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A Volunteer Doula Project: could it work here? Seminar Programme TimeAgendaPresenter 9:15 Welcome and Introduction 9:20 Setting the Scene: Doula care,

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Presentation on theme: "A Volunteer Doula Project: could it work here? Seminar Programme TimeAgendaPresenter 9:15 Welcome and Introduction 9:20 Setting the Scene: Doula care,"— Presentation transcript:

1 A Volunteer Doula Project: could it work here? Seminar Programme TimeAgendaPresenter 9:15 Welcome and Introduction 9:20 Setting the Scene: Doula care, the evidence base Shauna Powers 9:40 The Goodwin Volunteer Doula Project, Hull Heather Barnes 10:10 Volunteering Doula Services: A Canadian Perspective Shauna Powers 10:30 Coffee Break 11:00 Question/Answer Panel Discussion Heather Barnes, Amanda Hunter, Inga Cosway, Shauna Powers 11:30 Summary and close Shauna Powers

2 Birth Doulas: the evidence base Shauna Powers, RN, BScN, MSc NHS Lothian Health Promotion Service Support from the Start

3 What is a Doula? A Greek word meaning woman caregiver A Greek word meaning woman caregiver Now means a trained and experienced labour companion- a woman who mothers a mother Now means a trained and experienced labour companion- a woman who mothers a mother She provides emotional comfort, physical support, and assistance in obtaining information before, during and after childbirth She provides emotional comfort, physical support, and assistance in obtaining information before, during and after childbirth

4 Why have a Doula? Recognizes birth as a key life experience Recognizes birth as a key life experience Understands the physiology and emotions of birth Understands the physiology and emotions of birth Assists in preparing a birth plan Assists in preparing a birth plan Stays by the womans side throughout labour Stays by the womans side throughout labour Provides emotional support Provides emotional support

5 Dimensions of labour support: Emotional Support –encouragement, reassurance, continuous physical presence Emotional Support –encouragement, reassurance, continuous physical presence Informational Support –help families gather information about their labour, their options, explanations, non- medical advice Informational Support –help families gather information about their labour, their options, explanations, non- medical advice Physical Support –comfort measures, positioning, massage, breathing, pain relief (non pharmaceutical) Physical Support –comfort measures, positioning, massage, breathing, pain relief (non pharmaceutical)

6 The Case for a Volunteer Doula Programme in Leith Commissioned by The Junction: Young People, Health and Well-being after need recognized Commissioned by The Junction: Young People, Health and Well-being after need recognized Evidence-based review of Doula and consistent labour support Evidence-based review of Doula and consistent labour support Review of Goodwin Volunteer Doula Programme (Hull) Review of Goodwin Volunteer Doula Programme (Hull) Recommendations to carry idea forward Recommendations to carry idea forward

7 Evidence 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

8 Systematic Reviews Zhang et als. (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.

9 Systematic 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.

10 Systematic Review Hodnett et al. 2007 (Cochrane Review) Hodnett et al. 2007 (Cochrane Review) Sixteen trials involving 13,391 women Sixteen trials involving 13,391 women Primary comparison: women who had continuous intrapartum support were likely to have a slightly shorter labour, were more likely to have a spontaneous vaginal birth and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth experiences. Primary comparison: women who had continuous intrapartum support were likely to have a slightly shorter labour, were more likely to have a spontaneous vaginal birth and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth experiences. Subgroup analyses: in general, continuous intrapartum support was associated with greater benefits when 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 available. Subgroup analyses: in general, continuous intrapartum support was associated with greater benefits when 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 available.

11 Individual Studies and Systematic Reviews (Powers 2009) Medical Intervention Cited Decreased Caesarean Section Rates McGrath & Kennell, 2008 Keenan 2000 Kennell et al. 1999 Klaus et al. 1986 Trueba et al. 2000 Hodnett et al. 2008 (SR) Scott et al. (SR) Zhang et al. (SR) Decreased need for forceps and vacuum delivery Kennel et al. 1991 Hodnett et al. 2008 (SR) Scott et al. (SR) Zhang et al. (SR) Decreased need for oxytocin induction Kennel et al. 1991 Klaus et al. 1986 Hodnett et al. 2008 (SR) Scott et al. (SR) Zhang et al. (SR) Decreased need for epidural analgesia McGrath & Kennell, 2008 Keenan 2000 Kennell et al 1991 Hodnett et al. 2008 (SR) Scott et al. (SR) Zhang et al. (SR)

12 Effect of Doula Care on Psycho-social outcomes (Powers, 2009) OutcomeCited Higher self-esteem and less emotional distress Manning-Orenstein 1998 Trueba et al. 2000 Scott et al. 1999 (SR) Hoddnett et al. 2008 (SR) Higher rates of exclusive breastfeeding initiation Scott et al. 1999 (SR) Langer et al. 1980 Positive prenatal expectations, positive perceptions of their infants, support from others and self-worth Campbell et al. 2007 (SR) Sosa et al. 1980 Shorter labours Langer et al. 1998 Kennell et al. 1998 Keenan 2000 Klaus et al. 1986 Hodnett et al. 2008 (SR) Scott et al. (SR) Zhang et al. (SR)

13 Limitations 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 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 available. How much is Decreased: Varies widely (10-50%)

14 Doula UK 165 surveys were returned from 735 births. All births were in the UK in 2008 Intervention Doula UK National Average Caesarean Section rate 15%24.3% Epidural Anaesthesia 20%30% Inductions10%20% Goedkoop V. MIDIRS Midwifery Digest, vol 19, no 2, June 2009, pp 217-218, Available at: http://www.doula.org.uk/content/duk/about/Survey_Results.asp Goedkoop V. MIDIRS Midwifery Digest, vol 19, no 2, June 2009, pp 217-218, Available at: http://www.doula.org.uk/content/duk/about/Survey_Results.asp Natural Birth (no induction, medicated pain relief, augmentation or instrumental delivery 45% Doula was single birth partner 11% Breastfed at birth 86%

15 Support from the Start Support from the Start: Support from the Start: Overall, EL fairs better than other areas of the Lothians overall, but what about the pockets of deprivation missed by these statistics? Overall, EL fairs better than other areas of the Lothians overall, but what about the pockets of deprivation missed by these statistics? How can we help families who are hidden by the statistics? How can we help families who are hidden by the statistics?

16 Midlothian Breastfeeding Rates at 6-8 week review Midlothian, NHS Lothian and Scotland rates 2002-2008 Source: Scottish Neighbourhood Statistics website: www.sns.gov.uk,www.sns.gov.uk Accessed February 19, 2010

17 East Lothian Breastfeeding Rates @ 6-8 week review East Lothian, NHS Lothian and Scottish Rates, 2002- 2008 Source: Scottish Neighbourhood Statistics website: www.sns.gov.uk,www.sns.gov.uk Accessed February 12, 2010

18 Breastfeeding Rates in EL @6-8 weeks Source: Community Health Profile 2004

19 Inequalities 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

20 Thank-you! Questions???

21 References Doula UK. 2009. [online] Available at: http://www.doula.org.uk. Accessed February 19, 2010.http://www.doula.org.uk 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 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 Shauna.Powers@nhslothian.scot.nhs.uk


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