Evidence and guidelines for trauma-informed doula care.

OBJECTIVE: Trauma and trauma-related health conditions are common during pregnancy, but there is little evidence and guidance on how doulas (trained lay birth assistants) can provide trauma-informed care. The purpose of this narrative review is to critique and synthesize the existing evidence for trauma-informed doula care and to offer guidelines for practice. DESIGN: We conducted a narrative review of existing evidence in the peer-reviewed and gray literatures on trauma-informed care in maternity and perinatal settings including doula training curricula and community-based doula guidelines on trauma-informed doula care. Materials were analyzed for relevant data on trauma and pregnancy, evidence-based approaches for trauma-informed doula and perinatal care, and strengths/weaknesses of the evidence including research design, gaps in the evidence base, and populations included. SETTING: This narrative review focuses on trauma-informed doula care in the United States, although the evidence and guidelines provided are likely applicable in other settings. KEY CONCLUSIONS: To be trauma-informed, doulas must first realize the scope and impact of trauma on pregnancy including possible ways to recovery; then recognize signs and symptoms of trauma during pregnancy; be ready to respond by integrating evidence and sensitivity into all doula training and practices; and always resist re-traumatization. Trauma-informed doula care also centers on these 6 principles: safety; trustworthiness and transparency; peer support with other survivors; collaboration and mutuality; resilience, empowerment, voice, and choice; and social, cultural, and historical considerations. In practice, this includes universal trauma-informed doula care offered to all clients, trauma-targeted care that can be offered specifically to clients who are identified as trauma survivors, and connection to trauma specialist services.

Volunteer doulas' experiences supporting cesarean births: A qualitative analysis for preliminary program evaluation.

BACKGROUND: Cesarean birth is common in the United States and associated with increased incidence of medical complications and maternal dissatisfaction. Doula support is associated with improved maternal and newborn outcomes but is often restricted to vaginal birth. The aim of this scoping study was to explore the experiences of volunteer doulas who provide support to women during cesarean birth. METHODS: Qualitative study using semi-structured interviews with nine doula volunteers from one program to assess their experiences caring for clients in the operating room (OR). RESULTS: Doulas described their experiences supporting cesarean births in relation to four different relationship-level themes, relationships between: doulas and their clients (and clients' support persons); doulas and the physical environment (OR, labor and delivery unit); doulas and the OR interprofessional team; and doulas and the program culture. Doulas described perceived strengths and weaknesses of the OR-based program, and suggested improvements and future development opportunities. CONCLUSION: Doulas volunteering within this program highly valued their perceived role in the care of women experiencing cesarean birth, including reports of increasing evidence-based practices such as SSC and early breastfeeding initiation in the OR. These doulas reported successfully working around the physically challenging OR environment and alongside the cesarean interprofessional team.

DREAM: Empowering Preclinical Medical Students With Labor Support.

Introduction: Delivery Resources, Experiences, and Advocacy for Moms (DREAM) is an interprofessional service-learning program that empowers preclinical medical students by training them to provide labor support. Boston Medical Center is a safety-net hospital featuring an in-house doula service with limited coverage capacity. Consequently, many patients do not receive continuous labor support, although evidence shows that continuous labor support improves outcomes and may help reduce birth-outcome health disparities. We present a pragmatic approach to integrating preclinical students as labor-support staff and outline the methods and content of the training process as well as the evaluations used to assess program effectiveness. Methods: Students were trained by doulas (Birth Sisters) and midwives to provide prenatal, labor, and postpartum support. Students completed an orientation and training workshop and then partnered with a Birth Sister for one prenatal visit, labor, and postpartum visit prior to working independently. Student leaders provided structure, mentoring, and support for preclinical students. Pre- and postsurveys assessed student confidence and obstetric knowledge acquisition. Budget, logistics, and program evaluation process are reviewed. Results: Students demonstrated increased knowledge, as well as confidence in communication, advocacy, and support. Although balancing DREAM with academics was stressful, students continued to meet academic standards and felt their participation was gratifying and worthwhile. Student reflections and patient statements on their experience show the program was mutually beneficial. Discussion: Preclinical students need gratifying clinical opportunities to develop confidence in communication and advocacy skills. Partnering them with underserved women to provide labor support is a pragmatic and clinically valuable intervention.

Making the case for innovative reentry employment programs: previously incarcerated women as birth doulas - a case study.

