Doulas on TV: Frasier to Bones and Beyond

donainternational:

In honor of the repeat of Bones that aired last night:

Originally posted on The DONA Doula Chronicles:

screen-92134_640The birth community has been abuzz about the latest portrayal of doulas on a primetime television show. Yes, the doula in Bones was outside of our scope of practice and, in general, did not provide the appropriate emotional, informational and physical support she was hired to provide (which is why she was fired). Many blogs and social media accounts related to birth have decried this portrayal of doulas to the millions who watched Bones that week.

Wait…..over five MILLION people saw the episode of Bones that included a doula? And since then there have been dozens if not a hundred conversations in on-line birth communities about what doulas do and don’t do? Is that necessarily a bad thing? Would there have been so many conversations if the show portrayed a doula practicing within her scope and providing excellent support to the mother? Probably not. No one is talking about the…

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International Doula Month: DONA’s Social Media Campaign

Each May we celebrate International Doula Month to promote awareness of the benefits of doula support during the childbearing year and increase visibility of our profession in our communities. For International Doula Month 2015, DONA International has organized a social media campaign to spread the word about what doulas do, how we support families and the benefits associated with professional labor and postpartum support.

Here are five ways you can support International Doula Month via social media:

1. Make sure you are following DONA International’s official Facebook page for daily facts (and funnies) about doulas.

2.  Change your profile picture to one of these International Doula Month badges.

Certified Doula Badges

IDM15-profile pics-certified birthIDM15-profile pics-certified PP

DONA International Member Badges

IDM15-profile pics-member birthIDM15-profile pics-member PP

Doula Badges

IDM15-profile pics-birthIDM15-profile pics-PP

3.  Share our daily fact posts to your timeline and Facebook groups. For those who tweet and pin, feel free to share on Twitter and Pinterest as well!

4. Post about your experience as a doula, why you love what you do, your favorite quotes or resources about doulas.

5. Use the hashtags #IDM15 and #DONAIntl when you post this month.

We’ll have more here at The DONA Doula Chronicles for International Doula Month as well. Happy International Doula Month!

Countdown to International Doula Month

With only a few days left in April, International Doula Month is just around the corner. May was designated as International Doula Month in 1998 and is a great time to plan an event, collaborate with community organizations dedicated to the health of women and families, or contact the press about the important work of doulas.

Looking for ideas to increase awareness of doulas in your community? We shared some ideas a few weeks ago.

DONA International will be kicking off a social media campaign with images you can use for your profile picture, facts about doulas and suggestions to help you spread the work on Facebook, Twitter, Pinterest, etc. Be sure to look for and use the hastags #IDM15 and #DONAIntl too.

We’ll share more here at The DONA Doula Chronicles soon and be sure to follow DONA International via:

Our official Facebook page

The DONA International Facebook group

Cesarean Resources for Doulas

Cesarean Awareness MonthTo round out The DONA Doula Chronicle’s posts for Cesarean Awareness Month, we have compiled a list of resources for doulas and our clients about cesareans, doula support for these births and, since many cesareans are repeat cesareans, resources on vaginal birth after cesarean. While this collection is not complete, of course, we hope it will provide a good resource collection for doulas supporting families birthing via cesarean. Know of other resources? Please add them in the comments!

Doulas & Cesareans

The International Cesarean Awareness Network (ICAN) has an article on their blog written by a certified doula on the value of doula support for a planned cesarean: http://www.ican-online.org/blog/2015/03/world-doula-week-a-doula-at-a-cesarean-birth/

ICAN also offers an article on doulas, entitled “Professional Labor Support,” available for download and distribution to clients, students and providers. While focused on the role of doulas in general, the document specifically mentions that mothers planning cesareans and VBACs can benefit from doulas. The writer shares her experience using a doula for her vaginal birth after two cesareans, including a quote from her husband on the support he received from their doula.

A Doula Can Reduce Your Odds of a Cesarean” is available at vbac.com, as well as links to research showing that women supported by doulas have fewer interventions, including cesareans. This article also provides a good overview of doulas as well.

