Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care.

INTRODUCTION: The aim of this study was to compare maternal and neonatal outcomes in the care provided by Doula, trained lay companion, and routine midwifery care in the labor and obstetric units. In this study, only results related to maternal outcomes were presented. METHOD: This is a quasi-experimental study, which was conducted on 150 women with low-risk pregnancies who had been selected for vaginal birth at private clinics and public hospitals of Arak, Iran. Participants were divided into three groups, two intervention groups, doula and trained lay companion, and one control group, midwife's routine care. The intervention groups, in addition to receiving routine care from the labor and maternity units, also received support and training by doula or a trained lay companion, but 50 the control group received only routine midwifery care. In the control group and the trained companion, the samples were taken from 10 clinics of different parts of the city by random sampling method using the SIB center system. Then, among selected numbers, we randomly selected samples for each group. But in Doula group, because of limited number of samples, convenience sampling was used and all women enrolled in doula care were included in the study until the number reached 50. In each group, outcomes such as the duration of active phase and second stage of labor, as well as the severity of pain, anxiety and maternal satisfaction with birth were measured and compared with other groups. Data were collected by a researcher-made checklist, the Spielberger's State-Trait Anxiety Inventory (STAI), the Pain Visual Assessment Scale (VAS), and the Hollins Martin's Birth Satisfaction Scale-Revised (BSS-R). Data were analyzed by SPSS-22 statistical software using Kruskal Wallis, Chi-Square, ANOVA and Fisher's exact tests. FINDINGS: Based on the results, the mean duration of active phase between three groups was 234.68 ± 118.74, 256.66 ± 108.75 and 279 ± 94.37 min, respectively (p = 0.022). Also, the mean duration of second stage in three groups was 10 ± 5.61, 10.35 ± 5.1 and 22.30 ± 75.57 min, respectively (p < 0.001). The difference between mean pain scores in the first, second, third, fourth and fifth hours was not statistically significant. The average difference in anxiety score in the two stages of labor was higher in the lay companion group, and this difference was statistically significant (p < 0.001); however, the level of satisfaction in doula group was higher compared to the lay companion and control groups (p < 0.00 1). CONCLUSION: According to present study, doula care has a greater effect on reducing the duration of labor than other care models. Based on the study, there was no statistically significant difference between the three groups in terms of variables such as the severity of labor pain. However, the level of anxiety of pregnant mothers in the group supported by lay companion was lower than the other two groups, which indicates the positive effect of mothers' training on increasing maternal comfort and satisfaction. It is suggested that further research investigate the severity of labor pain in groups supported by different care models and also we recommend the use of lay companion' support during childbearing of mothers who could not afford doula. TRAIL REGISTRATION: This article has been registered in Iran's Clinical Trial Center with the code: IRCT20230620058548N1. 2023/08/29.

Paradoxes in the cultural doula concept for migrant women: Implications for gender-inclusive care versus migrant-friendly maternity care.

OBJECTIVE: Swedish healthcare policies promote gender equality, shared parenting and cultural diversity. In response to the risk of adverse outcomes for migrant women, cultural doulas were introduced as support for migrant women during pregnancy and/or labour. The aim is to investigate potential tensions in the cultural doula concept in relation to policies of gender equality and diversity. DESIGN: An interview study was designed to analyse perceptions of the cultural doula concept among healthcare providers in Swedish sexual and reproductive healthcare. Through the framework of Bacchi's approach 'What Is the Problem Represented to Be?' and Hochschild's concept of 'global care chains', we analyzed whether the introduction of the cultural doula concept is in line with the policies of gender equality and culturally sensitive care by exploring paradoxes, unintended consequences and what was not reflected upon. SETTING AND PARTICIPANTS: Semi-structured interviews (n = 18) with midwives and obstetricians at hospitals in two Swedish counties during 2022. MEASUREMENTS AND FINDINGS: The interviews were analyzed through thematic analysis. Cultural doulas were perceived as multi-tasking resources for facilitating integration and providing healthcare information and psychosocial support. Respondents did not identify doula support as a cultural practice in migrants' origin countries. Despite awareness of cultural differences in gender norms, many respondents stated that doula support included male partners. KEY CONCLUSIONS: The cultural doula concept includes paradoxes in relation to gender equality and diversity. Rather than empowering migrant women, the cultural doula concept is related to gendered patterns of low-educated, underpaid care work. Labour support interventions including migrant women's social network and intensified partner involvement would be more in line with Swedish policies of gender equality, shared parenting and cultural sensitivity when needed. However, doulas may be an imperfect solution for women lacking partners or social networks, for example, newly arrived migrant women, if no support is to be found within the perinatal care system. IMPLICATIONS FOR PRACTICE: Midwives and obstetricians need reflexivity about what the problem is represented to be when it comes to gender equality and cultural sensitivity in their collaboration with cultural doulas, boundaries between roles, how they handle confidentiality, and why cultural doulas are needed in relation to migrant women's integration.

