What Do Community Doulas Think About the Future of the Doula Workforce?

INTRODUCTION: Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce. METHODS: The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and workshops were analyzed using the Framework Method. RESULTS: The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of learning through mentorship. DISCUSSION: Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology, and other aspects of doulas' positioning within the healthcare system.

Top Ten Tips Palliative Care Clinicians Should Know About End-of-Life Doulas.

Palliative care has made great strides in improving the lives of people living with serious illness, with an empirical premise for increasing quality, and sometimes quantity of life. Yet in some cases, there exist gaps that impede the ability of palliative care clinicians to truly advocate, procure, and provide the comprehensive services needed for patients, family caregivers, and communities, particularly in the contexts of caring for marginalized populations and working in under-resourced practice settings. The end-of-life doula role has emerged over the last decade and the availability of trained doulas in the community has burgeoned. An end-of-life doula is a nonmedical, holistic support person who provides education, guidance, emotional, spiritual, and practical support to persons and families navigating serious and terminal illness, ideally early in the disease process, throughout the time surrounding death, and during bereavement. A pervasive Western culture of avoiding the subject of death means that we, as a society, often do not know or remember how to navigate the journey of end of life in a way that is caring, compassionate, skilled, holistic, and centered on the needs and worldview of the dying one. The ten tips provided here can guide palliative care clinicians to leverage collaboration with trusted, community-based end-of-life doulas to ensure comprehensive and people-centered palliative care.

Promoting Safe Sleep: The Role of Doulas in Black Communities.

BACKGROUND: Accidental suffocation and strangulation in bed continues to be a critical issue in Black communities, despite the widespread initiatives to promote safe sleep. Doulas are in an ideal position to promote safe sleep, particularly in hard-to-reach communities that are more distrusting of conventional medical providers. Little is known about their practices and perspectives for putting infants down to rest. This study informs this gap in the literature. PURPOSE: The purpose of this study was to explore doulas' perspectives and practices in the field of putting infants down to sleep. The researchers aimed to determine whether Black caregivers that work with doulas are likely to encounter safe sleep education. METHODS: The researchers used a descriptive approach to inquiry. They conducted three focus groups with a total of 17 Black doulas. The researchers independently and critically reviewed the transcriptions and observation notes from each group to identify codes. They then triangulated the results using Artificial Intelligence-driven tools. FINDINGS: The study found four themes: (1) Individualized Services, (2) Cultural Sensitivity, (3) Negotiating Safety, and (4) Safe Sleep Education. CONCLUSIONS: The study concluded doulas have a commitment to promoting safe sleep. The researchers found that doulas engage in practices that help caregivers to integrate safe sleep practices into their lifestyle and to adapt them to meet their needs. The researchers also documented a desire for more information and instruction on safe sleep among practicing doulas.

Impact of doula's continuous support on serotonin release in parturients: a pilot randomized clinical trial.

Objective: To evaluate whether the continuous support provided by doulas influences the endogenous release of serotonin in parturients. Methods: This pilot study included 24 primigravidae at term. Of these, 12 women received continuous doula support (Experimental Group), whereas the other 12 received the usual assistance without doula support (Control Group). Blood samples were collected from all the women at the active and expulsion stages of labor and at the fourth period of labor (Greenberg period) for evaluation of their serotonin levels using high-performance liquid chromatography. Results: The average serotonin concentrations in the control and experimental groups were respectively 159.33 and 150.02 ng/mL at the active stage, 179.13 and 162.65 ng/mL at the expulsion stage, and 198.94 and 221.21 ng/mL at the Greenberg period. There were no statistically significant differences in serotonin concentrations between the two groups at the active and expulsion stages of labor. By contrast, within the experimental group, a significant increase in serotonin concentration was observed in the Greenberg period compared with the levels in the active and expulsion stages (p < 0.05). Conclusion: The novelty of this study relies on the ability to correlate the influence of the continuous support offered by doulas with the release of serotonin in parturients, with the results suggesting that the assistance received during labor can modulate the levels of hormone release in the Greenberg period. Brazilian Registry of Clinical Trials: RBR-4zjjm4h.

"A Vulnerable Time To Be a Young Family in an Emergency": Qualitative Findings From an Exploration of an Emergency Perinatal and Infant Feeding Hotline in Louisiana.

BACKGROUND: Birthmark Doula Collective, a cooperative that provides doula and lactation services in the Greater New Orleans area, mounted an emergency response after two Category 4 storms: Hurricane Laura (2020) and Hurricane Ida (2021). The response included activating a no-cost emergency perinatal and infant feeding hotline. Both disasters coincided with a resurgence of COVID-19 infections in Louisiana. RESEARCH AIM: The aim of this study is to understand how an emergency perinatal and infant feeding hotline supported infant and young child feeding in emergencies during hurricanes in Louisiana. METHOD: This study used a cross-sectional, retrospective qualitative design in a population with low breastfeeding rates. We conducted a content analysis of 97 hotline call logs from Hurricanes Laura and Ida, focus groups with lactation support providers who staffed the hotline during either storm (n = 5), and interviews with mothers who called during Hurricane Ida (n = 2). Focus groups and interviews lasted 30 and 60 minutes, respectively. Transcripts were analyzed using thematic analysis techniques. RESULTS: Call logs revealed infant feeding needs (e.g., mastitis, low milk supply, relactation, and infant formula requests) and non-infant feeding needs (e.g., infant supplies, perinatal and infant care referrals, shelter information). Infant formula was the most requested supply during both hurricanes. Maternal participants discussed family vulnerabilities during Hurricane Ida. Staff described training and strategies to provide support while maintaining their own well-being. CONCLUSION: Providing a free emergency hotline service is one way to support pregnant and postpartum people and their families seeking infant feeding advice, supplies, and support in the immediate aftermath of a disaster.

