An Integrative Review: The Role of the Doula in Breastfeeding Initiation and Duration

The objective of this integrative review was to assess birth and postpartum doulas'' roles in supporting breastfeeding initiation and duration. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and Scopus were searched using the key terms doula and breastfeeding. Fourteen articles met inclusion criteria. Six key themes were identified. Doulas may acquire only modest amounts of lactation-specific education; however, doula care still enhances the breastfeeding care provided by health-care professionals. Doulas offer prenatal and intrapartum support that encourages breastfeeding initiation in the hospital, as well as providing breastfeeding support in the community and home settings. This reinforces the unique role of the doula in bolstering maternal–infant health. The effect of doulas on breastfeeding duration is less clear.     

How Birth Doulas Help Clients Adapt to Changes in Circumstances,Clinical Care,and Client Preferences During Labor

This study examined how doulas adapt to challenges in client’s labors. There were 104 Canadian and 92 American doulas who responded to a survey distributed at a doula conference. We report results from open-ended questions in which doulas describe how they manage changes deviating from the mother’s birth plan and how they navigate differences of opinion between themselves and providers. Four themes emerged: giving nonjudgmental support, assisting informed decision making, acting as a facilitator, and issues with advocacy. Although 30% of doulas said that advocacy and information giving could result in conflict with providers, doulas reported working within their scope of practice and striving to be part of the team. Issues in doula responsibility and patient advocacy remain, and ongoing role clarification is needed.     

My lovely C-section

Katherine and Andrew Taylor chose to have a planned home birth. With the support of her husband, Andrew, and her midwife and doula, Katherine labored at home for 48 hours before transferring to the hospital. Baby Luke was born by cesarean about 20 hours later. Confident and supported, the Taylors were able to make informed decisions and have a positive birth experience, although it was not what they had planned.     

Elizabeth Belle’s Birth Story

In this article, Jessica and Samuel Boro share the story of the birth of their daughter, Elizabeth Belle. With the physical and emotional support of her husband and her doula, this mother was able to cope with a long labor and have the natural birth she wanted. Her husband describes how important the doula was for him.     

Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended.     

Alternative strategy to decrease cesarean section: support by doulas during labor

This research was conducted in a public general hospital in Mexico City, Mexico. The objective was to evaluate efficacy of the support given by a doula during labor to reduce cesarean rate. From March 1997 to February 1998, a group of 100 pregnant women were studied. These women were at term, engaged in an active phase of labor, exhibited 3 cm. or more cervical dilatation, were nuliparous, had no previous uterine incision, and possessed adequate pelvises. The group was randomly divided into two subgroups comprising 50 women, each: The first subgroup had the support of a childbirth educator trained as a doula, while the second subgroup did not have doula support. Measurements were recorded on the duration of labor, the use of pitocin, and whether or not the birth was a vaginal birth or cesarean section. Characteristics and gestational age were similar in both groups. Results confirmed that support by doulas during labor was associated with a significant reduction in cesarean birth and pitocin administration. There was a trend toward shorter labors and less use of epidurals. The results of this study showed, as in other trials measuring the impact of a doula's presence during labor and birth, that doula support during labor is associated with positive outcomes that have physical, emotional, and economic implications.     

Doulas as community health workers: lessons learned from a volunteer program

Doulas, women who primarily provide social support during childbirth, have been associated with a number of positive health outcomes. Because the primary model of practice for doulas is a fee-for-service model in which families privately hire a doula, many expectant women who could benefit from doula support are unable to access the service. The Doulas Care program, located in Ann Arbor, Michigan, represents one model in which doulas provide services without charge. As a result of their extended role in the community, doulas who work with the Doulas Care program have unique educational needs. Through the use of focus groups with the program's volunteer doulas, educational needs related to overcoming barriers to being a doula working in the community were identified. Recommendations for education and training are made to improve the support doulas offer as community health outreach workers.     

"Going Beyond the Call of Doula": A Grounded Theory Analysis of the Diverse Roles Community-Based Doulas Play in the Lives of Pregnant and Parenting Adolescent Mothers

This article presents some of the most salient qualitative results from a larger program evaluation of pregnant and parenting adolescents who participated in a community-based doula program. Using grounded theory analysis, seven problem-solving strategies emerged that doulas apply in helping pregnant and parenting adolescents navigate multiple social and health settings that often serve as barriers to positive maternal- and child-health outcomes. The ethnographic findings of this study suggest that the doulas provide valuable assistance to pregnant and parenting adolescents by addressing social-psychological issues and socio-economic disparities. "Diverse role-taking" results in doulas helping pregnant adolescents navigate more successfully through fragmented social and health service systems that are less supportive of low-income adolescents, who are often perceived to be draining scarce resources. The findings have implications for the roles of community-based doulas assigned to low-income adolescents of color seeking to overcome obstacles and attain better educational and economic opportunities.     