The American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) issued a joint statement last year, “Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery.” The paper states that one of the most effective tools available to reduce the cesarean rate is doula support.

Cesarean Birth Resources

The Truth about C-Sections, a five minute video by renowned birth researcher Eugene Declerq, PhD, is a quick but comprehensive overview dispelling myths about what is driving the c-section rate in the United States.

For a more expanded video on this topic, Birth by the Numbers: Myth and Reality Concerning US Cesareans is a video lecture with visuals by Dr. Declerq lasting just over 20 minutes.

What Every Pregnant Woman Needs to Know About Cesarean Section” is a 14 page booklet from Childbirth Connection published in 2012.

ICAN offers a reading list on their website useful for both doulas and our clients. Included are books on recovery after a cesarean, collections of stories of women who have had cesareans and chronicles of women who advocated for a VBAC.

A collection of white papers is also available from ICAN on Breastfeeding After A Cesarean, Recovering From A Cesarean – Tips On Healing and The Suture Debate.

The Evidence for Skin-to-Skin Care after a Cesarean is an excellent resource from Evidence Based Birth that outlines the value of skin-to-skin care in general and research specific to skin-to-skin after a c-section.

VBAC Specific Resources

While most c-sections are primary cesareans, about 25% of all c-sections are repeat surgical births. Supporting women who are seeking a VBAC requires unique considerations and preparedness for doulas. In this case, the mother’s past birth experience is a significant factor in her preparation for her next birth.

ACOG offers a brief VBAC Frequently Asked Questions document for patients which clearly states that mothers who have birthed via cesarean have a choice in how they have their next baby.

In 2010, ACOG released a Practice Bulletin specifically about VBAC which states that women with one or two previous cesareans, including those carrying twins, are candidates for a trial of labor:

Making Informed Decision About VBAC or Repeat Cesareans” from vbac.com is an evidence-based article, updated just last month, that outlines what women should know about VBAC and a strong list of resources for additional information helpful to doulas and families, including a Lamaze International webinar.

Cesarean Awareness Month Film: Trial of Labor

Trial of Labor movieTrial of Labor is a documentary about four women seeking a vaginal birth after cesarean (VBAC). The film is a powerful chronicle of their experiences reflecting on their cesarean births, seeking information about VBAC, navigating care provider and hospital policies, healing their emotional wounds and following them through their births with their current pregnancies.

The film opens with the women telling their labor and cesarean birth stories. Some were induced, others had labors which began spontaneously. They go on to describe their surgical birth experience and what it was like to meet their babies for the first time in the operating room. C-sections are shown in the opening segment as well, including one where a vacuum is used. The women then reflect on their experiences and why they had cesareans – concern for the life and safety of their children, failure to progress, failed inductions prior to 40 weeks and fetal distress indications on an electronic fetal heart monitor. Their fear, shame and frustration are evident as they discuss feeling as though they were not listened to or respected. One woman says she felt very misinformed about labor, birth and the risks of interventions. “What do you say when you doctor’s telling you that you are going to die if you do this any other way than he sees fit? I didn’t want to die,” she says. Another describes herself as “foolish” and expresses anger at the medical system because she felt she lacked a voice and options in her birth. The guilt these women carry is enormous. They talk about how they feel that they didn’t put in the time and effort for a natural birth, didn’t stand up for themselves and how they feel they failed their children and themselves. It is clear that attempting a VBAC is key to their emotional healing from their previous birth experience. One woman describes a trial of labor as the ability “to be allowed the freedom to trust your body”.

About 20 minutes into the film doulas are mentioned. One mother had a doula for her first labor and birth and is using a doula again. Another chose to hire a doula for her current pregnancy and planned VBAC for greater support in the labor and delivery room. This mom goes on to say she chose to have a doula to advocate for her, which we DONA International doulas know is outside of our Scope of Practice. While this particular woman says she wants to be able to make informed decisions in labor, her description of what she is expecting from her doula illustrates that we still have work to do to educate families on our role. Doulas, as non-medical support people, do not say, as this mother expects, “No, you know what, I don’t think she needs Pitocin” or “I think she can get through this without an epidural for a little longer.” Doulas are later mentioned as providing key support to partners, allowing them to process their own feelings as a parent and the conflict they may feel in trying to support the mother’s wishes. Childbirth educators and doulas wishing to show this film to families will want to be sure to discuss the role of doulas as important informational, emotional and physical support providers and be clear that we cannot and do not offer medical advice or intervene between a patient and care provider.