Reclaiming narratives of empowerment around Black maternal health: a strengths-based, community-informed focus group study.

OBJECTIVES: Research on Black maternal populations often focuses on deficits that can reinforce biases against Black individuals and communities. The research landscape must shift towards a strengths-based approach focused on the protective assets of Black individuals and communities to counteract bias. This study engaged the local Black community using a strengths-based approach to discuss the assets of Black maternal populations and to inform the design of a future clinical trial focused on reducing Black maternal health disparities. DESIGN: Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including the strengths of the local community, strengths specific to pregnant community members, how the strengths of community members can support pregnant individuals, and how the strengths of pregnant community members can facilitate a healthy pregnancy. The focus group interviews were transcribed verbatim and analyzed using thematic content analysis. RESULTS: Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) the power of pregnancy and motherhood in Black women, (2) challenging negative perceptions and media representation of Black mothers, (3) recognizing history and reclaiming cultural traditions surrounding birth, and (4) community as the foundation of Black motherhood. CONCLUSION: Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered relationships with the Black community, elucidated possible solutions to improve Black women's health and wellness, and offered direction on our research design and intervention.

Beyond Birth Work: Addressing Social Determinants of Health With Community Perinatal Support Doulas.

Adverse maternal and infant health outcomes among African Americans are increasingly recognized as indicators of a critical public health crisis in the United States. Research has found that stress is related to structural racism and the social determinants of health (SDOH) that cause avoidable, unfair inequities in resources, education, power, and opportunities across ethnic groups. This paper describes the SDOH needs and experiences of pregnant Black women from the perspective of doulas and Birthing Beautiful Communities (BBC) clients. The design was a qualitative description, using data collected over time (2017-2018, 2020-2021, and 2023). This study took place in Cleveland and Akron, Ohio and the sample included 58 clients, 26 doulas, and 2 resource intake specialist assistants (RISAs). Qualitative data included individual client interviews, three doula focus groups, and one interview with two BBC RISAs. Three coders used content analysis to deductively identify SDOHs and calculate the number of interviews that contained information about specific SDOHs. Although the sample reported issues with all SDOH, particular ones caused a cascade of SDOH effects. Transportation issues, for example, impeded women from being able to make it to work, doctor's appointments, and to purchase essential baby items (e.g., food, infant supplies). An inability to work-whether because of transportation challenges or pregnancy-related health complications-led to unstable housing and an inability to deal with transportation challenges. Many clients mentioned that housing was a major issue, with many clients experiencing housing instability. Implications include ensuring SDOH information is collected from a trusted source who can advocate and ensure access to a wide range of local resources, ensuring policies protect pregnant women from experiencing a cascade of SDOH that may contribute to continuing health disparate infant and maternal health outcomes in African American women.

The Impact of Covid-19 on Community Perinatal Doula Support Services for Black Women.

OBJECTIVES: To better understand the experiences of Black pregnant women during COVID-19, we examined Black pregnant clients' and doulas' experiences with perinatal support services amid COVID-19's social distancing protocols. METHODS: We used qualitative description, employing a social constructionist framework to interview 12 perinatal support doulas and 29 Black women who were pregnant or gave birth during the pandemic about their experiences during the pandemic, when social distancing was required. RESULTS: Three key themes were identified: (1) Clients experienced increased social isolation; (2) Doulas' exclusion from medical visits limited women's access to support and advocacy; (3) Doula support as a sisterhood helped clients mitigate effects of COVID isolation. CONCLUSIONS FOR PRACTICE: Doulas should be considered essential support persons for Black pregnant women and should not be excluded from the birthing team. Support through technology is acceptable for some clients but less desirable for others and restricted doula's ability to build rapport and be hands on with their clients.

A Qualitative Study of Hospitals and Payers Implementing Community Doula Support.

INTRODUCTION: The impact of doula care on birth outcomes is well-established; however, doula support remains underutilized. Identifying barriers and facilitators to implementation is integral as the demand for doula care increases. The primary objective of this study was to examine doula program implementation across hospitals and payers at varying stages of implementation. METHODS: Representatives from 4 hospitals and 2 payers participated in focus group discussions. The doula programs were categorized as anticipated, initial, and advanced implementation statuses. Coding and thematic analysis were conducted using a deductive application of the Consolidated Framework for Implementation Research. RESULTS: There were 20 participants across 5 focus group discussions. Participants were mostly female, and nearly all had worked at their organization for at least 2 years. Salient themes shared across participants included valuing internal outcome data or peer-reviewed literature to support doula care as well as anecdotal stories; the reality of the resource-intensive nature of doula care implementation that goes beyond funding for doulas; and both the need for individual champions for change, such as midwives, and a supportive organizational culture that values health equity. DISCUSSION: The findings of this study highlight 3 contextual aspects that should be considered when implementing doula programs. These recommendations include: (1) use of a combination of research evidence and anecdotes when eliciting stakeholder support; (2) consideration of resources beyond funding such as program implementation support; (3) critical evaluation of organizational culture as a primary driver influencing the implementation of doula care. The future of the doula workforce in United States hospitals rests on the crux of intentional buy-in from hospital administration and clinical providers as well as the availability of requisite resources.