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.

'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.

Changes to Birth Plans Due to COVID-19: A Survey of Utah Midwives and Doulas.

INTRODUCTION: This study seeks to understand the experiences of Utah midwives and doulas caring for patients during the recent coronavirus disease 2019 (COVID-19) pandemic. Specifically, the goal of the study was to describe the perceived impact on the community birth system and explore differences in the access and use of personal protective equipment (PPE) between in- and out-of-hospital births. METHODS: This study used a cross-sectional, descriptive study design. A 26-item survey developed by the research team was sent via email to Utah birth workers, including nurse-midwives, community midwives, and doulas. Quantitative data were collected during December 2020 and January 2021. Descriptive statistics were used in the analysis. RESULTS: Of the 409 birth workers who were sent a link to the survey, 120 (30%) responded: 38 (32%) CNMs, 30 (25%) direct-entry or community midwives, and 52 (43%) doulas. The majority (79%) reported changes to clinical practice during the COVID-19 pandemic. Community midwives (71%) who responded indicated practice volume increased. Survey participants reported an increased patient preference for home births (53%) and birth center births (43%). Among those with one or more patient transfers to the hospital, 61% experienced a change in the process. One participant reported that it took 43 minutes longer to transfer to the hospital. Community midwives and doulas reported poor access to a regular source of PPE. DISCUSSION: Survey participants reported changes to planned birth locations during the COVID-19 pandemic. When necessary, transfers to hospitals were reported to be slower. Community midwives and doulas reported having insufficient access to PPE and reported limited knowledge about COVID-19 testing resources and resources for educating patients on COVID-19. This study adds an important perspective to the existing literature on COVID-19 by indicating that policymakers should include community birth partners in community planning for natural disasters and future pandemics.

Multicultural doula care from the perspectives of immigrant women in Norway: A qualitative study.

OBJECTIVES: The aim of the study was to illuminate immigrant women's experiences of multicultural doula care as part of the 'Vulnerable, pregnant and new in Norway - Safe during childbirth with a multicultural doula' project. METHODS: The qualitative design was based on Braun & Clarke's thematic analysis. Semi-structured interviews were held, assisted by an interpreter, with seven immigrant women from three different countries. RESULTS: The overarching theme illuminated a significant caring relationship between the immigrant women and their multicultural doula. The relationship was important for the women's positive childbirth experience. Furthermore, four themes emerged as follows: feeling alone and scared; needing to be looked after; not knowing the language; and giving birth in a new and unfamiliar culture. The results revealed that the women felt safeguarded by the multicultural doula. They felt cared for and understood when the doulas acted as guides, knowing the culture and language, in collaboration with the midwife in maternal care. CONCLUSIONS: Multicultural doulas can contribute to optimizing the quality of care provided to immigrant women during pregnancy and childbirth, with focus on an equal quality of care for all women. The findings can raise awareness of cultural competence in midwifery practice. More research is needed to develop new models that incorporate multicultural doulas into healthcare policies.

Melanated Group Midwifery Care: Centering the Voices of the Black Birthing Community.

