We’re being published by Demeter Press!

The Maternity Support Survey team is happy to announce a forthcoming volume on doulas, which will contain a chapter based on our research on nurse-doula interactions in hospital birth.

The edited collection, Doulas and Intimate Care: Bodies, Borders and Birth, (by Angela Castañeda and Julie Johnson Searcy), will be published by Demeter Press in October 2015.

From Demeter Press: The book focuses on doulas and the intimate practices involved with doula care. It raises critical questions about the social and cultural meanings of attending to women during the transition to motherhood. In her book The Tender Gift (1973), medical anthropologist Dana Raphael first applied the word doula to birth culture when describing the importance of “mothering the mother” and increasing successful breastfeeding results during the fourth trimester. Today the term doula covers a much broader field of birth work, which includes birth, postpartum and full spectrum doulas or doulas who care for women during abortion, adoption, surrogacy, miscarriage and stillbirth. This collection includes academic and personal essays written by a diverse group of scholars, including practicing midwives and doulas. This volume privileges the voices of doulas and researchers who study doulas, as we explore intimate labor, knowledge and the construction of different material realities of the birthing body. Contributing chapters focus on doulas as cultural brokers and translators during birth, doulas as mediators between birthing bodies and other care professionals such as labor and delivery nurses, the work of full spectrum doulas as birth activists working as abortion doulas, and the ways in which doulas negotiate the multiple identity transformations surrounding birthing bodies. As doulas negotiate their work, they represent a community in constant negotiation of borders and boundaries, one where we can turn as scholars to think through the process of birthing and what it means for the kind of work mothering entails.

Pre-order your copy today or ask your library to order this important contribution to doula scholarship.  Use this link: http://demeterpress.org/books/doulas-and-intimate-care-bodies-borders-and-birth/

Maternity Support Survey quoted in Daily Beast story on forced episiotomy

Our birth social media networks shared a story that broke last week about a young woman’s lawsuit against her obstetrician for performing an episiotomy (apparently making 12 cuts) despite her express refusal of consent.   One of the Maternity Support Survey team, co-Investigator Louise M Roth, PhD (University of Arizona), was interviewed in the Daily Beast, sharing the findings of our research:

And in a recent survey of more than 2,000 doulas, childbirth educators, and labor and delivery nurses across the U.S. and Canada, Louise Marie Roth, an associate professor of sociology at the University of Arizona, found that 63 percent of maternity support workers either “occasionally” or “often” witness a provider “engage in procedures without giving the woman a choice or time to consider,” and 17 percent report that providers go through with procedures even when they are explicitly against the wishes of a laboring woman.

“When you’re in the moment and things are urgent, it can be difficult to have the kind of comprehensive conversation that needs to happen to get really good, informed consent,” Roth told The Daily Beast.

Still, Roth stressed that a pregnancy doesn’t negate a woman’s civil rights. “There is no informed consent without informed refusal. If you can’t say ‘no’, then you don’t have informed consent.”

We are pleased that our research has been able to provide context to the story of Kimberly Turbin, from the perspective of “maternity support workers,” or the focus of our survey.  We will continue to analyze the data exploring how often doulas, childbirth educators and labor & delivery nurses witness ethically troubling events in the course of providing care to birthing women in the U.S. and Canada.  We will present our findings on this issue at the forthcoming annual meeting of the American Anthropological Association, November 18-21, Denver Colorado.  The theme for the meeting is “Familiar/Strange.”

On some level, birth is familiar to us all – we were all born, and we have a general idea from personal experience, popular culture and for some, professional knowledge, how birth happens and what is the best way for birth to be socially organized.  We can know, if we read the books and online postings, and the scientific literature, quite a bit about women’s experiences of childbirth. Yet we know little about the views of maternity workers, especially labor & delivery nurses, and how they compare to views of doulas or childbirth educators.  What is familiar to a nurse is a strange world to the pregnant women and her family; childbirth educators and doulas attempt to be a conduit in making the strange familiar through their advance preparation classes and continuous presence at the birth, respectively.  Our research tries to capture, through survey research methodology, how maternity support workers are similar to or different from each other in their views, and what factors might help account for their views.

Lactation Consultants, Doulas, and the Negotiation of Paid Caring

We are excited that one of our Maternity Support Survey team, Jennifer Torres, is writing about her research on doulas and lactation consultants!