Vivência e expectativas de doulas em região brasileira de fronteira / Experience and expectations of doulas in a Brazilian border region

RESUMO O estudo buscou compreender a vivência e as expectativas das doulas que atuam ou atuaram em dois municípios de região de fronteira: Foz do Iguaçu e Cascavel, Paraná, Brasil. Tratou-se de uma pesquisa qualitativa pautada no referencial da Fenomenologia Social. A coleta das informações deu-se por entrevistas com roteiro semiestruturado em língua portuguesa. As entrevistas foram feitas on-line. Os resultados foram classificados em seis categorias: motivação para tornar-se doula, conhecimento sobre o papel da doula, o cotidiano das doulas, abarcando as subcategorias de experiências exitosas e desafios da atividade na região de fronteira, a invisibilidade da doulagem, as expectativas enquanto doulas frente ao cenário obstétrico e o esperado da sua atuação profissional. O estudo permitiu compreender a vivência das doulas e o conhecimento do papel da sua função no Sistema Único de Saúde (SUS), no setor privado e em partos domiciliares, evidenciando a importância da atuação multiprofissional. Foram ponderadas resistências no cenário obstétrico por desconhecimento dos profissionais da assistência sobre o papel da doula. Em relação à atuação na região de fronteira, as doulas relataram o acompanhamento de mulheres paraguaias no Brasil e, com menos frequência, no Paraguai. As barreiras culturais e linguísticas foram destacadas como obstáculos para o exercício profissional em outro país.

ABSTRACT The study sought to understand the experience and expectations of doulas who worked or worked in two municipalities in the border region: Foz do Iguaçu and Cascavel, Paraná, Brazil. This was a qualitative research based on the framework of Social Phenomenology. The collection of information took place through interviews with a semi-structured script in Portuguese. The interviews were done online. The results were classified into six categories: motivated to become a doula, knowledge about the role of the doula, the daily life of the doulas, covering the subcategories of successful experiences and challenges of the activity in the border region, the invisibility of the doula, the expectations as doulas facing the obstetric scenario and what is expected of their professional performance. The study made it possible to understand the experience of doulas and knowledge of the role of their role in the Unified Health System (SUS), in the private sector and in home births, highlighting the importance of multidisciplinary action. Resistance in the obstetric scenario was considered due to the lack of knowledge on the part of care professionals about the role of the doula. Regarding work in the border region, the doulas reported accompanying Paraguayan women in Brazil and, less frequently, in Paraguay. Cultural and linguistic barriers were highlighted as reasons that make professional practice in another country unfeasible.

Impact of doula's continuous support on serotonin release in parturients: a pilot randomized clinical trial

Abstract Objective: To evaluate whether the continuous support provided by doulas influences the endogenous release of serotonin in parturients. Methods: This pilot study included 24 primigravidae at term. Of these, 12 women received continuous doula support (Experimental Group), whereas the other 12 received the usual assistance without doula support (Control Group). Blood samples were collected from all the women at the active and expulsion stages of labor and at the fourth period of labor (Greenberg period) for evaluation of their serotonin levels using high-performance liquid chromatography. Results: The average serotonin concentrations in the control and experimental groups were respectively 159.33 and 150.02 ng/mL at the active stage, 179.13 and 162.65 ng/mL at the expulsion stage, and 198.94 and 221.21 ng/mL at the Greenberg period. There were no statistically significant differences in serotonin concentrations between the two groups at the active and expulsion stages of labor. By contrast, within the experimental group, a significant increase in serotonin concentration was observed in the Greenberg period compared with the levels in the active and expulsion stages (p < 0.05). Conclusion: The novelty of this study relies on the ability to correlate the influence of the continuous support offered by doulas with the release of serotonin in parturients, with the results suggesting that the assistance received during labor can modulate the levels of hormone release in the Greenberg period. Brazilian Registry of Clinical Trials: RBR-4zjjm4h

