San Francisco General Hospital Volunteer Doula Program

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San Francisco General Hospital Volunteer Doula Program

United States
Organization type: 
nonprofit/ngo/citizen sector
< $1,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

The SFGH Volunteer Doula Program provides comprehensive, culturally and linguistically appropriate doula services and trainings to underserved women. The Program’s mission is to empower women through the birth process by offering continuous doula support to women in labor, postparutm support as well as education and trainings for the doulas that serve them.

About Project

Problem: What problem is this project trying to address?

The problem that we are addressing is twofold. The first issue is the existing lack of support during pregnancy, birth and postpartum for low-income women of color in the U.S. Secondly, birth in the hospital setting is often over-medicalized and treated as a pathological condition rather than a natural and empowering process for women. Because of this, hospital birth can be disempowering and physically and/or emotionally traumatizing for the women, their partners, family, and other support people.

Solution: What is the proposed solution? Please be specific!

We are one of only a handful of in-hospital, volunteer doula programs in the U.S., the only shift-based hospital program in our area and one of two programs in the US that offer bi-lingual birth doula trainings. This latter aspect of our program means that we are able to recruit and train women to serve as doulas in their own communities. The women who deliver at SFGH are almost entirely low-income, minority, and often non-English speaking. Our program provides doula services that would otherwise be inaccessible to the large Latina and other minority populations in our area, as well as offering through our trainings a viable job option for women who wish to seek paid doula work outside the hospital setting. This is critical for the women in our community who have few job skills and/or access to job training. After extensive web research, I discovered that we are also unique in offering spanish language post-partum doula trainings. Our goal is to expand our program to include postpartum doula support in the home. Postpartum doulas will provide support with breastfeeding, household chores, and infant care up to 6 weeks postpartum. The women who birth at SFGH often have little to no support when they return home . Studies suggest the possibility that doula support may decrease the incidence and severity of postpartum depression – a particularly prevalent issue among our low-income African American clients. By providing new mothers with doula support we hope to increase continuance rates with exclusive breastfeeding, prevent or mitigate postpartum depression, and even reduce the numbers of infants who return to the hospital with severe health issues. The need for emotional and physical support before, during and after birth is largely unappreciated by the medical establishment despite studies showing that doula support may reduce length and complications in labor, promote breastfeeding, and support better parenting skills. We work to integrate appreciation for d
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

The women who have used our doula services have given consistently positive evaluations of their experiences with the doulas - saying that the doula support was invaluable and that they believe that their birth experiences would have been much more difficult without the presence of a doula. Studies show that women who feel empowered, respected and in control during their birth experience go on to be more confident and skilled as parents and more successful with breastfeeding. The results of the evaluation data that we have collected indicates that the women at SFGH who have had doulas have these kinds of positive feelings. One important aspect of that support is reflected in the C-section statistics at SFGH. Women supported by doulas at our hospital have a 14% C-section rate compared to 25% and higher among the total population of SFGH births. Epidural rates are 20% for women who have doula support vs. 38% for all birthing women at SFGH.
About You
San Francisco General Hospital Volunteer Doula Program
Section 1: You
First Name

Monnie Reba

Last Name



San Francisco General Hospital


, CA, San Francisco County

Section 2: Your Organization
Organization Name

San Francisco General Hospital Volunteer Doula Program

Organization Phone


Organization Address

1001 Potrero Ave. San Francisco, CA 94110

Organization Country

, CA, San Francisco County

Your idea
Country and state your work focuses on

, CA, San Francisco County

Do you have a patent for this idea?


Our program recruits and trains volunteer doulas that commit to serve at least 100 hours in 12-hour shifts at the SFGH Birth Center. SFGH Doulas provide judgment-free emotional and physical support to birthing women, thereby enabling them to have a sense of control and ownership in their birth experience. Our continuity of care through the entire labor and birth, through multiple shift changes among doctors, midwives and nurses, gives the patients a feeling of being cared for and valued. This respect can give them the confidence to birth in whatever way they wish.

SFGH doulas are able to be advocates and educators for everyone involved in a birth – from the women in labor to their partners, families, and even the medical providers. By listening to the woman and establishing trust with her, doulas are often able to convey and/or translate (sometimes literally between languages) the woman’s wishes to her family and medical caregivers.

In addition to providing free doula services, our program trains women from the patient population and local community health organizations to work as doulas. These local women and health workers are able to avoid the linguistic and cultural barrie


We have approximately 25 doulas volunteering at the hospital on a monthly basis. This translates to 200-300 women receiving doula services each year. We have trained an additional 30 doulas in 2010 who are at different stages in the volunteer orientation process of SFGH. This new group includes staff from local community organizations including Homeless Prenatal, Teenage Pregnancy and Parenting Program, Black Infant Health and Good Samaritan (the latter organization serves undocumented immigrants and victims of domestic violence). We have trained our first group of postpartum doulas and are in the negotiation process with the SFGH administration for designing the protocol for home visits by postpartum doulas.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

Several factors will contribute to the success of our program. Having reached functional capacity as a volunteer-run and staffed organization for the past five years, we are preparing to expand with a plan for organizational development, capacity building, and fundraising.