Gender & Society

by Jennifer Torres

Lactation consultants, who provide breastfeeding support, and doulas, who provide labor support, are two relatively new and rapidly growing groups working in maternity care. The work they do builds upon traditional forms of care that have existed for centuries – supporting women through the process of childbirth and the early days of caring for a new baby. However, these two groups perform this work as an occupation, where they are paid to provide these very intimate forms of care.

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New Study: “How Doulas have a huge, positive impact on C-Section rates”

Recently posted on Huffington Post Parents, this study highlights the relationship between C-section rates and the presence of a Doula.

“What our study showed is that [lower odds of a C-section] don’t come with wanting a doula; it’s having a doula that is actually associated with important and substantial risk reductions,” Kozhimannil said.

For the full story, follow the link below to the Huffington Post Parents site.

http://www.huffingtonpost.com/2014/08/29/doula-benefits_n_5730720.html

 

Public Release!! Maternity Support Survey

We are pleased to share the public release of the Maternity Support Survey initial findings.  You are free to download the MSS report 5 1 14 FINAL and contact us if you have any questions.

How to cite this report:

Roth LM, Heidbreder, N, Henley MM, Marek M, Naiman-Sessions, M, Torres J and Morton CH.  2014.  Maternity Support Survey: A Report on the Cross-National Survey of Doulas, Childbirth Educators and Labor and Delivery Nurses in the United States and Canada.  http://www.maternitysupport.wordpress.com

 

Lamaze DONA Confluence Presentation in Kansas City!

Views of Doulas, Childbirth Educators and Labor and Delivery Nurses on Each Other, Emotional Burnout and Quality Improvement: Results from the Maternity Support Survey
Megan M. Henley and Christine H. Morton

This presentation provides an overview of results from the Maternity Support Survey, the first cross-national survey of doulas, childbirth educators, and labor and delivery nurses across the United States and Canada. Despite research on the benefits of supportive care during pregnancy, childbirth and postpartum, most researchers have explored how mothers and families view this care, with less attention to the views and experiences of individuals who provide such care (Liva et al. 2012; Morton & Clift, 2014). Similarly, research on maternity care providers has largely focused on midwives and obstetricians, neglecting the important roles of labor and delivery nurses, childbirth educators, and doulas (Monari et al. 2008; Morton & Clift, 2014; Reime et al. 2004; Smith et al. 2009). As a result, previous studies have not systematically studied or compared the practices and perceptions of workers who provide informational, emotional and physical support and advocacy to pregnant women. To address this gap in the literature, the Maternity Support Survey asked maternity support workers (doulas, childbirth educators, labor and delivery nurses) for their views on typical childbirth practices, their sense of efficacy in their maternity support roles, their orientation toward maternity support as a job or career, and their experiences with the American or Canadian health care system. This presentation is designed to inform learners of key findings from the Maternity Support Survey. These findings can increase participants’ knowledge of notable differences between these roles in terms of attitudes toward childbirth practices and toward other maternity support roles.

New Study: “How birth doulas help clients adapt to changes in circumstances, clinical care, and client preferences during labor”

How birth doulas help clients adapt to changes in circumstances, clinical care, and client preferences during labor. 
Amram NL, Klein MC, Mok H, Simkin P, Lindstrom K, Grant J.
J Perinat Educ. 2014;23(2):96-103. 

     This study examined how doulas adapt to challenges in client’s labors. There were 104 Canadian and 92 American doulas who responded to a survey distributed at a doula conference. We report results from open-ended questions in which doulas describe how they manage changes deviating from the mother’s birth plan and how they navigate differences of opinion between themselves and providers. Four themes emerged: giving nonjudgmental support, assisting informed decision making, acting as a facilitator, and issues with advocacy. Although 30% of doulas said that advocacy and information giving could result in conflict with providers, doulas reported working within their scope of practice and striving to be part of the team. Issues in doula responsibility and patient advocacy remain, and ongoing role clarification is needed.

           

     This recent article in the Journal of Perinatal Education focuses on how doulas help women adapt to unexpected changes in their birth plan during labor. The authors surveyed doulas attending a DONA International conference in Vancouver, Canada in 2008. In terms of interactions with care providers, the authors found that doulas acted according to the DONA International standard of practice.

     According to the doulas surveyed, “support” does not mean supporting women through one set birth path, but supporting them through any turn labor may take and respecting the decisions of all others involved in the process. The Maternity Support Survey found that doulas were more likely than other support workers to have strong opinions about common labor practices such as epidurals, induction, and the use of Pitocin. Yet, the authors of this article found that doulas surveyed were able to put aside their personal opinions and focus on the desires of the women they serve.

