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A Volunteer Doula Project: could it work here? A Volunteer Doula Project: could it work here? Seminar ProgrammeSeminar Programme
TimeTime AgendaAgenda PresenterPresenter
9:159:15 Welcome andWelcome and
IntroductionIntroduction
9:209:20 Setting the Scene: Doula Setting the Scene: Doula care, the evidence basecare, the evidence base
Shauna PowersShauna Powers
9:409:40 The Goodwin Volunteer The Goodwin Volunteer Doula Project, HullDoula Project, Hull
Heather BarnesHeather Barnes
10:1010:10 Volunteering Doula Volunteering Doula Services: A Canadian Services: A Canadian PerspectivePerspective
Shauna PowersShauna Powers
10:3010:30 Coffee BreakCoffee Break
11:0011:00 Question/Answer Panel Question/Answer Panel DiscussionDiscussion
Heather Barnes, Amanda Heather Barnes, Amanda Hunter, Inga Cosway, Hunter, Inga Cosway, Shauna PowersShauna Powers
11:3011:30 Summary and closeSummary and close Shauna PowersShauna Powers
Birth Doulas: Birth Doulas: the evidence basethe evidence base
Shauna Powers, Shauna Powers, RN, BScN, MScRN, BScN, MSc
NHS Lothian Health Promotion ServiceNHS Lothian Health Promotion Service
Support from the StartSupport from the Start
What is a Doula?What is a Doula? A Greek word meaning A Greek word meaning woman caregiverwoman caregiver Now means a trained and experienced labour companion- Now means a trained and experienced labour companion- aa woman woman
whowho mothers a mothermothers a mother She provides emotional comfort, physical support, and assistance in She provides emotional comfort, physical support, and assistance in
obtaining information before, during and after childbirthobtaining information before, during and after childbirth
Why have a Doula?Why have a Doula? Recognizes birth as a key life experienceRecognizes birth as a key life experience Understands the physiology and emotions of birthUnderstands the physiology and emotions of birth Assists in preparing a birth planAssists in preparing a birth plan Stays by the woman’s side throughout labourStays by the woman’s side throughout labour Provides emotional supportProvides emotional support
Dimensions of labour support:Dimensions of labour support:
Emotional SupportEmotional Support – –encouragement, reassurance, encouragement, reassurance, continuous physical presencecontinuous physical presence
Informational SupportInformational Support – –help families gather information help families gather information about their labour, their options, explanations, non-about their labour, their options, explanations, non-medical advicemedical advice
Physical SupportPhysical Support – –comfort measures, positioning, comfort measures, positioning, massage, breathing, pain relief (non pharmaceutical)massage, breathing, pain relief (non pharmaceutical)
““The Case for a Volunteer Doula The Case for a Volunteer Doula Programme in Leith”Programme in Leith”
Commissioned by The Junction: Young People, Health Commissioned by The Junction: Young People, Health and Well-being after need recognizedand Well-being after need recognized
Evidence-based review of Doula and consistent labour Evidence-based review of Doula and consistent labour supportsupport
Review of Goodwin Volunteer Doula Programme (Hull)Review of Goodwin Volunteer Doula Programme (Hull) Recommendations to carry idea forwardRecommendations to carry idea forward
Evidence Base of Doula SupportEvidence Base of Doula Support
Three systematic reviews were consulted.
31 studies examining the effect of consistent physical and emotional support to labouring women.
Most reviews assessed random control trials (RCTs) that compared the physical and emotional outcomes of constant physical emotional support, predominantly provided by a doula, compared with limited or intermittent labour support.
Each systematic review has shown a marked decrease in most obstetric interventions such as caesarean sections, forceps and vacuum delivery, oxytocin induction and use of epidural anaesthesia when consistent care was apart of the labour process
Systematic ReviewsSystematic ReviewsZhang et al’s. (1996) systematic review studied the results of doula
support with young, first-time mothers with an average age of 20, involving 1,349 women. Those with doula support were:
Twice as likely to have a spontaneous delivery as the control group with no doula support.,
spent 2.8 hours less in active labour than the control group felt more satisfied with their birth experience Had an easier time bonding with their infant
Had breastfeeding initiation rates higher than those without doula support.
Systematic ReviewsSystematic Reviews Scott et al (1999), Systematic review that looked at 11 RCTs, involving a total of 4,391
women. These studies examined the outcomes of constant versus intermittent care by either medical professionals, doulas or lay female attendants.
The authors concluded that intermittent care in any form had no significant effects on medical outcomes or interventions.