As these women continue on their VBAC journeys they encounter many obstacles, including doctors telling them they had no choice but to have a c-section if they wanted to remain their patients, hospitals with VBAC bans and insurance companies that won’t cover birth center or homebirths for VBACs. The physical and emotional vulnerability they experience is profound. It seems that the confidence they gained as they chose and planned for a VBAC is tenuous and easily eroded by their care providers. As one mother put it, “It feels like they just set you up to doubt your decision; start to feel that you are putting your baby’s life at risk, being completely outrageous.” The mothers face looming deadlines for non-stress tests and ultrasounds and pressure to go to the hospital in early labor based on their doctor’s concerns regarding VBACs. The film also includes brief interviews with physicians who discuss the liability risk they feel is inherent in VABCs.

In the end, these four women gain a great deal of healing from their trial of labor experiences even though not all have vaginal births (I won’t spoil the ending for you!). One woman describes her trial of labor as “very healing” and another says she now knows there is a choice. You can see that, despite their very real fears of reprisal, for going against the preferences and recommendations of their care providers, these women, in their own words, feel “strong,” “powerful” and “empowered” by the experience.

One of the final interviews in Trial of Labor says it best when the mother reflects on how it doesn’t matter if a mother births vaginally or via cesarean. As she says, “What matters is the mother you are after that birth happens”.

Trial of Labor is an intense chronicle of the experiences of four women seeking a vaginal birth after cesarean. With additional conversation about the true Scope of Practice of doulas, it can be a powerful film to share with families. Even first time mothers can learn a great deal from the movie about the power of information, self-advocacy, a support network and choice. The film is currently screening across the United States and free viewings via their website are also available for a limited time. Find out more at trialoflabor.com.

— Adrianne Gordon, CD(DONA), MBA

ACOG Seeks Better Adoption of Evidence-Based Standards

The American Congress of Obstetricians and Gynecologists (ACOG) released a new Opinion from their Committee on Patient Safety and Quality Improvement encouraging the use of protocols and checklists to help providers implement the Congress’ recommendations and protocols. ACOG has made standardization of care a key goal to address the wide variation in practice within the field in an effort to improve patient safety and overall outcomes. The Opinion states that while variation in care is at times completely appropriate, standardized protocols and checklists have been shown to improve patient safety. The Congress goes on to state that protocols should be developed through an OB-GYN led process that is multidisciplinary, collaborative and includes hospital administration, nurses, patient advocates and other health care professionals.

“The motivation and intent for any protocol or checklist should be to ensure high quality, safe and, when possible, evidence-based practice.” – Clinical Guidelines and Standardization of Practice to Improve Outcomes, Committee Opinion, ACOG

As doulas, one of our main roles is education and providing the families we serve with evidenced-based information to use in their decision making. This most recent publication from ACOG emphasizes just how needed this function is for birthing families. In their news release ACOG states that adoption and implementation of their guidelines “lags behind their publication” in part due to lack of awareness by physicians of those guidelines. The Opinion states, “For 78% of medical practice guidelines, more than 10% of physicians are not aware of their existence.” Informing our clients of ACOG’s guidelines for care and empowering pregnant and postpartum mothers to ask their providers about those guidelines appears to be a valuable service to both patient and care provider alike!

The U.S. Department of Health & Human Services maintains a National Guideline Clearinghouse available to the public and searchable by topic. You can find their collection of ACOG’s guidelines here: http://www.guideline.gov/browse/by-organization.aspx?orgid=85

ACOG guidelines

 

 

 

 

 

 

Doulas and the families we serve can also search ACOG’s own site for specific guidelines (i.e. “clinical guidelines VBAC”).

