In Shelby County, Tennessee, the African-American infant mortality rate exceeds the state and national average by more than 50 percent. The infant mortality rate is determined by the number of infant deaths per 1000 live births and is used to measure the overall health of communities worldwide. The Urban Child Institute (TUCI) 2012, reported that in 2010, 13.4 of 1000 infants born to African-American mothers in Shelby County, Tennessee died before their first birthday. These numbers are numbing; all while exceeding the national average of 6.1 deaths per 1000 live births. According to a report published by the National Center for Health Statistics (NCHS)(Murphy, Xu, and Kochanek, 2012), nationally there are many reasons why infant mortality rates are high, such as congenital malformations, sudden infant death syndrome (SIDS), unintentional injuries deemed as accidents, and respiratory issues. However, in Shelby County, Tennessee the leading causes of infant mortality are low birth weight and prematurity (State of Tennessee, 2012). Other suspected attributing factors to the high mortality of infants are a lack of prenatal care, teen pregnancy and single-parenting; however, no research has proven these theories (TUCI, 2012) or found any definite reasons for the increased mortality among African-American infants. The purpose of this proposal is to determine if partnering doulas with pregnant African-American women in Shelby County, Tennessee in their first trimester will decrease the infant mortality rates. Lately there has been an increase in the use of doulas in the United States (US), however research has found that many of the mothers who can benefit the most from these intimate relationships do not have access to the services because of socioeconomic status (SES) (Low, Moffat, and Brennan, 2006). Doulas are trained nonmedical professionals who assist women by providing nonmedical emotional, physical, and educational support throughout the pregnancy or postpartum although some doulas are trained for both periods. The goal of doulas is to ensure that women have a comfortable pregnancy and birth and are empowered to make decisions that best fit their birthing plan. In addition, doulas are able to connect with mothers and families while respecting culture differences and lifestyle choices. The healthcare system is the US has a bleak past and has a ways to go if it ever to be perfected and offer equal access and treatment to all citizens. Similar to the shameful history of slavery, African-Americans endured many hardships and challenges to gain access to physicians and hospitals. Research shows that during the 1930s, African-American midwives attended approximately 80 percent of all African-American births in the south and the morbidity and mortality rates were alarmingly high (Thomas, 2006). In spite of the bills and laws created to offer African-Americans equal access to healthcare facilities and physicians, the service was not equal and many argue that this inequality continues to exist in the healthcare system. This study hypothesizes that African-American women especially in the lower socioeconomic tier tend to avoid doctor’s visit because they feel uncomfortable and degraded by their physicians and staff. The support of doulas may encourage women to take control of their prenatal health while equipping them with the tools and knowledge to demand physician attention, encouraging them to ask the important questions while designing a birthing plan, and educating them on their options when it comes to choosing or maintaining a healthcare physician. This support is essential because mothers depend on medical physicians to assist them during their pregnancy however; it is possible that some physicians allow historically preconceived stereotypes to deter them from rendering the best possible care for African-American mothers and their infants. By placing doulas with pregnant moms for the...
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