Doulas da morte: uma revisão de escopo / Death doulas: a scoping review

Introdução. O profissional doula da morte é considerado um colaborador solidário, cujo objetivo é melhorar a qualidade de morte no processo de terminalidade de pacientes, de forma a proporcionar uma 'boa morte'. Objetivo. O objetivo do estudo é mapear as evidências científicas sobre os papéis das doulas da morte na terminalidade da vida. Materiais e Métodos. Trata-se de uma revisão de escopo realizada nas bases de dados CINHAL, EMBASE, WOS, PUBMED e LILACS usando descritores de saúde conectados pelos operados booleanos AND e OR no espaço temporal entre 2000 e 2021. Resultados: Dos 467 artigos encontrados, somente 11 fizeram parte da amostra final. Dentre a diversidade e flexibilidade de papéis, os profissionais doulas realizam tarefas, serviços e prestam cuidados práticos e não clínicos durante todo o processo de morrer, morte, pós-morte e luto de pacientes e seus familiares, bem como promovem educação para a morte, levando em consideração as dimensões biopsicossocial e espiritual do cuidado humano. Possíveis barreiras no movimento de doulas da morte incluem a inconsistência nos programas de treinamento existentes e a ausência de um órgão regulamentador para a supervisão da prática e a padronização de honorários. Discussão. O trabalho das doulas da morte concentra-se na presença e atenção plenas, escuta sensível, compassiva e centrada na pessoa em processo de terminalidade, respeitando os seus desejos e horando sua biografia. Conclusão. As doulas de morte podem aumentar os serviços de cuidados de fim de vida existentes, fornecendo serviços de cuidados holísticos e personalizados em todos os cenários da rede de atenção à saúde, contudo, há necessidade de estudos mais rigorosos para explorar a percepção dos profissionais de saúde sobre esse papel e investigar resultados clínicos entre pessoas que estão morrendo e suas famílias.

Introduction: The professional death doula is considered a supportive collaborator, whose goal is to improve the quality of death in the process of terminality of patients, to provide a 'good death'. Objective: The objective of the study is to map the scientific evidence on the roles of death doulas in the terminality of life. Materials and Methods: This is a scoping review conducted in the databases CINHAL, EMBASE, WOS, PUBMED and LILACS using health descriptors connected by the Boolean operands AND and OR in the time frame between 2000 and 2021. Results: Of the 467 articles found, only 11 were part of the final sample. Among the diversity and flexibility of roles, professional doulas perform tasks, services and provide practical and non-clinical care throughout the dying, death, postmortem and bereavement process of patients and their families, as well as promote death education, considering the biopsychosocial and spiritual dimensions of human care. Possible barriers in the death doula movement include the inconsistency in existing training programs and the absence of a regulatory body for the supervision of practice and the standardization of fees. Discussion: The work of death doulas focuses on full presence and attention, sensitive, compassionate listening, and centering on the person in the process of terminality, respecting their wishes and honoring their biography. Conclusion: Death doulas can augment existing end-of-life care services by providing holistic and personalized care services across health care settings, however, there is a need for more rigorous studies to explore health professionals' perceptions of this role and investigate clinical outcomes among dying people and their families.

Introducción: La doula de la muerte profesional se considera un colaborador de apoyo, cuyo objetivo es mejorar la calidad de la muerte en el proceso de terminalidad de los pacientes, con el fin de proporcionar una "buena muerte". Objetivo: El objetivo del estudio es mapear la evidencia científica sobre las funciones de las doulas de muerte en la terminalidad de la vida. Materiales y Métodos: Se trata de una revisión exploratoria realizada en las bases de datos CINHAL, EMBASE, WOS, PUBMED y LILACS utilizando descriptores de salud conectados por los operandos booleanos AND y OR en el marco temporal comprendido entre 2000 y 2021. Resultados: De los 467 artículos encontrados, sólo 11 formaron parte de la muestra final. Entre la diversidad y flexibilidad de roles, las doulas profesionales realizan tareas, servicios y proporcionan cuidados prácticos y no clínicos a lo largo del proceso de morir, muerte, postmortem y duelo de los pacientes y sus familias, así como promueven la educación sobre la muerte, teniendo en cuenta las dimensiones biopsicosociales y espirituales del cuidado humano. Entre los posibles obstáculos al movimiento de las doulas de la muerte se encuentran la incoherencia de los programas de formación existentes y la ausencia de un organismo regulador para la supervisión de la práctica y la normalización de los honorarios. Discusión: El trabajo de las doulas de la muerte se centra en la presencia y atención plena, la escucha sensible, compasiva y centrada en la persona en proceso de terminalidad, respetando sus deseos y honrando su biografía. Conclusión: Las doulas moribundas pueden aumentar los servicios existentes de atención al final de la vida proporcionando servicios de atención holísticos y personalizados en todos los entornos de atención sanitaria; sin embargo, se necesitan estudios más rigurosos para explorar las percepciones de los profesionales sanitarios sobre esta función e investigar los resultados clínicos entre los moribundos y sus familias.

Cuidado obstétrico na pandemia de COVID-19: Interrelações comunicacionais entre enfermeiro obstetra, mulher e doula / Obstetric care in the COVID-19 pandemic: Communication interactions between nurse midwives, woman, and doula / Cuidado obstétrico en la pandemia de COVID-19: Interrelaciones comunicativas entre enfermero obstetra, mujer y doula

Resumo Enquadramento: O cuidado obstétrico e a garantia da experiência de parto, assim como as interações profissionais foram atingidas pela pandemia de COVID-19, sendo necessárias reestruturações. Objetivo: Retratar o processo de comunicação entre a doula e o enfermeiro no cuidado obstétrico no contexto da pandemia de COVID-19. Principais tópicos em análise: Perturbações na interação da equipa de saúde têm vindo a repercutir-se em elementos como a comunicação em saúde e a colaboração, com déficits nas relações interpessoais entre enfermeiro e doula direcionadas à mulher. Associa-se à autonomia na execução e às interações profissionais, em que os conflitos e a perda de qualidade na assistência são observados. Reformas no trabalho em saúde incluindo respeito e qualidade no cuidado à mulher, família e comunidade são urgentes. Conclusão: O processo de comunicação tem sido prejudicado pela pandemia de COVID-19, o que exige o desenvolvimento de mecanismos de interação que facilitem as atividades de cuidado e as estratégias de melhoria das relações de poder que ocorrem entre enfermeiro obstetra e doula no cuidado da mulher.

