1. Karen Burt, MD Director, Integrative Health Program

2. Herstory – Collaborators Natasha Pinto, MD – 1 st Year resident: involved with UCSD Doula Program (now extensive). We adapted their materials. Drs. Lisa Keller and Karen Burt – both involved in Natural Birthing for 30 years. Roz Hunter, RN: previously a midwife. Coordinator Alex Dronkers, RN: from Netherlands. Scheduling. Carole Hagin, CNM: midwife for 30+ years. Training Doula Volunteers: Evaluation

3. Herstory Materials from UCSD adapted : Mission, Policy and Procedures, Strategy and Actions, Standards of Practice First Training: February 7, 2009 Nurse Focus Groups: questions, concerns, fears, expectations Meet the Doula’s: Nurses and doulas met Experienced Doula chosen to do the first couple of births. Slow roll out in April of more doulas on-call. Ongoing Doula Potluck/trainings Q 2 months.

4. What is a Doula? Doulas can give support to pregnant women and their families – before, during and after the birth. Friend, mentor, and labor coach. Doulas in many cultures – usually women with a lot of life experience. In labor: provide continuous physical, emotional and informational support. In private sector: provide advocacy for a safe and satisfying birth experience

5. Perspectives in Childbirth: Health Care System : SAFETY is the top priority Laboring Woman: Birth is a Life Passage in which both SAFETY and SATISFACTION have great significance - affects: self esteem, parenting, breast-feeding skills, immediate birth outcomes Satisfaction: influenced more by quality of support she receives, feeling in control of herself, and feeling she was actively involved in decisions than by degree of pain, number of interventions, or even the medical outcomes.

6. Who are the CCRMC Doulas? Young women interested in Doula, nursing, or midwifery as a profession Women attracted to assisting in the peri-natal time, especially birthing Older women desiring to mentor Professional Doulas (in the private sector) who want to donate their skills to the underserved population

7. Doula Role at CCRMC Continuous labor support (Non-Medical): Cochrane Library published in 2003: “Women who had continuous intra-partum support were less likely to have intra-partum analgesia, operative birth or to report dissatisfaction with their childbirth experiences.” Nursing often too busy, though they would like to be there Doulas On-Call : two 12 hr or one 24 hr shift per month – stay for birth Available for: Laboring women who are alone Laboring women whose family is unable to support them well Even with epidurals Future: possible expansion of role

8. Doula Birth Support Breathing Massage Birthing Ball Positioning Ambulation Compresses hot and cold Guided Imagery / visualization Music Lighting Shower Verbal Encouragement Instruction and Support for Partners and Family members Communication with Nursing and Medical personnel

9. Evaluation: Birth Log Primip/Multip Language Ethnicity Family present Hours of Labor / Stage when Doula arrived Interventions Pain Management Delivery (NSVD, VBAC, Vacuum, Forceps, C-Sec) Outcome of baby (weight, Apgars, gestational age)

10. Evaluation: Questionaire Volunteers call patients in 1-4 weeks and ask: - Was the Doula helpful during the labor and birth? - What was most helpful about the Doula? breathing help Massage compresses positioning comforting words - Would you recommend a doula to your friend? - Comments

11. Issues that Arose Making a smooth entry into L&D – with nursing and medical support The doula commitment to continuous support can be exhausting Volunteer status of the organizers / support team

12. Successes 10 Doulas involved – several more in the wings Doulas volunteering for administration assistance ~20 Doula Assisted Births Doula nominated for Service Excellence Award Excellent reception by nursing

13. Next Training Mid - August Hope for 10-15 new trainees Distribute flyer to anyone interested!!!! Q 2 month mini-trainings: Spanish phrases, ergonomics, back labor, positioning, massage, inductions and augmentations, epidurals, etc.