Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review

The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.

Can labor support based on Kolcaba's Theory reduce the negative consequences of fear of childbirth? A pilot study

BACKGROUND

The fear of childbirth (FOC) causes negativities such as increased an need for analgesia and interventions related to labour, prolonged labor, and childbirth dissatisfaction. It has been shown that birth support can be an effective strategy for reducing these negative outcomes. Also, labour support based on a nursing theory can help improve care outcomes.

AIM

This study aimed to examine the effects of nursing care structured according to Kolcaba's theory on duration, pain, and comfort of childbirth.

METHODS

This pilot study was a randomised controlled study. Before the participants were randomized, their FOC levels were determined using the Wijma Delivery Expectancy/Experience Scale A (WDEQ-A). Ninety women who had a FOC (WDEQ-A >66) were randomised into groups. The study was completed with 46 women (21 intervention, 25 control). The intervention group received the labour support based on Kolcaba's Theory of Comfort. The control group received standard care at birth.The data were collected using the Wijma Delivery Expectancy/Experience Scale A and the Comfort Behavior Checklist during pregnancy and labour. They were analysed using non-parametric tests.

RESULTS

The women in the intervention group had shorter latent and active phases (p = 0.002), lower pain scores (p = 0.000), and higher levels of birth comfort (p = 0.002).

RELEVANCE FOR THE CLINICAL PRACTICE

Labor support structured according to Kolcaba's Theory of Comfort contributes to increased comfort and decreases childbirth pain. This study can guide healthcare professionals who provide labour support on how to plan, provide, and assess care for woman who are giving birth.