Abstract Background: Obstetric care, a positive birth experience, and professional interactions were affected by the COVID-19 pandemic and had to be restructured. Objective: To describe the communication process between doulas and obstetric nurses during the COVID-19 pandemic. Main topics under analysis: Disturbances in the interaction of the health team have impacted aspects such as communication in health and collaboration, with deficits in the interpersonal relationships between nurses, doulas, and women. It is associated with autonomy of action and professional interactions, where conflicts and loss of quality of care were observed. Health sector reforms are urgent, including the delivery of respectful and quality care to women, families, and communities. Conclusion: The communication process has been negatively affected by the COVID-19 pandemic, requiring the development of interaction mechanisms to facilitate care activities and strategies to improve power relations between obstetric nurses and doulas in caring for women.

Resumen Marco contextual: La atención obstétrica y la garantía de la experiencia del parto, así como las interacciones profesionales se han visto afectadas por la pandemia de COVID-19, y es necesario reestructurarlas. Objetivo: Retratar el proceso de comunicación entre la doula y el enfermero en la atención obstétrica en el contexto de la pandemia de COVID-19. Principales temas en análisis: Las alteraciones en la interacción del equipo de salud han impactado en elementos como la comunicación sanitaria y la colaboración, y conllevan déficits en las relaciones interpersonales entre enfermeros y doulas dirigidas a la mujer. Se asocia a la autonomía en la ejecución y a las interacciones profesionales, en las que se observan conflictos y pérdida de calidad en la asistencia. Urge llevar a cabo reformas en el trabajo sanitario que incluyan el respeto y la calidad en la atención a la mujer, la familia y la comunidad. Conclusión: El proceso de comunicación se ha visto perjudicado por la pandemia de COVID-19, lo que exige desarrollar mecanismos de interacción que faciliten las actividades de atención y las estrategias de mejora de las relaciones de poder que tienen lugar entre enfermero obstetra y doula en la atención a la mujer.

Relação de Trabalho entre Enfermeiros Obstétricos e Doulas na Assistência ao Parto / The work relationship between obstetric nurses and doulas in assistance to childbirth / La relación de trabajo entre enfermeros obstétricos y doulas en la asistencia al parto

Objetivo: O estudo objetiva descrever a relação de Enfermeiros Obstétricos e Doulas na assistência ao trabalho de parto e parto. Métodos: Estudo qualitativo, descritivo e prospectivo, realizado no Centro de Parto Normal localizado em Castanhal, com sete Enfermeiras Obstétricas e três Doulas. Os dados foram coletados entre dezembro/2017 e maio/2018, por meio de entrevista semiestruturada e Análise de Conteúdo de Bardin. Resultados: Emergiram as seguintes categorias: Assistência holística à gestante; A Enfermagem Obstétrica e as Doulas: o desafio no entrecruzar de práticas; Associação de práticas na assistência ao parto normal. Conclusão: Apesar dos relatos evidenciados de conflitos entre as Doulas e as Enfermeiras Obstétricas, é possível identificar uma boa relação na associação de práticas proporcionando benefícios à parturiente. (AU)

Objective: The study aims to describe the relationship between Obstetric Nurses and Doulas in assisting labor and delivery. Methods: A qualitative, descriptive and prospective study, carried out with seven Obstetric Nurses and three Doulas. Data were collected between Dec 2017 to May 2018, through a semi-structured interview and Bardin Content Analysis. Results: The speeches were classified into the following categories: Holistic care for pregnant women; Obstetric Nursing and Doulas: the challenge in the intertwining of practices; Association of practices in assisting normal delivery. Conclusion: Despite the evidences of conflicts between the Doulas and the Obstetric Nurses, it is possible to identify a good relation in the association of practices providing benefits to the parturient. (AU)

Objetivo: El estudio objetivó describir la relación de Enfermeros Obstétricos y Doulas en la asistencia al trabajo de parto y parto. Métodos: Estudio cualitativo, descriptivo y prospectivo, realizado en el Centro de Parto Normal ubicado en Castanhal, con siete Enfermeras Obstétricas y tres Doulas. Los datos fueron recolectados entre diciembre/2017 y mayo/2018, por medio de entrevista semiestructurada y Análisis de Contenido de Bardin. Resultados: Se plantearon las siguientes categorías: Asistencia holística a la gestante; La Enfermería Obstétrica y las Doulas: el desafío en el entrecruzar de prácticas; Asociación de prácticas en la asistencia al parto normal. Conclusion: A pesar de los relatos evidenciados de conflictos entre las Doulas y las Enfermeras Obstétricas, es posible identificar una buena relación en la asociación de prácticas proporcionando beneficios a la parturienta. (AU)

Mulheres assistidas por doulas: estudo exploratório / Women assisted by doulas: exploratory study