First Year (Current): Create a Task Force to address priority areas to build our organization (this group was formed a month ago). The priority areas include, Education, Communication and Outreach, Finance and Fundraising, Membership and Community. Initiate English language Birth and Postpartum doula trainings (completed). Successfully negotiate with the SFGH Administration to expand our doula program to postpartum home visits.
Meet with the public health nurses to gain support for our in-home doula program.

Second Year: Continue to recruit and train volunteers for the program. Successfully initiate and complete Spanish-only birth and post partum doula trainings. Continue English trainings. Obtain funding thorugh grants or private donors to enable continuing trainings for local women who are unable to pay tuition. Implement the postpartum doula home visit program working closely with the public health nurses to set up a program that is also supportive of their home visit program . Continue building partnerships with government agencies including public health nurses and with local NGOs to effectively support and expand our client base. Approach the administration of the hospital to negotiate for a salaried position for the Director of the doula program.

Third Year: Develop diversified revenue streams: an individual donor base, ongoing grant funding, fees from trainings, and t-shirt sales. Develop our website as an effective fundraising tool. Continue funding for the Director position and obtain funding for a part-time Program Coordinator who would be recruited from the doula community. Continue to build and enhance our relationships with other community organizations.

What would prevent your project from being a success?

To date, our program has been a success but the primary issue we face is sustainability. For five of the six years of our existence the SFGH Doula program has been almost exclusively led and administered by a volunteer program director. We have had temporary support from volunteer doulas within the program and unpaid interns from San Francisco State University.

While we anticipate continuing to rely on volunteers from the community, we need funding to support administration of the program, especially in light of the anticipated expansion of our program. The vital time and energy commitment from the director and a possible program coordinator are incompatible with the current volunteer status. Lack of resources either funding or a decrease in our volunteers would prevent us from continuing successfully. In ability to create paid job positions to expand and administer the program could well result in the demise of the program as at this time if the unpaid director were to step down we don’t have a viable way for this project to continue.

How many people will your project serve annually?


What is the average monthly household income in your target community, in US Dollars?

$100 ‐ 1000

Does your project seek to have an impact on public policy?

What stage is your project in?

Operating for more than 5 years

In what country?

, CA, San Francisco County

Is your initiative connected to an established organization?


If yes, provide organization name.

San Francisco General Hospital and Trauma Center

How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?

Does your organization have any non-monetary partnerships with NGOs?


Does your organization have any non-monetary partnerships with businesses?


Does your organization have any non-monetary partnerships with government?


Please tell us more about how these partnerships are critical to the success of your innovation.

Our partnerships allow us broader access to target populations, the capacity to build a supportive community for our doulas and patients, and the ability to deliver comprehensive services to our clients. By training doulas already working for and involved with community organizations, we are able to connect directly with those organizations whose clients are usually served medically by SFGH. They serve our clients in turn with needed support including housing, drug rehabilitation, counseling, clothing and ongoing family support. The community health workers from other organizations contribute to doula education in our program on cultural competency and diverse socio-economic issues such as homelessness, drug use, domestic violence and sexual abuse.

What are the three most important actions needed to grow your initiative or organization?

1. Fundraising and creating diversified funding streams.
2. Creating organizational systems that assist us in building capacity to achieve our goals.
3. Continued recruitment of skilled and committed doulas.

The Story
What was the defining moment that led you to this innovation?

My first defining moment was being birthed by a mother who was anesthetized during my birth with narcotics and amnesia inducing drugs, not able to see her baby for hours after the birth and was not supported to breastfeed. My awareness of the trauma of my own birth led me to work in the birthing field to empower and support other women to have more control and awareness of, and satisfaction with their own birth processes. After working for many years in a county hospital serving low income women I came to believe that the services that doulas offer are one of the most powerful forces to initiate change in how birth is viewed, supported (or not) in the hospital setting and society as a whole and doulas are also a strong force in returning the power of birth to the women who are birthing. To bring doulas with their philosophy of supporting a woman to have the birth she wants into the hospital where women are often rendered powerless and traumatized during and after birth provides a powerful force for creating change in the dehumanized process that birth often becomes in the hospital setting.

Tell us about the social innovator behind this idea.

Monnie Reba Efross has been a staff nurse in the Birth Center at San Francisco General Hospital for 30 years. Previous to this she worked as a volunteer and then staff member in the Berkeley Women’s Health Collective, an organization that trained lay people to perform medical procedures and led groups to empower women and girls to take control of their health and healthcare. Monnie has an MA in Nursing and is a Lamaze Certified Childbirth Educator. She teaches childbirth education classes at SF general hospital and has also worked as a private doula, health coach and medical advocate.
Monnie has a strong committment to empowering women in the healthcare system and ultimately in their lives.

aches childbirth education classes at SF general hospital and has also worked as a private doula, health coach and medical advocate.
Strong committment to empowering women in the healthcare system

How did you first hear about Changemakers?

Through another organization or company

If through another, please provide the name of the organization or company

San Francisco Doula Group