Gale Berkowitz

A comparison of intermittent and continuous support during labor: A meta-analysis

Our goal was to contrast the influence of intermittent and continuous support provided by doulas during labor and delivery on 5 childbirth outcomes. Data were aggregated across 11 clinical trials by means of meta-analytic techniques. Continuous support, when compared with no doula support, was significantly associated with shorter labors (weighted mean difference -1.64 hours, 95% confidence interval -2.3 to -.96) and decreased need for the use of any analgesia (odds ratio.64, 95% confidence interval.49 to.85), oxytocin (odds ratio.29, 95% confidence interval.20 to.40), forceps (odds ratio.43, 95% confidence interval.28 to.65), and cesarean sections (odds ratio.49, 95% confidence interval.37 to.65). Intermittent support was not significantly associated with any of the outcomes. Odds ratios differed between the 2 groups of studies for each outcome. Continuous support appears to have a greater beneficial impact on the 5 outcomes than intermittent support. Future clinical trials, however, will need to control for possible confounding influences. Implications for labor management are discussed.

Options for Recovery: Promoting Success among Women Mandated to Treatment

In recent years imprisonment has been used increasingly for a wide range of nonviolent and petty offenses committed by women. Among incarcerated women, particularly those who are pregnant or parenting, substance use and its deleterious consequences are often exacerbated by imprisonment. Women who have been identified as chemically dependent are also at high risk for losing custody of their children. In California, the Options for Recovery (OFR) treatment program provided an alternative to incarceration or relinquishment of custody of children for chemically dependent pregnant and parenting women. This three-year pilot project offered alcohol and other drug abuse treatment and case management to these women, and included special training and recruitment of foster parents for their children. Findings from a three-year, multimethod evaluation study showed that women who were mandated to OFR treatment programs were more likely to successfully complete treatment than women who had enrolled in OFR voluntarily. An economic analysis of the costs associated with women in OFR compared with the combined costs of incarceration and alcohol and other drug abuse treatment produced a ratio in favor of OFR. Additionally, some innovative service alternatives for women mandated to treatment were developed during the project. The impact of such changes have implications for improving womens and family health.

Options for recovery : California's perinatal projects

In response to the increasing magnitude of problems related to perinatal exposure to alcohol and other drugs, a novel interagency collaboration was formed that involved the California Departments of Alcohol and Drug Programs, Developmental Services. Health Services, and Social Services. This collaboration was named Options for Recovery (OFR). Its mission was to promote the recovery of pregnant, postpartum, and parenting chemically dependent women and the enhancement of the health of their children by providing comprehensive and coordinated alcohol and other drug treatment, case management, and recruitment and training of foster parents and relative caregivers. Seven OFR pilot projects were selected. Findings from the three-year evaluation of the pilot projects showed that the initiative was successful in connecting women with essential services, promoting perinatal recovery and child health, and increasing family reunification of children in foster care. Women who were most likely to complete alcohol and other drug treatment were younger, high school graduates, mandated to treatment, or those who participated in treatment 150 days or more. Participants reported high levels of satisfaction with OFR. The findings indicate that OFR served the unique needs of high-risk perinatal populations. Future efforts should try to reach women early in their pregnancies and should provide a wide array of alcohol and other drug treatment approaches that are responsive to the myriad needs of women and their children.

California's approach to perinatal substance abuse: toward a model of comprehensive care.

In the late 1980s and early 1990s there was a growing awareness of the many health, social, psychological, treatment, and recovery needs of pregnant and parenting women and their drug-exposed children. This awareness sensitized policymakers and service providers to the necessity for women-centered programs. Many points of intervention, from primary prevention to treatment of drug dependence, are required to adequately respond to the various needs of this heterogeneous population; a comprehensive women-centered model of care is required that includes health, social, and personal support services. In addition, programs are needed that are aimed at the prevention and treatment of use, abuse, and addiction to alcohol and tobacco, which are dangerous to womens health and birth outcomes and responsible for more costs to society than are associated with use of illicit drugs. The existing system of social services and health care has been fragmented and uncoordinated in responding to substance-abusing women generally, and especially to those who are pregnant and/or parenting. A panel of experts and policymakers in California delineated the appropriate components of a model of service delivery for pregnant and parenting women. This article assesses the implementation of California programs that were informed by the model.

