Historically and world-wide, women have tended to other women who were pregnant or provided physical and emotional support during childbirth (Meadow, 2014). With the medicalization of childbirth in the 20th century in many parts of the world, the role of the doula emerged to fill the void of supporting the woman who was laboring and thereby keeping her from being alone in a medical environment (Meadow, 2014). The interest in doulas has grown tremendously over the past thirty years with doula-training organizations now existing on six continents (Meadow, 2014). Roth, Henley, Seacrist, and Morton (2016) reported that doulas attend approximately 5% to 6% of all births in the United States.
Many positive outcomes have been identified when a doula is present. Hodnett, Gates, Hofmeyr, and Sakala (2013) identified clinically meaningful and positive benefits such as shorter labors and more spontaneous vaginal deliveries, fewer cesarean sections or instrumental births, less use of epidurals or pain medications, greater maternal satisfaction, and neonates who were less likely to have low Apgar scores at birth. The American Congress of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine reinforced the need of doulas as valuable labor support, and identified doulas as “underutilized” (ACOG, 2016).
Despite the positive outcomes associated with doulas, the lack of knowledge, speculation, and misunderstanding of a doula’s role can lead to conflict between members of the obstetrical team and the doula, but especially with intrapartum nurses. Although the benefits and positive outcomes associated with the presence of a doula are numerous (Hodnett et al., 2013), misunderstanding and conflict can lead to miscommunication which can be detrimental. Communication has been identified to promote trust and leads to improved collaboration (Steel, Frawley, Adams, & Diezel, 2015).
The purpose of this evidence-based practice (EBP) change project was to use an educational intervention to increase L&D nurses’ knowledge of doulas and improve the L&D nurse’s attitude towards collaboration with doulas. The Johns Hopkins EBP model was utilized as a conceptual framework to implement the education. The educational intervention was presented by the project manager in four scheduled sessions and included EBP, the role of doulas, and the scope of doula-care. Twenty-one participants completed the pre and post-test developed for this project. Outcomes that were measured included L&D nurses’ knowledge of the doula’s role and L&D nurses’ attitude towards collaboration with the doula. Using descriptive analysis, the differences in group mean scores from pre to post-test were reported indicating learning had occurred. A comparative analysis on specific questions related to knowledge, and again with specific questions addressing attitude towards collaboration was also reported.
An educational intervention effectively increased L&D nurses’ knowledge of the role of the doula and identified L&D nurses’ positive attitudes toward collaboration with doulas as the benchmark was achieved for each outcome. Recommendations and global implications include: education regarding the inclusion of doulas as members of the interprofessional obstetrical team; institutional, state, national, and international policy changes to acknowledge and include the doula as a member of the obstetrical team for insurance purposes and financial reimbursement; and more shared exposure of doulas for medical and nursing students in their educational programs to be effective in collaborating and truly interprofessional.
A doula is a wonderful asset to the obstetrical team. The evidence is overwhelming in both the quantity and quality of the clinical benefits afforded to mother and infant. This EBP change project was effective to increase the knowledge of L&D nurses and to identify positive attitudes towards collaboration, of which both are vital to an efficacious outcome. Intrapartum nurses and doulas can work in tandem to attain a beneficial intrapartum experience and maximize effects for maternal and neonatal outcomes.