Objective: To evaluate the perception of women assisted by doulas in relation to their role. Method: Exploratory study with a quantitative approach. The data were collected by the snowball technique, through a digital questionnaire. Descriptive statistical analysis was performed. Results: The sample comprised 322 participants, with an average age of 31.8 SD ± 5.4 years, mostly white, married, with higher education and only one pregnancy. 95% of the participants recognized the importance of the doula's work and had a positive perception of the follow-up, in addition to claiming (93%) that their work contributed a lot during childbirth, especially in the physical and emotional areas (48%). Regarding the interaction with the nursing team, 51% stated that there was. Conclusion: The doula is a professional who contributes to the humanization of childbirth care, her support was considered positive and beneficial, however, her inclusion in the childbirth care team is a challenge to be faced.(AU)

Objetivo: Evaluar la percepción de las mujeres asistidas por doulas en relación a su rol. Método: Estudio exploratorio con enfoque cuantitativo. Los datos fueron recolectados mediante la técnica de bola de nieve, a través de un cuestionario digital. Se realizó análisis estadístico descriptivo. Resultados: La muestra estuvo conformada por 322 participantes, con una edad promedio de 31,8 DE ± 5,4 años, en su mayoría blancos, casados, con estudios superiores y un solo embarazo. El 95% de las participantes reconoció la importancia del trabajo de la doula y tuvo una percepción positiva del seguimiento, además de afirmar (93%) que su trabajo aportó mucho durante el parto, especialmente en el área física y emocional (48%). En cuanto a la interacción con el equipo de enfermería, el 51% afirmó que sí. Conclusión: La doula es una profesional que contribuye a la humanización de la atención al parto, su apoyo se consideró positivo y beneficioso, sin embargo, su inclusión en el equipo de atención al parto es un desafío a enfrentar.(AU)

Objetivo: Avaliar a percepção das mulheres assistidas por doulas em relação ao papel das mesmas. Método: Estudo exploratório com abordagem quantitativa. Os dados foram coletados pela técnica snowball, através de um questionário digital. Realizada análise estatística descritiva. Resultados: Fizeram parte da amostra 322 participantes, com idade média de 31,8 DP± 5,4 anos, maioria branca, casada, com nível superior e apenas uma gestação. 95% das participantes reconheceram a importância do trabalho da doula e tiveram uma percepção positiva do acompanhamento, além de alegarem (93%) que o trabalho destas contribuiu muito durante o parto, principalmente nas área física e emocional (48%). Em relação a interação com a equipe de enfermagem, 51% afirmaram que houve. Conclusão: A doula é uma profissional que contribui para a humanização da assistência ao parto, seu apoio foi considerado positivo e benéfico, porém, sua inserção na equipe de assistência ao parto constitui-se um desafio a ser enfrentado.(AU)

Comprehension on doula's work at a maternity in Jequitinhonha Valley - MG / Compreensão sobre o trabalho da doula em uma maternidade do Vale do Jequitinhonha - MG

Abstract Objectives: to analyze the understanding of puerperae, doulas and the care team about the presence of a doula during the pregnant women's parturition process. Methods: this is a qualitative study, using semi-structured interviews as a data collection instrument. The saturation criterion was used to limit the sample and proceed to the Content Analysis. Results: 19 participants were interviewed, 10 were the health team, 5 were doulas and 4 were puerperae. After the analysis, three categories were identified: the doula's presence during the pregnant women's labor and their meaning, the doula's follow up during the pregnant women's labor and its improvements, the influence of doulagem in the academic formation. The presence of doulas brought to the parturient security, support, humanization and follow-up on childbirth process. The team brought comfort and tranquility.The doulas scored benefits for academic training. Conclusions: it was possible to recognize doula as part of the humanized care, to provide subsidies for a reflection of her work, and to reveal the influence of the practice of doulagem for academic formation of doulas at university.

Resumo Objetivos: analisar a compreensão das puérperas, das doulas e da equipe assistencial sobre a presença da doula durante o processo de parturição das gestantes. Métodos: trata-se de estudo qualitativo, utilizando como instrumento de coleta de dados entrevistas semiestruturadas. O critério de saturação foi utilizado para limitar a amostra e procedida a Análise de Conteúdo. Resultados: foram entrevistados 19 participantes, sendo 10 da equipe de saúde, 5 das doulas e 4 das puérperas. Após análise, foram identificadas três categorias, sendo elas: presença da doula durante o trabalho de parto das gestantes e seus significados, acompa-nhamento da doula durante o trabalho de parto das gestantes e suas melhorias, a influência da doulagem na formação acadêmica. A presença das doulas trouxe para a parturiente segurança, apoio, humanização e acompanhamento do processo de parto. Para a equipe trouxe conforto e tranquilidade. As doulas pontuaram benefícios na formação acadêmica. Conclusões: foi possível reconhecer a doula como parte do cuidado humanizado, prover subsídios para uma reflexão do seu trabalho, além de revelar a influência da prática da doulagem para formação acadêmica das doulas universitárias.