Native American Women in Alcohol and Substance Abuse Treatment

Alcohol and other drug use is a serious problem among American Indian and Alaska Native women. However, information about their needs for treatment is lacking. In response, a study was conducted to document the life experiences and perceived recovery needs of American Indian and Alaska Native women at nine treatment centers nationwide. The data show that most of these women have experienced various forms of abuse and neglect from childhood into adulthood and have been exposed to alcohol and other drugs from an early point in fair lives. Most of these women have made multiple attempts to recover from their addictions, offen for the sake of fair children. The information derived from this study can be used as the foundation for further research about the treatment needs of American Indian and Alaska Native women.

Options for Recovery: Promoting Perinatal Drug and Alcohol Recovery, Child Health, and Family Stability:

The perceived magnitude of perinatal chemical dependency in California was the impetus for an interagency partnership within the California Health and Welfare Agency called Options for Recovery (OFR). It offered alcohol and drug treatment and recovery, case management, and recruitment and training of foster parents and relative caregivers to chemically dependent pregnant and parenting women. A 3-year, multi-method evaluation was conducted that included quantitative analyses of secondary data sources, semi-structured interviews with staff and clients, self-administered surveys of staff and clients, client focus groups, and child developmental assessments. Findings indicate that to achieve success, programs structured on the OFR model must recruit chemically dependent women early in their pregnancies, provide mechanisms for retention, offer a continuum of treatment modalities within the service system, make available a comprehensive array of ancillary services, and be responsive to the social, cultural, and familial context within which these women live.

Community and treatment program challenges for chemically dependent American Indian and Alaska Native women

Alcohol and other drug (AOD) use is a serious and growing problem among American Indian and Alaska Native (AI/AN) women. In addition, there is wide variation across communities in AOD use patterns, access to treatment for substance use, and access to other needed health services. An evaluation study was conducted to document the needs of AI/AN women in AOD treatment and the treatment services and community factors that both facilitate and impede recovery at nine IHS-funded treatment centers. The data illuminate the challenges posed to the treatment centers, and how communities influence the substance use patterns of AI/AN women, as well as prevention efforts and health promotion. The information derived from this study can be used to improve services for AI/AN women and the potential role of communities in reducing substance use among AI/AN women.

Methodological Issues and Practices in Measuring Perinatal Alcohol and Other Drug Treatment Outcomes

Information about the effectiveness of alcohol and other drug treatment programs for chemically dependent women is limited, partly due to a general lack of studies, as well as methodological limitations among those that do exist. This manuscript describes some issues and practices derived from the design and implementation of an evaluation of health and social outcomes of participants in the California Perinatal Services Network, a statewide effort designed to promote perinatal alcohol and other drug treatment and recovery through effective services. Certain advantages and disadvantages for sampling, recruitment, and data analytic strategies based on findings from this research are presented that may be useful to the planning and implementation of other AOD outcomes investigations.

Using a multimethod approach to measure success in perinatal drug treatment.

In the evaluation study of Options for Recovery (OFR), a comprehensive statewide initiative to promote perinatal drug and alcohol recovery, a critical step in the design and implementation of the research was to define and operationalize indicators of success. Rather than rely on any single evaluation method, a number of different data-gathering strategies were used to illuminate andprovide a context for data that pertained to a given indicator. Qualitative information, derived from the interviews with staff and clients, yielded a set of treatment success indicators that was used to guide the selection of quantitative variables, as well as provide a contextual understanding of the quantitative findings. The quantitative findings helped to objectify the qualitative information. This article discusses the practical application of this multimethod approach and its effectiveness in measuring client success and illuminating the complexities of perinatal substance use treatment and recovery.