Volunteer doula Breanna Spartz, a senior nursing student, performs massage on expectant mom Wendy Long at the New Beginnings Birth Center in Brookings.
Expectant mom Katy VanderWal, right, of rural Brookings, uses a birthing ball during labor with the help of her doula, Taylor Mertz. VanderWal gave birth to a baby girl, Callie, in December 2011, the same month in which Mertz completed her nursing degree.
Doulas increase parent satisfaction with birthing experience
Tuesday, March 18, 2014
Fewer medical interventions, fewer hours in labor and increased satisfaction with the birthing experience—that's what national statistics say a doula's support during labor and delivery means to women and their partners. A doula is a trained woman who provides nonmedical support during labor and delivery.
In 2011, Brookings Health System became the first hospital in South Dakota to offer the services of volunteer doulas for labor and delivery at its New Beginnings Birth Center and, in 2012, the first in the nation to offer volunteer doulas for postpartum support--free of charge.
The services of a doula can cost a couple anywhere from $350 to $1,000, according to doula.com.
A team of four South Dakota State University researchers gathered feedback on the volunteer program from patients and their partners, doulas and health care professionals at Brookings Health System. They also evaluated the effectiveness of its promotional materials. Their research was funded in part by the Women and Giving Foundation at the SDSU Foundation and in part by the Rural Health Research Center at SDSU.
"This was an opportunity to learn about our program and better serve the needs of area women," says Brookings Health System Director of Obstetrics Mary Schwaegerl.
Only an estimated 3 percent of mothers who deliver in Brookings opt to use the services of a volunteer doula. Schwaegerl and her team hope to increase participation based on the results of this research.
Calming expectant parents Assistant professors Jennifer Anderson and Rebecca Kuehl in communication studies and theatre, Sun Woo Kang in counseling and human development and Hilary Hungerford in geography interviewed parents, expectant parents, doctors and nurses regarding the doulas' effect on the birthing experience. In addition, they questioned doulas about the effect the program has on them and evaluated the program's promotional materials.
The SDSU team interviewed 11 parents and 20 expectant parents. Only a few had prior knowledge about or experience with a doula.
"If they had a positive experience with a doula, they wanted to have one again," Kuehl says. One respondent said she would never have a baby without a doula.
Those who had a previous negative birth experience felt that a doula would improve the quality of their experience, according to Anderson. Their experiences with doulas were overwhelmingly positive.
Surprisingly, some expectant mothers chose a doula as a means to help their partners cope, Kang explains. "If the laboring women see their partners as more comfortable in the room, that's going to be a support for them."
"A doula helps the husband know how to navigate the situation," Anderson adds. Couples felt the doula brought them closer together.
Doulas interviewed emphasized this, saying, "my job is to help them have the best birth experience that they can," reports Anderson. "This is not a women's issue; it's a family issue."
Based on these responses, Kuehl--a persuasion expert--recommended that doula promotional materials also describe ways in which doulas benefit fathers. In addition, the team suggested that information on the doula program continue to be distributed at birthing classes.
When considering the differences between births with and without a doula, the 14 Brookings health care professionals interviewed pointed out how calming the constant presence of a doula was, not just to the patient but to everyone in the room, Kuehl explains. "That speaks very highly of the doula program here and how well coordinated it is."
In addition, the Brookings facility allows doulas to go into the operating room with moms who must undergo a cesarean section, according to Schwaegerl. Marilyn Hildreth, CEO of JM Birth Consultants, PLLC, explains this is something many hospitals will not do even when moms request it. The certified doula and approved doula trainer has been instrumental in starting doula programs nationally and internationally.
Anderson reports that women facing a C-section said that they needed their doulas even more.
Moms can begin skin-to-skin contact with their newborns immediately following the birth, regardless of the type of birth they have, Hildreth explains. This, in turn, leads to greater breast-feeding success.
"Postpartum doulas are especially helpful for mothers who are recovering from a C-section," Schwaegerl says. Brookings Health System Doula Coordinator Emily Delbridge, marketing and public relations director Julia Yoder and Schwaegerl were an integral part of this collaborative project.
Statistics from the Doula Organization of North America show a 25 percent decrease in length of labor, 50 percent reduction in C-sections and improved mental health and infant care for mothers who use doulas. At Brookings Health System, the C-section rate in 2012 was 12 percent, far below the national average of 33 percent, but Schaegerl explains this has been consistently low for the past five years.
In addition, the moms require less medical intervention, adds Anderson. That translates to lower health care costs.
The Brookings program has also become a template for other hospitals in the region. Mercy Medical Center in Des Moines is developing a similar program and Hildreth has received inquiries from other South Dakota hospitals on how to implement such a program.
Enriching doula experiences Brookings Health System has 26 trained doulas who volunteer either for one 24-hour shift or two 12-hour shifts per month, according to Schwaegerl. Of those, 18 are SDSU students. Brookings Health System pays the doula's training costs in return for her volunteering for one year.
The nine doulas interviewed in the study described their experiences as "transformative and fulfilling," Anderson explains, noting that it is "a rich emotional experience to help bring another life into the world."
All felt that the training Hildreth provided had given them the skills they needed. "They were fired up and excited to provide the services," Kuehl says. "Doulas want to be called," Anderson adds.
Obstetrics director Schwaegerl is now using the volunteer doula's first shift as an orientation to the unit whether the doula gets called or not. This step already helps doulas feel more connected to the staff, she says.
The doulas interviewed who are SDSU nursing students said the additional training and work in an obstetrical setting made them "standout candidates for their first job," reports Anderson.
In her first year as a doula, SDSU nursing student Breanna Spartz helped with one birth. The labor lasted five to six hours and this was the woman's first child—the national average is 12 to 18 hours, according to birthwithmidwife.com.