ACOG search

DONA International Stands Against “Informed Doulas Report”

anap

Editor’s Note: Ana Paula Markel is the Director of International Development for DONA International, a certified birth doula and birth doula trainer, and certified childbirth educator based in Los Angelos, California, USA. She has provided this statement from DONA International in response to the recent report from Spain’s General Nursing Council. — AG

DONA International is a non-profit organization of doulas that strives to train and educate each of our doulas to provide the highest quality and standard of care for birth and/or postpartum support to birthing women and their families. We promote continuing education for doulas and provide a strong communication link among and between doulas, families and the medical birthing community. Our membership exceeds 6,500 doulas in 50 different countries.

DONA International upholds strong guidelines for doulas with its Standards of Practice and Code of Ethics, maintaining that doulas are non-medical support professionals for families in the childbearing year.

DONA International would like to take a stand against the “Informed Doulas Report” from the Consejo General de Enfermeria (General Nursing Council) in Spain. The report and website contain serious and untrue allegations against the profession of labor support (doulas) that are considered defamatory and untrue, and falsely accuses doulas of engaging in harmful practices.

DONA International has been in touch with The European Doula Association and understands that at no point were they consulted; neither were any Spanish doula organizations nor parents or medical professionals who have worked with doulas. It also appears that the Consejo General de Enfermeria either did not examine or take into consideration various medical publications and studies about the benefits of labor support.

The true role of the doula:
A doula is a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth, or one who provides emotional and practical support during the postpartum period. Studies have shown that when doulas attend births, labors are shorter with fewer complications, and babies are healthier and breastfeed more easily. Evidence shows that the quality services of a postpartum doula can ease the transition that comes with the addition of a baby to a family, improve parental satisfaction and reduce the risk of mood disorders.

A Birth Doula:
• Recognizes birth as a key experience the mother will remember all her life
• Understands the physiology of birth and the emotional needs of a woman in labor
• Assists the woman in preparing for and carrying out her plans for birth
• Stays with the woman throughout the labor
• Provides emotional support, physical comfort measures and an objective viewpoint, in addition to helping the woman get the information she needs to make informed decisions
• Facilitates communication between the laboring woman, her partner and her clinical care providers
• Perceives her role as nurturing and protecting the woman’s memory of the birth experience
• Allows the woman’s partner to participate at his/her comfort level

Numerous clinical studies have found that a doula’s presence at birth:
• Tends to result in shorter labors with fewer complications
• Reduces negative feelings about one’s childbirth experience
• Reduces the need for synthetic oxytocin, forceps or vacuum extraction, and cesarean
• Reduces the mother’s request for pain medication and/or epidurals

A birth doula certified by DONA International is designated by the credentials CD(DONA).

A Postpartum Doula:
• Offers education, companionship and nonjudgmental support during the postpartum period
• Assists with newborn care, family adjustment, meal preparation and light household tidying
• Offers evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills for new parents, and makes appropriate referrals when necessary

Research shows parents who receive postpartum support:
• Feel more secure and cared for
• Are more successful in adapting to new family dynamics
• Have greater success with breastfeeding
• Have greater self-confidence
• Have less postpartum depression
• Have lower incidence of abuse

A postpartum doula certified by DONA International is designated by the credentials PCD(DONA).

Doulas support families from all ethnic, religious and social backgrounds globally.

Women have complex needs during childbirth and the weeks that follow. In addition to medical care and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences.

DONA International doulas are educated and experienced in childbirth and the postpartum period. They are prepared to provide physical (non-medical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. They offer a comforting touch that makes childbearing women and families feel nurtured and cared for.

Furthermore, the 2013 Cochrane Review on continuous support for women during childbirth concluded that “all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training [i.e. a doula], appears to be most beneficial.” (Hodnett et al, 2013)

The 2012 commentary by The World Health Organization Reproductive Health Library “Continuous support for women during childbirth” states, “Considering all the advantages and possible lower costs to the health system associated with the presence of a doula (less likelihood of cesarean sections and analgesia use), covering the cost of doula services should be considered by policy-makers.”

