'Do we need doulas ?' - Perspectives of maternity care managers on the role of doulas in Poland.

AIM: The purpose of this study was to analyse perinatal care managers' perspectives on the role of doulas in Poland and to consider how managers' perspectives might affect the opportunities for doulas to practice in individual hospitals. DESIGN: This is a qualitative descriptive study. METHOD: The total of 17 hospitals was selected for the study. Semi-structured interviews were conducted with 11 manager staff members. RESULTS: Three groups of facilities were identified: '0' (n = 6) - refused to give interviews, 'A' (n = 8) - marginal experience in working with doulas, and 'B' (n = 3) - regular experience in working with doulas. The hospitals from Group A showed indifference towards working with doulas. Group B declared a positive attitude towards such cooperation. Attitudes towards doulas vary among executives and are related to the frequency of doula-assisted births. Our results indicate factors that may influence the attitude of medical staff towards doulas and which may contribute to improve future initiatives meant to facilitate collaboration between midwives and doulas. PATIENT OR PUBLIC CONTRIBUTION: This study explored the lived experiences of perinatal care managers.

Cooperation between midwives and doulas in the context of perinatal care - a integrative review of qualitative and quantitative studies.

BACKGROUND: A doula is a person who provides support to women in the perinatal period without providing medical services. During childbirth, the doula becomes a member of the interdisciplinary team. This integrative review aims to analyse the nature of the cooperation between doulas and midwives, its efficiency and challenges and ways of strengthening this cooperation. METHODS: A structured integrative review of empirical and theoretical studies written in English was conducted. The literature search included MEDLINE, Cochrane, Scopus, ProQuest, Science Direct, Web of Science, and Embase Health Source: Nursing/Academic Edition databases. The analysis included papers published in 1995-2020. Dedicated documents were searched for different combinations of terms and standard logical operators. A manual search of the studies was included for additional references. RESULTS: Twenty-three articles from 75 full-text records were analysed. Three main themes emerged. (1) doulas are needed to prop up the system (2) barriers in collaboration between midwives and doulas; and (3) how cooperation between midwives and doulas can be strengthened. None of the articles referred directly to the impact of collaboration between midwives and doulas on the quality of perinatal care. CONCLUSION: This is the first review to analyse the impact of collaboration between midwives and doulas on the quality of perinatal care. Ensuring adequate collaboration between doulas and midwives requires effort from both of these professional groups and the health care system. However, such collaboration is supportive for birthing women and the perinatal care system. Further research in terms of the impact of this collaboration on the quality of perinatal care is needed.

"I knew there has to be a better way": Women's pathways to freebirth in Poland.

BACKGROUND: Each year a small number of women decide to birth at home without midwifery and medical assistance despite the availability of maternity services in the country. This phenomenon is called freebirth and can be used as a lens to look into shortcomings of maternity care services. AIM: By exploring women's pathways to freebirth, this article aims to examine the larger context of maternity services in Poland and identify elements of care contributing to women's decision to birth without midwifery and medical assistance. METHODS: A qualitative methodology was used employing elements of ethnographic fieldwork, including digital ethnography. Semi-structured interviews with twelve women who freebirth, analysis of online support groups, secondary sources of information and elements of participant observation were used. FINDINGS: Women's decisions to freebirth were born out of their previous negative experiences with maternity care. Persistent use of medical technology and lack of respect from maternity care providers played a major role in pushing women away from available Polish maternity services. While searching for a better environment for themselves and their babies for the subsequent births, women experienced a rigidity of both mainstream and homebirth services and patchy availability of the latter that contributed to their decisions to freebirth. CONCLUSIONS: Freebirth appears to be a consequence of inadequate maternity services both mainstream and homebirth rather than a preference. Women's freebirth experiences can be used to improve maternity care in Poland and inform similar contexts globally.

Is job seniority a protective factor against anxiety among midwives during the SARS-CoV-2 pandemic?

INTRODUCTION: Introduction. The pandemic SARS-Cov-2 outbreak necessitated the implementation of changes in everyday obstetric attendance, which demands continuity of care. Employment of sudden changes in obstetric attendance could have increased anxiety among medical personnel. OBJECTIVE: The aim of the Communication was to analyse the influence of professional experience on the level of anxiety in a group of midwives during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: The analysis included 100 midwives: average professional experience: 11.51 years (max. 36; median 7,5; SD: 10.37; p<0.0001). The largest group of respondents was employed in a tertiary referral hospital (n = 40), the smallest in a medical clinic (n = 7). A preliminary study using an online questionnaire, the Generalized Anxiety Disorder Screener (GAD-7), posted on Internet fora, Facebook fan pages of The Childbirth with Dignity Foundation, and the Foundation for Midwives, using the Snowball sampling method. The Ethics Committee for Research Projects at the Institute of Psychology, University of Gdansk, approved the research project (Approval No. 35/2020). RESULTS: The average score was 9.390 (max. 21, median 8.5; SD; 5.228). The length of professional experience did not correspond to the level of anxiety (r = -0.0097; p = 0.9237). In 20 respondents, no anxiety was traced, while the smallest group indicated severe anxiety (n = 15). Professional experience did not influence the level of anxiety in either group with different level of anxiety (ANOVA test; p = 0.465). . CONCLUSIONS: Professional experience did not influence the level of anxiety. In order to prevent exacerbation of anxiety symptoms, different factors which may playa vital role in enhancing the level of anxiety must be analysed.