Nursing Student Birth Doulas' Influence On the Childbearing Outcomes of Vulnerable Populations.

Of 1,511 women served by nursing student birth doulas (Birth Companions) between 1998 and 2014, 34.5% were identified as vulnerable (refugees, non-English speakers, teens, low income, low education). This retrospective evaluation of the Birth Companions Program showed that vulnerable mothers had more epidurals and smaller babies, and attempted breastfeeding less frequently than nonvulnerable. There was no difference in the frequency of caesarean births, pitocin induction/augmentation, low birth weight, or preterm newborns among the vulnerable women. Birth Companion interventions may have a role in influencing these outcomes. The Birth Companions program will use this analysis to identify additional services for these populations.

Evaluation of a student-nurse doula program: an analysis of doula interventions and their impact on labor analgesia and cesarean birth.

INTRODUCTION: The aim of this study was to describe specific doula interventions, explore differences in doula interventions by attending provider (certified nurse-midwife vs obstetrician), and examine associations between doula interventions, labor analgesia, and cesarean birth in women receiving doula care from student nurses. METHODS: A secondary analysis of data from the Birth Companions Program at the Johns Hopkins University School of Nursing was conducted using t tests, chi-square statistics, and logistic regression models. RESULTS: In the 648 births in the sample, doulas used approximately 1 more intervention per labor with certified nurse-midwife clients compared to obstetrician clients. In multivariate analysis, the increase in the total number of interventions provided by doulas was associated with decreased odds of epidural (adjusted odds ratio [AOR] 0.92; 95% confidence interval [CI], 0.86-0.98) and cesarean birth (AOR 0.90; 95% CI, 0.85-0.95). When examined separately, a greater number of physical interventions was associated with decreased odds of epidural (AOR 0.85; 95% CI, 0.78-0.92) and cesarean birth (AOR 0.80; 95% CI, 0.73-0.88), but number of emotional/informational interventions was not. DISCUSSION: Student nurses trained as doulas have the opportunity to provide a variety of interventions for laboring clients. An increase in the number of interventions, especially physical interventions, provided by doulas may decrease the likelihood of epidural use and cesarean birth.

Doula care: nursing students gain additional skills to define their professional practice.

Students enter professional nursing with a desire to acquire knowledge, develop skills, and provide nurturing support during life-changing experiences such as childbirth. "Community Perspectives on the Childbearing Process," an elective course at Johns Hopkins University School of Nursing, provides an opportunity to learn and use the skills of physical, emotional, and informational labor support as a "doula." As the first of its kind offered in a school of nursing, this service-learning opportunity offers students the unique opportunity to learn the skills of labor support through an in-depth, hands-on experience. The experience helps students develop a proactive perspective on childbirth and to advocate and support women's choices in labor. Since its inception, more than 379 students have attended 405 births. Students, who become doulas while being educated as nurses, gain new skills, real practice experience, and strong professional standards and identity.

Lower epidural anesthesia use associated with labor support by student nurse doulas: implications for intrapartal nursing practice.

Interventions of baccalaureate nursing students, trained as doulas, were examined for their association with epidural anesthetic use. Doulas, trained to support laboring mothers, are associated with shorter labors and fewer medical interventions. Data from a convenience sample of 89 vaginal births attended between 1999 and 2002 were analyzed. Analysis showed an association of lower epidural use with increased complementary doula interventions (.62 OR, P=.003) and an association of higher epidural use with longer labors (1.22 OR, P=.004). No significant association was found between epidural use and parity, income, education and type of health care provider. These findings support previous research of decreased analgesia use by doula-supported women and suggest benefits of the interventions by student nurse doulas. Students trained in providing low-tech supportive care may change the environment for intrapartum nursing practice. Institutional changes may be required to allow greater opportunity for intrapartal nurses to provide support to laboring women.

A community-based free nursing clinic's approach to management of health problems for the uninsured: the hepatitis C example.

Poverty, as an outgrowth of lack of opportunity in employment, basic education, affordable housing, and racism, directly affects disparities in health status. Health care providers are challenged to identify and overcome systemic barriers to health services for the poorest patients. This article describes the population of patients and the model of care offered by the Wald Community Nursing Center, a free nurse-managed clinic in Baltimore, Maryland. Hepatitis C infection is used to illustrate the confounding factors of a costly, chronic health problem and the interventions that have been instituted to overcome them.