Vivências na assistência à mulher: percepção das doulas / Experiences in women's care: doulas' perception

Objetivo: conhecer a percepção das doulas quanto às suas vivências na assistência à mulher no pré-parto, parto e pós-parto. Método: trata-se de pesquisa qualitativa, do tipo descritiva, com sete doulas de uma casa de apoio à gestante. Coletaram-se os dados por meio de entrevistas semiestruturadas, sendo submetidos à técnica de Análise de Conteúdo na modalidade Análise categorial. Resultados: emergiram-se quatro categorias: "Um trabalho que é serviço"; "Trabalho da doula no pré-parto: momento para a informação e o preparo da mulher"; "Trabalho da doula no parto: apoio contínuo e alívio da dor"; "Trabalho da doula no pósparto: olhar voltado para a amamentação e perdas fetais". Conclusão: conclui-se que os relatos demonstram o reconhecimento da importância da assistência por estas mulheres no período gestacional, parto e puerpério e sinalizam a necessidade de aprofundamento e reconhecimento de alguns eixos formativos para os cursos de formação das doulas.(AU)

Objective: to know the perception of the doulas regarding their experiences in assisting women in prepartum, delivery and postpartum. Method: it is a qualitative research, of the descriptive type, with seven doulas of a house to support the pregnant woman. The data were collected through semi-structured interviews, being submitted to the Content Analysis technique in the category Analysis category. Results: four categories emerged: "A work that is service"; "Doula work in the prepartum: moment for the information and the preparation of the woman"; "Doula labor at childbirth: continuous support and pain relief"; "Doula's postpartum work: looking at breastfeeding and fetal losses". Conclusion: it is concluded that the reports show the recognition of the importance of the care provided by these women during the gestational, puerperal and puerperal periods and indicate the need for deepening and recognition of some formative axes for the doulas training courses.(AU)

Objetivo: conocer la percepción de las doulas en cuanto a sus vivencias en la asistencia a la mujer en el preparto, parto y postparto. Método: se trata de una investigación cualitativa, del tipo descriptivo, con siete doulas de una casa de apoyo a la gestante. Se recolectaron los datos por medio de entrevistas semiestructuradas, siendo sometidos a la técnica de Análisis de Contenido en la modalidad Análisis categorial. Resultados: surgieron cuatro categorías: "Un trabajo que es servicio"; "Trabajo de la doula en el preparto: momento para la información y la preparación de la mujer"; "Trabajo de la doula en el parto: apoyo continuado y alivio del dolor"; "Trabajo de la doula en el postparto: mirar hacia la lactancia y pérdidas fetales". Conclusión: se concluye que los relatos demuestran el reconocimiento de la importancia de la asistencia por estas mujeres en el período gestacional, parto y puerperio y señalan la necesidad de profundización y reconocimiento de algunos ejes formativos para los cursos de formación de las doulas.(AU)

Percepção e ações de doulas no processo de humanização do parto / Doulas' perceptions and actions in the process of humanization of labor and delivery / Percepción y acciones de las doulas en el proceso de humanización del parto

OBJETIVO: identificar o que significa para as doulas o parto humanizado e quais ações elas desenvolvem no processo de humanização com parturientes e puérperas. MÉTODO: estudo descritivo-exploratório, de abordagem qualitativa, realizado em uma maternidade pública estadual pertencente à Secretaria de Estado da Saúde do Amazonas. Foram realizadas cinco entrevistas com doulas. Para análise dos dados, utilizou-se a análise de conteúdo de Lawrence Bardin. RESULTADOS: identificaram-se duas categorias temáticas - significado de parto humanizado na visão das doulas, seu papel frente à assistência à parturiente e puérpera. CONCLUSÃO: as ações das doulas convergem para o comprometimento com a humanização das práticas de saúde, respeito e autonomia da mulher no ato de partejar, fazendo-se necessária mais disseminação do conhecimento da legalização da atuação de doulas e a sensibilização da equipe multiprofissional.(AU)

Objective: to identify the meaning given by doulas to humanized practices in labor and delivery and the doulas' actions in the process of humanization of the care for pregnant and postpartum women. Methods: a descriptive-exploratory qualitative study conducted in a public maternity hospital managed by the Secretaria de Estado da Saúde do Amazonas. A total of five interviews were conducted with doulas. Content analysis by Lawrence Bardin was used for data analysis. Results: two categories emerged from the data analysis ­ the meaning given by doulas to the humanization of labor and delivery care, and the role of doulas in the care of pregnant and postpartum women. Conclusion: doulas' actions are focused on their commitment to the humanization of health care practices, respect, and autonomy for women in labor and delivery. Dissemination of knowledge about doulas' legal practices and awareness of doulas' role in a multidisciplinary team is needed. (AU)

Objetivo: identificar el significado del parto humanizado para las doulas y qué acciones llevan a cabo en el proceso de humanización con las mujeres en el parto y el posparto. Método: estudio exploratorio descriptivo de enfoque cualitativo realizado en una maternidad pública estatal de la Secretaría de Salud del estado de Amazonas. Se realizaron cinco entrevistas con doulas. Para el análisis de datos se utilizó el análisis de contenido de Lawrence Bardin. Resultados: se identificaron dos categorías temáticas: significado del parto humanizado desde el punto de vista de las doulas y su rol en el cuidado de las mujeres parturientas y en el posparto. Conclusión: las acciones de las doulas convergen para el compromiso con la humanización de las prácticas de salud, el respeto y autonomía de las mujeres en el acto de la partería, lo cual requiere mayor difusión del conocimiento sobre la legalización de las doulas y concienciación del equipo multiprofesional. (AU)