The European Convention on Human Rights offers protection to all individuals making choices in childbirth. In recent cases, the courts have asserted that Article 8 of the Convention protects women’s right to decide the circumstances and location in which they give birth. Women should never have any medical procedure performed without consent, should be able to decline unwanted interventions, however minor they may seem to staff, and should always be provided with sufficient, objective and unbiased information to make an informed choice. In extreme cases, disrespectful treatment during childbirth may also violate Article 3 of the Convention which relates to cruel, inhuman or degrading treatment.

For decades, DONA International has been collaborating with medical professionals in a supportive and productive fashion. In fact, in January of 2014, the American Congress of Obstetricians and Gynecologists released a statement, in which they endorsed doula care.

DONA International also understands that there are incidents, as in any profession, where individuals may not represent the profession well or properly, and for that, we have a formal grievance process to examine such cases, when needed.

In conclusion, DONA International encourages The Consejo General de Enfermeria of Spain to remove the report and the associated website, and to conduct a proper, evidence-based study. DONA International would like to volunteer its assistance in this effort.

 

References:

European Doula Network: Response to the Consejo General de Enfermería (General Nursing Council, Spain) ‘Dossier de prensa – La verdad sobre las doulas
http://www.european-doula-network.org/doula/media.php

DONA International Position Paper: The Birth Doula’s Contribution to Modern Maternity Care, 2012 http://www.dona.org/PDF/Birth%20Position%20Paper_rev%200912.pdf

DONA International Position Paper: The Postpartum Doula’s Role in Maternity Care, 2012 http://www.dona.org/PDF/positionpaper_PPdoula_083011.pdf

Hodnett, ED, et al. “Continuous Support for Women during Childbirth (Review),” 2012 http://www.cochrane.org/CD003766/PREG_continuous-support-for-women-during-childbirth

WHO Reproductive Health Library, “Continuous Support for Women during Childbirth. http://apps.who.int/rhl/pregnancy_childbirth/childbirth/routine_care/cd0003766_amorimm_com/en/

European Convention on Human Rights http://www.echr.coe.int/Documents/Convention_ENG.pdf

ACOG Obstetric Care Consensus. “Safe Prevention of the Primary Cesarean Delivery.” http://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery

Celebrating Doulas: World Doula Week!

hand-644145_1280Happy World Doula Week! According to the website, World Doula Week was chosen to coincide with the spring equinox which is associated with fertility in many cultures. This is a great opportunity to share about the role of doulas and the benefits of doula support.

Did World Doula Week catch you unprepared to organize an event this year? No worries, May is International Doula Month and now is the time to make plans! Established in 1998 to promote the value of doula support, International Doula Month was selected to coincide with Mother’s Day. With five weeks left for planning, here are some ideas to recognize and celebrate our role as those who mother the mother:

Organize a film showing. Movies are a great way to gather people together and allow them to learn about the important work of doulas. The Business of Being Born and Orgasmic Birth are popular choices. A post-film discussion with doulas can be a great way to round out the event.

Give a presentation about doulas. Childbirth classes, community events and even provider’s offices can provide good opportunities to share about doulas and do a little marketing.

Media outreach. Do you have a client who is willing to share her story? Your local newspaper, magazines or public radio show may be interested in either an interview or a written piece from you. Contact writers or hosts who cover families or health for the best results.

Host a client reunion. This can be a fun way to get families together and stay connected with past clients. Partner with other doulas to make it a larger event and even more fun.

Leverage social media. Plan a series of posts for May with images (make sure they are available for use, of course), quotes and resources about doulas. A little pre-planning and research can go a long way toward getting the message out about doulas via Facebook, Twitter or Pinterest. You can also share the video Essential Ingredient: Doula which is available for free via YouTube.

Send cards to clients. If an event is too much to take on, start gathering addresses for past clients and pick-up cards wishing them a Happy Mother’s Day.

Now is a great time to order brochures or other materials from the DONA Boutique, get additional business cards printed, check out available venues and reach out to other doulas in your areas to begin planning events for International Doula Month (and of course make notes for World Doula Week 2016!).

We’d love to hear about what you’ve done to celebrate World Doula Week and your plans for International Doula Month! Please share in the comments below.

