, a variety of outcomes are assessed at followup time points. These outcomes include prenatal medical care, prenatal bonding with infant, feelings of efficacy during labor, anesthesia use during labor, breastfeeding, positive parenting behaviors, parenting attitudes and stress, infant health, maternal health, maternal depressive symptoms, and child behavior and development.

Primary Outcomes

Secondary Outcomes

• Breastfeeding duration(3 week, 3 month, and 13 months postpartum)
• Center for Epidemiologic Studies Depression Scale (CES-D)(37 weeks pregnancy, and 3 weeks, 3 months, 13 months, 30 months, and 4 years postpartum)
• Adult Adolescent Parenting Inventory (AAPI)(3 months, 13 months, 30 months, and 4 years postpartum)
• Mullen Scales of Early Learning - Visual Reception(13 months and 30 months postpartum)
• Subsequent pregnancy(3 month,13 months, 30 months, and 4 years postpartum)
• Woodcock-Johnson III Tests of Achievement(4 years postpartum)
• Parenting Stress Inventory (PSI)(3 weeks, 3 months, 13 months, 30 months, and 4 years postpartum)
• Timing of solid food introduction(3 weeks, 3 months, and 13 months postpartum)
• Knowledge of Infant Development Inventory (KIDI)(3 months,13 months, and 30 months postpartum)
• Infant Toddler Social and Emotional Assessment (ITSEA)(13 months and 30 months postpartum)
• Labour Agentry Scale(3 weeks postpartum)
• Use of labor analgesia(3 weeks postpartum)
• Maternal Postnatal Attachment Scale (MPAS)(3 weeks postpartum)
• Infant/child hospitalizations(3 weeks, 3 months, 13 months, 30 months, and 4 years postpartum)
• Parent-Child Conflict Tactics Scales (CTS PC)(13 months, 30 months, and 4 years postpartum)
• Maternal Antenatal Attachment Scale (MAAS)(37 weeks of pregnancy)
• Infant/child ER visits(3 weeks, 3 months, 13 months, 30 months, and 4 years postpartum)
• Infant/child immunizations(13 months, 30 months, and 4 years postpartum)
• Preschool Language Scales-5 (PLS-5)(13 months postpartum)
• National Institute of Child Health and Human Development (NICHD) mother-child interaction measures.(3 months, 13 months, and 30 months postpartum)