Postpartum Care in the NICU (PeliCaN), a cluster RCT of doula support and healthcare navigation

About This Grant

The largest contributors to maternal postpartum mortality are mental health and cardiovascular conditions and women that give birth prematurely are at the highest risk. To prevent maternal deaths, the American Academy of Pediatrics and American College of Obstetricians and Gynecologists have clear recommendations focused on screening for depression and treatment if necessary, and monitoring and management of high blood pressure in the first weeks after birth. Of the ~100,000 mothers that give birth annually to preterm infants <34 weeks, more than 40,000 do not receive recommended postpartum care because they are engaged in the care of their sick newborns in the neonatal intensive care unit (NICU), typically far away from home and separate from their own obstetric clinicians’ offices for weeks to months. Evidence is mounting that engaging doulas, peers with lived experience that provide emotional and logistical support for mothers, is associated with improved perinatal health care the routine antepartum, intrapartum and postpartum domains, but there have been no investigations of doulas in the NICU. Our team conducted a 1:1 randomized control pilot randomized controlled trial (RCT) of doulas in Postpartum Care in the NICU (PeliCaN) in a single center and found significant improvement in postpartum care receipt by 12 weeks among intervention (doula care) compared to control. Building on our pilot work, we now propose a Type 1 hybrid effectiveness- implementation, stepped-wedge cluster RCT in 10 metro-Philadelphia NICUs to rigorously test the effectiveness of doulas in promoting receipt of evidenced-based postpartum care to improve mental health and postpartum blood pressure – outcomes strongly associated with postpartum morbidity and mortality. We will analyze individual-level effectiveness outcomes for 900 mother- infant dyads (450 intervention, 450 usual care). In Aim 1, we will examine primary effectiveness of PeliCaN during NICU stay, to improve maternal adherence to recommended postpartum health screenings for depression and high blood pressure (BP) (or adherence to BP management if directed by obstetric clinician for existing hypertension), as well as attendance at a postpartum visit with an obstetric clinician by 12 weeks. In Aim 2, we will examine secondary effectiveness of PeliCaN to improve health outcomes at 6 months by decreasing the proportion of mothers’ screening positive for depression symptoms and increasing the proportion of mothers with hypertensive disorders attending a primary care physician or cardiologist for blood pressure management. In Aim 3, we will examine implementation outcomes of feasibility, acceptability, and fidelity of this innovative doula-driven healthcare delivery model in the NICU.