A Volunteer Doula Project: could it work here? Seminar Programme

1. A Volunteer Doula Project: could it work here? Seminar Programme

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 • Now means a trained and experienced labour companion- awoman whomothers a mother • 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 • Understands the physiology and emotions of birth • Assists in preparing a birth plan • Stays by the woman’s side throughout labour • Provides emotional support

5. Dimensions of labour support: • Emotional Support –encouragement, reassurance, continuous physical presence • 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)

6. “The Case for a Volunteer Doula Programme in Leith” • Commissioned by The Junction: Young People, Health and Well-being after need recognized • Evidence-based review of Doula and consistent labour support • Review of Goodwin Volunteer Doula Programme (Hull) • 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. Zhang 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 Reviews

9. 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 Reviews

10. Systematic Review • Hodnett et al. 2007 (Cochrane Review) • 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. • 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)

12. Effect of Doula Care on Psycho-social outcomes(Powers, 2009)

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 UK165 surveys were returned from 735 births. All births were in the UK in 2008 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

15. 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? • How can we help families who are hidden by the statistics?

16. Midlothian Breastfeeding Rates at 6-8 week reviewMidlothian, NHS Lothian and Scotland rates 2002-2008 Source: Scottish Neighbourhood Statistics website: 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, Accessed February 12, 2010

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

19. 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 Inequalities

20. Thank-you! Questions???

21. References Doula 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