Joint ACOG/SMF Statement on Maternity Health Levels

In a joint statement released last month entitled Obstetric Care Consensus: Levels of Maternity Care the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) called for the creation and adoption of a classification system for maternity care. The statement outlines five levels of care which increase in their ability to handle medical complications for pregnant and postpartum women: Birth Centers, Level 1 (Basic Care), Level II (Specialty Care), Level III (Subspecialty Care) and Level IV (Regional Perinatal Health Care Centers).

The statement goes on to describe each level of care center, the type of care providers available and examples of the patients appropriate for each. For example, birth centers are described as providing care for low risk women, those with uncomplicated, singleton pregnancies with a baby in the vertex position. The capabilities of a birth center include the ability to provide low-risk maternal care, transfers to a higher level facility should the need arise and medical consultation at all times. In this document, every patient at a birth center is to be attended by certified nurse midwives, certified professional midwives and other legally licensed midwives. Level III facilities, on the other hand, care for complex maternal, obstetric and fetal conditions and provide advanced imaging services such as ultrasound at all times, have medical and surgical intensive care units for pregnant patients, offer round the clock anesthesia services onsite, and have both maternal fetal medicine specialists and critical care providers onsite at all times. The overall idea is to match the patient with the right level of care for her needs so as to improve outcomes for maternity care. ACOG and SMFM propose that this system be coordinated regionally so that patients have access to varying levels of care.

consensus for maternity care

This idea of a tiered and integrated system of care based on specific capabilities is not at all new. In fact, in 1976, the March of Dimes issued a report (Toward Improving the Outcome of Pregnancy) that outlined a system to create designated levels of care for pregnant women and newborns based on their medical needs. In the nearly forty years since, a tiered system for neonatal care has been put in place based on the capabilities and staffing at hospitals and was last updated in 2012. Last month’s ACOG and SMFM statement notes that studies have shown that this system has improved outcomes for babies and calls for a similar system for maternity care. Currently, Arizona, Indiana and Maryland have guidelines which establish maternal care criteria but the three are operating independently and do not use the same designations or descriptions for each level. ACOG and SMFM suggest a nationally consistent system using agreed upon definitions and criteria.

At first glance, Obstetric Care Consensus: Levels of Maternity Care may appear to be of more interest to hospital administrators who want to obtain the appropriate designation for their facility than birthing families or the doulas who support them. However, this document has a great deal of educational value that doulas can reference. The descriptions for each facility level can help families better understand the differences between facilities and make more informed choices for a birthing location that best meets their medical needs as well as understand why they might be transferred to a higher level facility should complications arise. This joint statement also clearly supports midwifery care for uncomplicated pregnancies and birth centers as appropriate options for low risk mothers. This is very important in ensuring that families have a range of choices in care provider and facility for their births.

It is unclear how long it will take for such a system to be adopted nationwide. The report notes that many barriers will need to be overcome to implement such a system including determining if state or even national accreditation organizations need to be established and funded to oversee this system.

This is the second joint statement from ACOG and SMFM. Last year they jointly issue Safe Prevention of the Primary Cesarean Delivery, which directly referenced the value of doula support in lowering the cesarean birth rate. We can likely expect more collaboration between these two maternity care organizations in the future.

The Birth of a Hospital Doula Program

sujata_gamiEditor’s Note: Sujata Gami has been on staff with the Women’s Education Department at St. Francis Hospital in Greenville, SC as a childbirth educator since 2007. Her experience with the Alternative Birth Methods team she describes below has inspired her to become a certified birth doula, doula mentor and volunteer as the SPAR (State/Regional/Area Representative) for DONA International. Her story illustrates how we can impact not only families with our work but our entire community – even hospitals and providers – and be personally changed by that experience.
— Adrianne Gordon


In 2014, St. Francis Hospital in Greenville, SC formed an Alternative Birth Methods team, comprised of hospital administration, nurses, providers and educators. The objective of this interdisciplinary/collaborative team was to discuss and brainstorm growth strategies for hospital volume and promote communication among providers, nurses, the women’s education department and administrators using shared decision making and teamwork.