However with continuous support, medical interventions such as epidural analgesia, oxytocin augmentation, forceps and caesarean section delivery were significantly reduced.
Systematic ReviewSystematic Review Hodnett et al. 2007Hodnett et al. 2007 (Cochrane Review) (Cochrane Review)
Sixteen trials involving 13,391 women Sixteen trials involving 13,391 women Primary comparison: women who had continuous intrapartum Primary comparison: women who had continuous intrapartum
support were likely to have a slightly shorter labour, were more likely support were likely to have a slightly shorter labour, were more likely to have a spontaneous vaginal birth and less likely to have to have a spontaneous vaginal birth and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth intrapartum analgesia or to report dissatisfaction with their childbirth experiences. experiences.
Subgroup analyses: in general, continuous intrapartum support was Subgroup analyses: in general, continuous intrapartum support was associated with greater benefits when the provider was not a associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour and in member of the hospital staff, when it began early in labour and in
settings in which epidural analgesia was not routinely availablesettings in which epidural analgesia was not routinely available..
Individual Studies and Systematic ReviewsIndividual Studies and Systematic Reviews(Powers 2009)(Powers 2009)
Medical InterventionMedical Intervention CitedCited
Decreased Caesarean Section Decreased Caesarean Section RatesRates
McGrath & Kennell, 2008McGrath & Kennell, 2008
Keenan 2000Keenan 2000
Kennell et al. 1999Kennell et al. 1999
Klaus et al. 1986Klaus et al. 1986
Trueba et al. 2000Trueba et al. 2000
Hodnett et al. 2008 (SR)Hodnett et al. 2008 (SR)
Scott et al. (SR)Scott et al. (SR)
Zhang et al. (SR)Zhang et al. (SR)
Decreased need for forceps and Decreased need for forceps and vacuum deliveryvacuum delivery
Kennel et al. 1991Kennel et al. 1991
Hodnett et al. 2008 (SR)Hodnett et al. 2008 (SR)
Scott et al. (SR)Scott et al. (SR)
Zhang et al. (SR)Zhang et al. (SR)
Decreased need for oxytocin Decreased need for oxytocin inductioninduction
Kennel et al. 1991Kennel et al. 1991
Klaus et al. 1986Klaus et al. 1986
Hodnett et al. 2008 (SR)Hodnett et al. 2008 (SR)
Scott et al. (SR)Scott et al. (SR)
Zhang et al. (SR)Zhang et al. (SR)
Decreased need for epidural Decreased need for epidural analgesiaanalgesia
McGrath & Kennell, 2008McGrath & Kennell, 2008
Keenan 2000Keenan 2000
Kennell et al 1991Kennell et al 1991
Hodnett et al. 2008 (SR)Hodnett et al. 2008 (SR)
Scott et al. (SR)Scott et al. (SR)
Zhang et al. (SR)Zhang et al. (SR)
Effect of Doula Care on Psycho-social outcomesEffect of Doula Care on Psycho-social outcomes(Powers, 2009)(Powers, 2009)
OutcomeOutcome CitedCited
Higher self-esteem and less Higher self-esteem and less emotional distressemotional distress
Manning-Orenstein 1998Manning-Orenstein 1998
Trueba et al. 2000Trueba et al. 2000
Scott et al. 1999 (SR)Scott et al. 1999 (SR)
Hoddnett et al. 2008 (SR)Hoddnett et al. 2008 (SR)
Higher rates of exclusive Higher rates of exclusive breastfeeding initiationbreastfeeding initiation
Scott et al. 1999 (SR)Scott et al. 1999 (SR)
Langer et al. 1980Langer et al. 1980
Positive prenatal expectations, Positive prenatal expectations, positive perceptions of their positive perceptions of their infants, support from others and infants, support from others and self-worthself-worth
Campbell et al. 2007 (SR)Campbell et al. 2007 (SR)
Sosa et al. 1980Sosa et al. 1980
Shorter laboursShorter labours Langer et al. 1998Langer et al. 1998
Kennell et al. 1998Kennell et al. 1998
Keenan 2000Keenan 2000
Klaus et al. 1986Klaus et al. 1986
Hodnett et al. 2008 (SR)Hodnett et al. 2008 (SR)
Scott et al. (SR)Scott et al. (SR)
Zhang et al. (SR)Zhang et al. (SR)
LimitationsLimitations
Definition of “Doula” Agreement with “constant care” How doula care is defined has varied (lay support-family/friends,”female
companions”, trained and or certified doulas; usually this difference is not distinguished in systematic reviews.