"It was the greatest experience," Spartz says. "It brings all the things together that we're learning in class." Her nursing professor, Lois Tschetter, encouraged her to get involved in the program.
As a volunteer doula, Spartz says she was able to focus more on the patient and her care. The role of helper "gives you a different outlook."
Anderson says that nursing students reported that they applied doula techniques to calming patients in a clinical setting and even to calming themselves during stressful situations. Through the doula training, students learn physical and emotional comfort measures that nursing programs don't have time to teach, according to Hildreth.
"The SDSU nursing program is outstanding, above any I am aware of in the United States," says Hildreth. These nursing students and the Brookings doula program can have a far-reaching impact on health care in the state and beyond.
Brookings Health System to be First in the Nation to Offer Volunteer Postpartum Doula Program
Brookings, S.D. – Aug. 6, 2012 – Brookings Health System announced today the organization has extended its popular volunteer labor doula program to also include volunteer postpartum doulas. It is the first organization in the nation to offer volunteer postpartum doula services free of charge to parents.
“We’ve had a positive response from parents regarding our volunteer doulas helping them during the delivery process,” said Chief Nursing Officer Tammy Hillestad. “Our volunteer doulas are passionate about the entire childbirth experience, including supporting the mother, baby and family after delivery. They are eager to provide physical and emotional support to new moms and their families.”
Labor doulas are women who provide continuous labor support during childbirth, work together with the mother and her partner to assist with emotional and physical support, and use relaxation techniques such as positioning and comforting touch.
Postpartum doulas help parents in the first days after delivering a new baby to help them transition and adjust to having a newborn. They help parents with items like infant feeding, emotional and physical recovery from birth, mother-baby bonding, infant soothing and basic newborn care during their postpartum stay at Brookings Health System.
Brookings Health System’s volunteer doula program officially launched Oct. 1, 2011, in response to community feedback from three birth experience focus groups. Seventeen trained doulas volunteer one, 24-hour shift per month to help area parents during their birth experience.
Expectant parents who would like to use doula services during the labor, delivery, recovery and postpartum process at no cost to them may contact Doula Program Coordinator Emily Delbridge at firstname.lastname@example.org or (605) 696-9000 for more details.
Brookings Health System provides full obstetrics services to expectant parents and enables area residents to deliver their baby close to home with a local physician.
About Brookings Health System Brookings Health System, located in Brookings, South Dakota, includes a 49-bed hospital, the 79-bed Brookview Manor nursing home, and Brookhaven Estates apartments. It is a non-profit, city-owned facility that offers the community a full range of inpatient, outpatient, and extended care services. The emergency room is staffed 24 hours a day and provides around the clock medical-nursing care for patient needs ranging from minor injuries to life threatening crises. For more information about the services offered at Brookings Health System, please call (605) 696-9000 or visit us on the Web at brookingshealth.org.
Every one of the 10 nurses at Jefferson Healthcare’s Family Birth Center – including nurse director Kirsten Pickard – is being honored on Friday for their “mother-friendly” care.
Jefferson Healthcare is the first – and so far, only – hospital in the country to be given that recognition.
Marilyn Hilderth, chair of the Coalition for Improving Maternity Services, said on Monday that what she learned from interviewing all of those nurses is that they not only respect the wishes of the mother, but work as a team with health-care providers.
“The main theme would be respect for the mother,” said Hilderth of why she was so impressed with the nurses at Jefferson Healthcare’s Family Birth Center. “They protected the mother’s birth wishes.
“The other theme that sat me down was the team approach between health-care providers, the doctors and the nurses,” Hilderth said.
Hilderth presents honorary pins to the nurses in a special ceremony on Friday, Dec. 9 at the hospital.
Pickard said Hilderth was so excited that the entire department had taken the time to meet the requirements that she didn’t want to “just stick the pins in the mail.”
In addition to Pickard, nurses being recognized are Marly Yourish, Kelly Traenkenschuh, Anna Wallin, Anne Beers, Melanee Knudsen, Barbara Heckathron, Tanya Foldager, Katie Johnston, Clare Sherley, Penny Lawrence and per diem nurse Jen Patterson.
“We’re very, very proud and very, very excited about this week,” Pickard said of the honor.
The hospital delivers between 110 and 120 babies a year, and Pickard said she’d love to increase that number to 300 a year because “we could do a baby a day.”
In fact, going through a World Health Organization “baby-friendly” designation is next on Pickard’s to-do list.
“It usually takes four years, but I’m pretty sure we can do it this year. We kind of do it already,” Pickard said. There are four steps to that process, and the hospital already is achieving the second step. There are only 112 hospitals in the U.S. with that designation, she said.
Essays and interviews
Penny Lawrence, a nurse who has been at the Port Townsend hospital for 16 years, 10 of those in the birthing center, said on Dec. 5 that nurses not only had to answer questions, but also write essays about their practices, participate in an hour-long phone interview with Hilderth and obtain letters of recommendation.
“Why we stand out is that we are the only birth center in the country where we all practice with similar goals in mind. We support mother-friendly practices,” Lawrence said.
Hilderth said she was impressed that Jefferson Healthcare nurses not only understood that a woman might want a natural birth, but that “they were able to provide a home-birth-like atmosphere and bring that into a safe hospital setting.”
That said, Hilderth noted that if a woman wants epidural support, nurses respect those wishes as well.
The coalition is an organization of individuals and other national groups that are interested in the well-being of mothers, babies and families, and whose mission is to “promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs,” its website boasts.
“The designation recognizes hospitals which adhere to those evidence-based care delivery practices shown to provide the best outcomes for mothers and babies during labor and delivery,” the website states.