Fewer medical interventions, fewer hours in labor and increased satisfaction with the birthing experience -- that's what national statistics say a doula's support during labor and delivery means to women and their partners. A doula is a trained woman who provides nonmedical support during labor and delivery.
In 2011, Brookings Health System became the first hospital in South Dakota to offer the services of volunteer doulas for labor and delivery at its New Beginnings Birth Center and, in 2012, the first in the nation to offer volunteer doulas for postpartum support--free of charge. The services of a doula can cost a couple anywhere from $350 to $1,000, according to doula.com.
A team of four South Dakota State University researchers gathered feedback on the volunteer program from patients and their partners, doulas and health care professionals at Brookings Health System. They also evaluated the effectiveness of its promotional materials. Their research was funded in part by the Women and Giving Foundation at the SDSU Foundation and in part by the Rural Health Research Center at SDSU.
"This was an opportunity to learn about our program and better serve the needs of area women," says Brookings Health System Director of Obstetrics Mary Schwaegerl. Only an estimated 3 percent of mothers who deliver in Brookings opt to use the services of a volunteer doula. Schwaegerl and her team hope to increase participation based on the results of this research.
Calming expectant parents
Assistant professors Jennifer Anderson and Rebecca Kuehl in communication studies and theatre, Sun Woo Kang in counseling and human development and Hilary Hungerford in geography interviewed parents, expectant parents, doctors and nurses regarding the doulas' effect on the birthing experience. In addition, they questioned doulas about the effect the program has on them and evaluated the program's promotional materials.
The SDSU team interviewed 11 parents and 20 expectant parents. Only a few had prior knowledge about or experience with a doula.
"If they had a positive experience with a doula, they wanted to have one again," Kuehl says. One respondent said she would never have a baby without a doula.
Those who had a previous negative birth experience felt that a doula would improve the quality of their experience, according to Anderson. Their experiences with doulas were overwhelmingly positive.
Surprisingly, some expectant mothers chose a doula as a means to help their partners cope, Kang explains. "If the laboring women see their partners as more comfortable in the room, that's going to be a support for them."
"A doula helps the husband know how to navigate the situation," Anderson adds. Couples felt the doula brought them closer together.
Doulas interviewed emphasized this, saying, "my job is to help them have the best birth experience that they can," reports Anderson. "This is not a women's issue; it's a family issue."
Based on these responses, Kuehl--a persuasion expert--recommended that doula promotional materials also describe ways in which doulas benefit fathers. In addition, the team suggested that information on the doula program continue to be distributed at birthing classes.
When considering the differences between births with and without a doula, the 14 Brookings health care professionals interviewed pointed out how calming the constant presence of a doula was, not just to the patient but to everyone in the room, Kuehl explains. "That speaks very highly of the doula program here and how well coordinated it is."
In addition, the Brookings facility allows doulas to go into the operating room with moms who must undergo a cesarean section, according to Schwaegerl. Marilyn Hildreth, CEO of JM Birth Consultants, PLLC, explains this is something many hospitals will not do even when moms request it. The certified doula and approved doula trainer has been instrumental in starting doula programs nationally and internationally.
Anderson reports that women facing a C-section said that they needed their doulas even more.
Moms can begin skin-to-skin contact with their newborns immediately following the birth, regardless of the type of birth they have, Hildreth explains. This, in turn, leads to greater breast-feeding success.
"Postpartum doulas are especially helpful for mothers who are recovering from a C-section," Schwaegerl says. Brookings Health System Doula Coordinator Emily Delbridge, marketing and public relations director Julia Yoder and Schwaegerl were an integral part of this collaborative project.
Statistics from the Doula Organization of North America show a 25 percent decrease in length of labor, 50 percent reduction in C-sections and improved mental health and infant care for mothers who use doulas. At Brookings Health System, the C-section rate in 2012 was 12 percent, far below the national average of 33 percent, but Schaegerl explains this has been consistently low for the past five years.
In addition, the moms require less medical intervention, adds Anderson. That translates to lower health care costs.
The Brookings program has also become a template for other hospitals in the region. Mercy Medical Center in Des Moines is developing a similar program and Hildreth has received inquiries from other South Dakota hospitals on how to implement such a program.
Enriching doula experiences
Brookings Health System has 26 trained doulas who volunteer either for one 24-hour shift or two 12-hour shifts per month, according to Schwaegerl. Of those, 18 are SDSU students. Brookings Health System pays the doula's training costs in return for her volunteering for one year.
The nine doulas interviewed in the study described their experiences as "transformative and fulfilling," Anderson explains, noting that it is "a rich emotional experience to help bring another life into the world."
All felt that the training Hildreth provided had given them the skills they needed. "They were fired up and excited to provide the services," Kuehl says. "Doulas want to be called," Anderson adds.
Obstetrics director Schwaegerl is now using the volunteer doula's first shift as an orientation to the unit whether the doula gets called or not. This step already helps doulas feel more connected to the staff, she says.
The doulas interviewed who are SDSU nursing students said the additional training and work in an obstetrical setting made them "standout candidates for their first job," reports Anderson.
In her first year as a doula, SDSU nursing student Breanna Spartz helped with one birth. The labor lasted five to six hours and this was the woman's first child -- the national average is 12 to 18 hours, according to birthwithmidwife.com.
"It was the greatest experience," Spartz says. "It brings all the things together that we're learning in class." Her nursing professor, Lois Tschetter, encouraged her to get involved in the program.
As a volunteer doula, Spartz says she was able to focus more on the patient and her care. The role of helper "gives you a different outlook."
Anderson says that nursing students reported that they applied doula techniques to calming patients in a clinical setting and even to calming themselves during stressful situations. Through the doula training, students learn physical and emotional comfort measures that nursing programs don't have time to teach, according to Hildreth.
"The SDSU nursing program is outstanding, above any I am aware of in the United States," says Hildreth. These nursing students and the Brookings doula program can have a far-reaching impact on health care in the state and beyond.
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