Rebirth of childbirth: reflections on medicalization of the Brazilian obstetric care / Renacimiento del parto: reflexiones sobre la medicalización de la atención obstétrica en Brasil / Renascimento do parto: reflexões sobre a medicalização da atenção obstétrica no Brasil

ABSTRACT Objective: to reflect on the medicalization process of childbirth and birth and its consequences based on a Brazilian audiovisual media artifact. Method: reflective and interpretive analysis of the documentary O Renascimento do Parto (The Rebirth of Childbirth) based on Critical Discourse Analysis. Results: c-section emerges as an alternative to adverse conditions of pregnancy. However, it has become a routine and abusive practice of a medicalized obstetric care, thus becoming a social problem. In order to the incidence of c-sections decrease, women's protagonism must be restored, in addition to considering psychological, affective, emotional, spiritual, cultural, and contextual aspects in childbirth. Conclusion: childbirth is established as a material element and a mental phenomenon of social practices. We must interrupt the predominant model, allowing the body to express itself through the release of oxytocin, and decrease the segregation that c-section causes, thus enabling affective bonds.

RESUMEN Objetivo: reflexionar sobre el proceso de medicalización al parto y nacimiento y sus consecuencias, a partir de un artefacto mediático audiovisual brasileño. Método: análisis reflexivo e interpretativo del documental "O Renascimento do Parto", basado en el Análisis Crítico del Discurso. Resultados: la cesárea se configura como alternativa a condiciones adversas en la gestación. Sin embargo, se convirtió en una práctica rutinaria y abusiva, de una atención obstétrica medicalizada, pasando a ser un problema social. Para que la incidencia de cesáreas disminuya es necesario que sea restituido el protagonismo de la mujer, además de considerar aspectos psicológicos, afectivos, emocionales, espirituales, culturales y contextuales en el parto. Conclusión: el parto se configura como elemento material y fenómeno mental de las prácticas sociales. Es necesario romper con el modelo predominante, permitir que el cuerpo se exprese por medio de la liberación de oxitocina y disminuir la segregación que la cesárea provoca, proporcionando la formación de vínculos afectivos.

RESUMO Objetivo: refletir sobre o processo de medicalização ao parto e nascimento e suas consequências, a partir de um artefato midiático audiovisual brasileiro. Método: análise reflexiva e interpretativa do documentário "O Renascimento do Parto", baseada na Análise do Discurso Crítica. Resultados: a cesariana configura-se como alternativa para condições adversas gestacionais. Entretanto, tornou-se uma prática rotineira e abusiva, de uma atenção obstétrica medicalizada, passando a ser um problema social. Para que a incidência de cesarianas diminua é necessário que seja restituído o protagonismo da mulher, além de considerar aspectos psicológicos, afetivos, emocionais, espirituais, culturais e contextuais no parto. Conclusão: o parto configura-se como elemento material e fenômeno mental das práticas sociais. É necessário romper com o modelo predominante, permitir que o corpo se expresse por meio da liberação de ocitocina e diminuir a segregação que a cesariana provoca, proporcionando a formação de vínculos afetivos.

Doulas como gatilho de tensões entre modelos de assistência obstétrica: o olhar dos profissionais envolvidos / Doulas as a tension trigger between obstetric assistance models: the view of the professionals involved

RESUMO Este artigo analisa a percepção dos profissionais de saúde da maior maternidade do estado da Paraíba acerca da inserção das doulas no processo de cuidado. Trata-se de estudo qualitativo, com 24 profissionais de saúde, cujo instrumento de coleta de dados foi uma entrevista semiestruturada. O papel da doula na assistência à parturiente foi descrito como: oferta de suporte emocional, físico e de informação. Cada uma dessas dimensões disparou tensões com diferentes personagens envolvidas no parto, como psicólogas, fisioterapeutas e médicas. Nesse cenário, as profissionais tencionam a delimitação de técnicas/conhecimentos privativos de cada categoria, a fim de ratificar sua autonomia frente ao surgimento de mais uma figura no cuidado à gestante, sobretudo quando essa personagem coloca em xeque práticas tradicionalmente executadas na obstetrícia. A gênese dessas tensões vai além da presença de um 'novo' sujeito na cena do parto, mas é um reflexo da conjuntura obstétrica brasileira, permeada por disputas entre modelos de assistência e por espaços de atuação. Também desperta a necessidade de construção de um cuidado compartilhado e centrado na parturiente.

ABSTRACT This article analyzes the perception of the healthcare professionals of the largest maternity of the state of Paraíba about the insertion of doulas in the care process. This is a qualitative study, with 24 health care professionals, whose instrument of data production was a semi-structured interview. The role of the doula in the assistance to parturient was described as: offer of emotional, physical and informational support. Each of these dimensions has triggered tensions with different characters involved in childbirth, such as psychologists, physiotherapists and physicians. In this scenario, professionals intend to delimit individual techniques/knowledge of each category, in order to ratify their autonomy in the face of the emergence of another figure in the care of the pregnant woman, especially when this character puts in check practices traditionally executed in obstetrics. The genesis of these tensions goes beyond the presence of a 'new' subject at the delivery scene, but it is a reflection of the brazilian obstetric scenario, permeated by disputes between care models and performance space. It also raises the need to build a shared care and centered on the parturient.