 

 

Maternity Support Survey Report about to be released!

Here is the Executive Summary:  Full report to be released later this summer!

The Maternity Support Survey is a survey of maternity support workers from across the United States and Canada that investigates the following topics:

• Whether doulas and childbirth educators view their maternity support work as a career (including the conditions and financial challenges that maternity support workers face)
• How doulas and childbirth educators establish their expertise (the importance of certification and other credentials)
• How technology affects workload among labor and delivery nurses
• How health insurance and litigation concerns influence maternity support workers, organizational protocols, and the frequency of interventions into labor and delivery
• Emotional burnout among maternity support workers

The Maternity Support Survey partnered with the following organizations in the recruitment of participants: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), Birthing from Within, BirthWorks, CAPPA Canada, DONA International, Health Connect One, International Childbirth Education Association (ICEA), Lamaze International, and toLABOR (formerly ALACE).

Road map to the report

For this report, we provide an overview of the rationale for the survey, and background. We discuss the maternity context of the U.S. and Canada, including maternal outcomes, quality initiatives, and the role of maternity support workers in each country. The report describes the data and methods as well as partner organizations in this survey.

Next, we present basic descriptive summaries of the results of the survey using cross-tabulations and averages. We present demographic data by maternity support role. All other tables compare across roles only and include respondents from both the United States and Canada. To determine statistical significance of differences across groups, we used chi-square tests of significance and t-tests for differences in means across groups.

Highlights from the Maternity Support Survey

The majority of respondents in all roles were white women in their 40s who have a bachelor’s degree or higher. There is a great deal of consensus among the three roles in attitudes toward typical childbirth practices, but the level of agreement showed that, in many cases, doulas were likely to hold stronger views compared to childbirth educators and nurses. All three roles agreed that continuous electronic fetal monitoring has increased the cesarean rate, and that induction increases the risk of cesarean.

Future Analytic Directions

The research team is composed of scholars who have a variety of research interests. We have identified several topics for analysis in the near future. These topics and sample research questions are listed below:

• Doula work as a career. How do doulas sustain their practice through additional training and credentials?
• Breastfeeding attitudes and practices. How do maternity support workers compare in terms of their attitudes and practices around breastfeeding? How central is personal experience in their views on breastfeeding?
• Emotional intelligence and emotional burnout. How do maternity support workers differ by emotional intelligence, and how does emotional intelligence mitigate emotional burnout? How do these issues affect nursing quality of care and medical errors?
• ACA changes in doula care coverage. How might changes in reimbursement of doulas via the Affordable Care Act affect doula care work and the demographics of the doula workforce?
• Documentation and L&D Nurses. How do L&D nurses view documentation practices and its effects, if any, on their ability to care for birthing women?
• Orientation toward reproductive justice. How do maternity support workers compare in terms of their attitudes toward choice and rights in the context of reproductive and maternity practices?
• Country comparisons. How are the Canadian and the U.S. maternity care systems alike and different, in terms of maternity support workers?

Maternity Support Survey to present at Lamaze/DONA 2014

We are happy to announce that our abstract submission, Views of Doulas, Childbirth Educators and Labor and Delivery Nurses on Each Other, Emotional Burnout and Quality Improvement: Results from the Maternity Support Survey was selected as a Concurrent Session for the joint Lamaze/DONA conference program in Kansas City, MO September 18-21, 2014.

The Survey is CLOSED and the Data is COMING SOON!

Thanks to everyone who supported, shared and completed the Maternity Support Survey of doulas, childbirth educators and labor & delivery nurses in the US and Canada.

A total of 3,325 respondents completed the survey. Among them, 2,869 resided in the United States and 456 lived in Canada.

We are now busy analyzing the data.  Two members of our research team will be presenting preliminary findings at the Lamaze International Conference on Saturday October 12

• Providing their Best Care: A Survey Comparison of Attitudes Toward Labor Practices Among Labor & Delivery Nurses, Childbirth Educators and Doulas Across the United States by Megan M. Henley, MA (University of Arizona)
• Breastfeeding Attitudes and Practices of Doulas, Childbirth Educators and Labor & Delivery Nurses: Findings from the Maternity Support Survey by Jennifer M.S. Torres, MA

We look forward to sharing more of our findings soon.