Cochrane Review: “continuous intrapartum support was associated with greater benefits when continuous intrapartum support was associated with greater benefits when
the provider was not a member of the hospital staff, when it began early in the provider was not a member of the hospital staff, when it began early in labour and in settings in which epidural analgesia was not routinely labour and in settings in which epidural analgesia was not routinely available.”available.”
How much is “Decreased”: Varies widely (10-50%)
Doula UKDoula UK165 surveys were returned from 735 births. All births were in the UK in 2008 165 surveys were returned from 735 births. All births were in the UK in 2008
InterventionIntervention Doula UKDoula UK National National AverageAverage
Caesarean Caesarean Section rateSection rate
15%15% 24.3%24.3%
Epidural Epidural AnaesthesiaAnaesthesia
20%20% 30%30%
InductionsInductions 10%10% 20%20%
Goedkoop V. MIDIRS Midwifery Digest, vol 19, no 2, June 2009, pp Goedkoop V. MIDIRS Midwifery Digest, vol 19, no 2, June 2009, pp 217-218, Available at: 217-218, Available at: http://www.doula.org.uk/content/duk/about/Survey_Results.asphttp://www.doula.org.uk/content/duk/about/Survey_Results.asp
Natural Birth (no Natural Birth (no induction, induction, medicated pain medicated pain relief, augmentation relief, augmentation or instrumental or instrumental deliverydelivery
45%45%
Doula was single Doula was single birth partnerbirth partner
11%11%
Breastfed at birthBreastfed at birth 86%86%
Support from the StartSupport from the Start
Support from the Start:Support from the Start:
Overall, EL fairs better than other areas of the Lothians Overall, EL fairs better than other areas of the Lothians overall, but what about the pockets of deprivation missed overall, but what about the pockets of deprivation missed by these statistics?by these statistics?
How can we help families who are hidden by the How can we help families who are hidden by the statistics?statistics?
Midlothian Breastfeeding Rates at Midlothian Breastfeeding Rates at 6-8 week review6-8 week review
Midlothian, NHS Lothian and Scotland rates 2002-2008Midlothian, NHS Lothian and Scotland rates 2002-2008
Source: Scottish Neighbourhood Statistics website: www.sns.gov.uk,Accessed February 19, 2010
East Lothian Breastfeeding Rates East Lothian Breastfeeding Rates @ 6-8 week review@ 6-8 week review
East Lothian, NHS Lothian and Scottish Rates, 2002-2008
Source: Scottish Neighbourhood Statistics website: www.sns.gov.uk,
Accessed February 12, 2010
Breastfeeding Rates in EL Breastfeeding Rates in EL @6-8 weeks@6-8 weeks
Breastfeeding Rates
64.5
46.8
22.9 22.5
34
0
10
20
30
40
50
60
70
North Berwick East Lothian Wallyford &Whitecraig
Prestopnans Tranent N
Source: Community Health Profile 2004
InequalitiesInequalities The Greater Glasgow and Clyde Inequalities
Sensitive Practice Initiative (2009) Qualitative report examining the
experiences of vulnerable childbearing women.
These women reported feelings of: vulnerability, feeling like an “outsider” and difficulty communicating their wishes.
They expressed a need to become involved in their care and become part of the decision making process as opposed to being recipients of care.
Recommendation: This report advocated services that would respond to their specific and complex needs. It emphasised quality interpersonal communication and relationship building as the way to achieve this.
Green (2008) conducted a qualitative study involving 39 women who
had participated in the Goodwin Volunteer Doula project either as expectant mothers or volunteer doulas.
The expectant mothers highly valued “having someone there” who was on their “side”.
They often reported developing a supportive relationship with their doula and
feelings of personal empowerment.
The report concluded that the programme was a beneficial service to both childbearing women and volunteers doulas and suggests that this program has the potential to complement current maternity services
Thank-you!Thank-you!
Questions???Questions???
ReferencesReferencesDoula UK. 2009. [online] Available at: http://www.doula.org.uk. Accessed February 19, 2010.
Greater Glasgow and Clyde. 2009. Inequalities Sensitive Practice Initiative: Analysis of the Maternity Services User Engagement Survey, Final Report. Dalian House: Glasgow. Available online at: http://www.equalitiesinhealth.org/publications.html
Green, J. 2008. Volunteer Doulas for women in a Sure Start area: What does the service mean to them?. University of Hull: Hull.
Goedkoop V. MIDIRS Midwifery Digest, vol 19, no 2, June 2009, pp 217-218,
Powers, S. 2009. The Case for a Volunteer Doula Project in Leith (Unpublished). Available from author: Shauna.Powers@nhslothian.scot.nhs.uk
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