We discussed the major findings of the National Listening to Mother Survey III on attitudes, choice, control and decision making of childbearing families and its implications on perinatal care practice. Almost six in ten (59%) of the mothers in the survey agreed with the statement, ‘Giving birth is a process that should not be interfered with unless medically necessary.’ We discussed how the demographics of the population we served at St. Francis Women’s Hospital also had similar attitudes and wanted more choices and control in decision making.

In an open dialogue, our providers shared that their practices did offer choices and shared decision making to their patients; however, there were some areas where we as a team could focus our efforts to change perceptions related to meeting the non-medical, psychosocial needs of laboring women. We also discussed how our medical system is set up whereby the doctors and nurses are primarily responsible for the health and wellbeing of the mother and baby and that these priorities usually take precedence over the nonmedical, psychosocial needs of laboring women. The highly technical function of today’s clinical nurse and how it lessens her ability to give the type of continuous social support that can impact outcomes was also discussed. After exploring and talking about the role of a birth doula and the impact a trained, skilled labor support person can have to empower women, which can then lead to better birth outcomes and patient satisfaction, the team came to the consensus that a St. Francis Hospital Doula Program should be implemented.

Following the decision, my role was to understand the requirements of the DONA International birth doula certification process. I started the process of gathering information to chalk out the prerequisites of becoming a certified birth doula and, one step at a time, completed all of the requirements personally, including attending births as a doula in training. Throughout the process, I updated my manager in the Women’s Education department consistently about the doula’s Scope of Practice, details of documentation required, challenges I faced and feed-back from patients. My manager used the information to sketch out a plan to hire and train a cohort of doulas with the goal of having these newly hired birth doulas work as part of a team alongside our maternity-care providers and nurses at St. Francis Hospital.

Here is an outline of the milestones of conceptualizing, planning, implementing, hiring and training of the doula cohort:

St._Francis_Timeline

 

 

 

 

 

 

 

 

 

 

 

 

 

By utilizing an integrated and collaborative interdisciplinary team approach, the Alternative Birth Methods initiative at St. Francis was successful in:

  • Demonstrating effective communication between hospital administrators, providers, nurses and educators.
  • Information sharing amongst the team regarding what worked and what could be done differently
  • Conceptualizing, planning and implementing a hospital doula program set-up for success
  • Planning and organizing an in-service training for labor and delivery nurses to ensure that they buy into the hospital doula program.
  • Planning and organizing an in-service training for the newly hired doula cohort to ensure they were adequately trained to practice within the DONA International birth doula scope of practice.
  • Working out scheduling details for best client doula match-ups so that laboring women’s needs are met and contracted doulas get adequate financially sustainable work.

Another significant outcome of the interdisciplinary team meetings was that it was decided to have a Lamaze Evidence Based Nursing training for our nurses. Like the DONA International birth doula training, this training is evidenced based and served to get everyone in the maternity care team on the same page to effectively meet the medical, emotional, physical and psychosocial needs of women in labor, which we expect will lead to both better birth outcomes and greater patient satisfaction.

— Sujata Gami, MS, LCCE, FACCE, CD(DONA)

Learn more about the St. Francis Doula Program.

Resources:
Ballen, LE, Fulcher, AJ. (2006). Nurses and doulas: Complementary roles to provide optimal maternity care. JOGNN; 35(2): 304-311

Declercq, ER, Sakala, C, Corry, MP, Applebaum, S, Herrlich, A. (2013). Listening to Mothers SM III: New Mothers Speak Out. New York: Childbirth Connection, June.

Klaus, M.H., Kennell, J.H., & Klaus, P.H. (2012). The doula book: How a trained labor companion can help you have a shorter, easier, and healthier birth. Boston, MA: Merloyd Lawrence Books. ISBN: 0738215066/ISBN-13:9780738215068.

Simkin, P. (2013). The birth partner: A complete guide to childbirth for dads, doulas, and all other labor companions (4th ed.). Boston, MA: Harvard Common Press.

Hodnett ED. (2002). Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol; 186(5): S16072.

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www.dona.org

www.motherfriendly.org