Perceptions of nurses and mothers in four studies of the peripartum period

How individuals perceive themselves and how they are perceived by others are an important part of the relationships between childbirth educators, nurses, other health-care providers, and the families they serve. In this paper, four studies are reviewed. One study focused on labor nurses' perception of their roles. Three other studies, each using a different research strategy, examined mothers' perceptions of their experiences during the peripartum period.     

Harmonising the Efforts of School Nurses and Teachers in Health Promotion in Schools

A vital facet that adds value to schools is the partnership between the departments of education and health at national level. At the heart of making this partnership effective in order to achieve its potential is the need for synchronisation of the roles of school nurses and teachers to mitigate sustainability risks. In order to investigate the harmonisation of these roles, an explorative qualitative study was conducted with school nurses and teachers in three district municipalities in two provinces of South Africa. The aim was to determine the perceptions of these two groups of their respective roles and the possibility of harmonising these roles. The administrative task, which included obtaining the consent of parents for their children's immunisation provided an opportunity for sharing responsibilities. However, the roles of school nurses - health screening and immunisation - and the roles of teachers - screening for barriers to learning - could not be harmonised due to a lack of understanding of health promotion and a tendency to work in silos because of a lack of trust and openness. This was compounded by the school managers’ inability to provide guidance and leadership.     

Listening to Mothers II: A Lamaze Educator's Response

A Lamaze Certified Childbirth Educator and labor-support doula who provides services in two major, metropolitan areas shares her reactions and education experiences in dealing with the findings of Listening to Mothers II. She found that her first response to the survey findings involved assisting a community-wide effort to raise the awareness of women about their childbirth options, with a special emphasis on providers who practice in adherence to The Coalition for Improving Maternity Service's Mother-Friendly Childbirth Initiative. In addition, she added a component to her classes to help her students proactively explore why so few women feel they can assert their rights to refuse unnecessary interventions during childbirth.     

A Vaginal Birth After Cesarean,Attended by a Family Member Midwife Serving as Doula

In this column, a mother and her doula describe the strategies used during pregnancy and labor to maximize the success of a vaginal birth after a previous cesarean surgery.     

Accompanying the Path of Maternity: The Life History of a Colombian Doula

Doulas have fundamentally improved the health-care experience of pregnant women internationally. Women who recognize the importance of not being alone during pregnancy have embraced this role for centuries. However, less is known about doulas practicing in countries experiencing health inequities like Colombia. Miller''s methodology and Atkinson''s interview domain was used to answer the question “What life experiences led a Colombian woman to become a doula?” A central theme emerged, “A calling from within: Growing up to accompany the transition from woman to mother.” The path to becoming a doula evolved from life experiences involving health inequities, and a sense of femininity, maternity, and the women''s role in rural Colombia.     

My memorial garden

In this article, a doula describes one way in which she can honor infants who died prematurely.     

‘Birth work’ accompaniment and PhD supervision: an alternative feminist pedagogy for the neoliberal university

In this paper, we discuss how ‘with-woman’ midwifery and doula care provide resources for rethinking the theory and practice of academic supervision from a feminist perspective. We identify how the tradition of accompaniment in both birth work and academia is under threat given the economic reforms facing public sector education and health care. Despite these pressures, we suggest that the practice of focusing on the pregnant woman as an ‘expert’ on her pregnancy rather than on the foetus or the delivery – that is, the ‘product’ of her pregnancy – would help transform how we theorise and practise academic supervision. The aim of the supervisory relation would mean supporting the student’s direct relation to the intellectual, embodied and emotional process of completing the PhD. Such an approach suggests ways in which the pedagogical practices of contemporary midwifery and doula care can inform academic supervision in the neoliberal university.     

Care practice #3: continuous labor support

This updated edition of Care Practice Paper #3 presents the evidence for the benefits of continuous support in labor. The role of the doula is explained. Women are encouraged to plan for continuous support during labor and to consider including a woman experienced with childbirth among their labor support team.