Purpose The purpose of this paper is to make a case for novel and innovative reentry programs focused on women of color and to describe policy recommendations that are necessary to support the sustainability of these programs and in turn the success of the women who participate in them. Design/methodology/approach A review and analysis of the literature that described job-training opportunities specifically targeted to women exiting jail and the impact on recidivism provided limited information. The authors developed, implemented, and evaluated doula training program for low-income and women of color to determine if birth work could provide stable income and decrease recidivism. Findings Training low-income formerly incarcerated women to become birth doulas is an innovative strategy to solve employment barriers faced by women reentering communities from jail. Realigning women within communities via birth support to other women also provides culturally relevant and appropriate members of the healthcare team for traditionally vulnerable populations. Doulas are important members of the healthcare workforce and can improve birth outcomes. The authors' work testing doula training, as a reentry vocational program has been successful in producing 16 culturally relevant and appropriate doulas of color that experienced no re-arrests and to date no program participant has experienced recidivism. Originality/value To be successful, the intersections of race, gender, and poverty, for women of color should be considered in the design of reentry programs for individuals exiting jail. The authors' work provided formerly incarcerated and low-income women of color with vocational skills that provide consistent income, serve as a gateway to the health professions, and increase the numbers of well-trained people of color who serve as providers of care.

Evaluation of the East Bay Community Birth Support Project, a Community-Based Program to Decrease Recidivism in Previously Incarcerated Women.

The East Bay Community Birth Support Project provides entry into the health professions for previously incarcerated women and enhances access to culturally appropriate doula support for low-income communities. Sixteen women of color were trained as doulas: eight were identified as low-income and eight were previously incarcerated. Qualitative focus group data from program participants showed an increase in empowerment, improved assessment of skills, and confidence in perceived ability to provide doula support. To date, no incidents of recidivism have occurred.

La perinatalidad: el estado de la cuestión / Perinatal period: status of the issue

La cuestión de la perinatalidad en España no tiene el reconocimiento que debiera en las preocupaciones del desarrollo profesional del conocimiento, ni tampoco en la aplicación de recursos y prioridades en los sistemas sanitarios. Sin embargo, constituye una demanda social explícita, gestada en un contexto de cambios que están provocando aparición de nuevas patologías y de incertidumbres de muy variada condición. En este artículo se hace un intento de identificación del campo que corresponde a la perinatalidad y se apuntan algunos propósitos que podrían ser asumidos por los profesionales de la salud mental (AU)

In Spain, the issue of perinatal period does not have the relevance it should deserve among the priorities of knowledge development professionals; either in the application of resources and priorities in health systems. However, it is an explicit social demand, developed in a context of changes that are causing the emergence of varied new pathologies and doubts. This article tries to identify the field of perinatal period and some proposals that could be assumed by mental health professionals (AU)

Breast milk and labour support: lactation consultants' and doulas' strategies for navigating the medical context of maternity care.

This article provides a comparison of two occupational groups working in maternity care: International Board Certified Lactation Consultants, who assist women with breastfeeding, and DONA International certified birth doulas, who provide physical, emotional and informational support to birthing women. Using interviews with 18 lactation consultants and 16 doulas working in the USA, I compare these two groups' strategies for gaining entrance to the maternity care team and their abilities to create change in maternity care practices. Due to the organisation of occupational boundaries in maternity care and differences between the influence of the medicalisation of breastfeeding versus that of childbirth on those boundaries, lactation consultants are able to utilise a front-door entrance to the medical maternity system, entering as lactation specialists and advocates, while doulas use a back-door entrance, emphasising their care work and downplaying their advocacy. These different strategies result in different methods being available to each for effecting change. Lactation consultants create formal change, such as changing hospital policies and practices to be more pro-breastfeeding. Doulas create change informally, 'one birth at a time', by creating space for natural birth to occur in the hospital, as well as exposing medical providers to non-medical ways of giving birth.

Development of a doula intervention for postpartum depressive symptoms: participants' recommendations.

PROBLEM: About 10-15% of women experience postpartum depression (PPD). Doulas provide support and education about PPD. METHODS: This qualitative study used focus groups with mothers, doulas, and doula trainers to develop educational materials for doulas to help mothers identify symptoms of depression and seek treatment. FINDINGS: All participants preferred materials that use simple language and avoid psychiatric jargon. Three themes emerged: someone to talk to, flexibility, and interactivity. Materials developed include tri-fold brochure and content for an application for smartphones and digital tablets. CONCLUSIONS: Doulas can use these interactive materials to provide supportive, relationship-based care that complements nursing care.