Access to safe and dignified pregnancy, childbirth, and postpartum experiences is a fundamental right for all pregnant and postpartum people. In the United States, systemic racism fuels distrust and disengagement in a health care system that continues to dehumanize the Black community. The respectful maternity care literature explains how these systemic, structural, and institutional failings produce maternal health disparities and expose a pattern whereby Black women receive less adequate maternity care. The implementation of trustworthy policies and practices is urgently needed because no single intervention has or will substantially reduce maternal disparities. The purpose of this article is to describe a multicomponent maternity care innovation, Melanated Group Midwifery Care (MGMC). MGMC was codesigned with community partners and is responsive to the needs and desires of Black women, making MGMC a culturally adapted and patient-centered model. Racial concordance among care providers and patients, group prenatal care, perinatal nurse navigation, and 12 months of in-home postpartum doula support are 4 evidence-based interventions that are bundled in MGMC. We posit that a model that restructures maternity care to increase health system accountability and aligns with the needs and desires of Black pregnant and postpartum people will increase trust in the health care system and result in better clinical, physical, emotional, and social outcomes.

"Restoring the Sacred Part of Birth": Doula Care and Cesarean Birth in Switzerland.

At 32.3%, Switzerland ranks among countries with the highest rates of cesarean deliveries in Europe. Because cesareans generally negatively influence the birth experience, parents turn to holistic therapists to heal somatic and emotional disorders not addressed by standard biomedical follow-ups. Doula care is still emerging in Switzerland. Although doulas are not allowed in the operation rooms, they support parents before birth and during the postpartum period. They aim at improving the birth experience by restoring intimate, "sacred" elements of birth through symbolic and spiritual practices. Based on interviews with doulas, I explore their experiences and practices regarding surgical birth.

Fading into the woodwork: Doula work and hospital-based practice.

Doulas offer emotional support to women during pregnancy, childbirth, and the early postpartum period. In hospitals, doulas support their clients without holding formal status as employees or as a regulated profession. Drawing on interviews with 26 doulas in Toronto, Canada, along with analyses of the legacy of medical dominance in maternity care, I examine how doulas accomplish their work in hospitals. I find that doulas face challenges accessing physical resources and struggle to provide their model of care in light of routine hospital procedures and interventions. In response, many doulas develop strategies to address the constraints imposed by their work contexts. These findings suggest that the medical model of birth is resistant to even minor modifications or perspectives that view birth holistically rather than solely dependent on medical intervention.

Les doulas offrent un soutien émotionnel aux femmes pendant la grossesse, l'accouchement et le début de la période postnatale. Dans les hôpitaux, les doulas soutiennent leurs clients sans avoir un statut officiel d'employées ou de profession réglementée. À partir d'entretiens avec 26 doulas à Toronto, au Canada, et d'analyses de l'héritage de la domination médicale dans les soins de maternité, j'examine comment les doulas accomplissent leur travail dans les hôpitaux. Je constate que les doulas ont du mal à accéder aux ressources physiques et à fournir leur modèle de soins à la lumière des procédures et interventions hospitalières habituelles. En réponse, de nombreuses doulas développent des stratégies pour faire face aux contraintes imposées par leur contexte de travail. Ces résultats suggèrent que le modèle médical de l'accouchement résiste à des modifications même mineures ou à des perspectives qui considèrent l'accouchement de manière holistique plutôt que de dépendre uniquement d'une intervention médicale.

Death doulas as supportive companions in end-of-life care: A scoping review.

BACKGROUND: Death doulas have gained greater attention recently by offering psychosocial, spiritual and other non-clinical support for patients with time-limiting diseases, including their families, with the potential to complement existing end-of-life care services. However, their roles, scope of practice and care impact remain poorly understood. AIM: To describe existing knowledge on death doulas regarding their roles, care impact, training and regulation. DESIGN: This scoping review utilised Levac et al.'s framework and textual narrative synthesis to summarise the findings. DATA SOURCES: PubMed, Scopus, CINAHL, PsycINFO, ProQuest, Google Scholar were searched for relevant articles from inception to 20 May 2021. Empirical studies, narrative reports, unpublished theses and studies in English were included. RESULTS: Thirteen articles were included. Death doulas take on diverse roles in end-of-life care. Their roles include providing psychosocial, spiritual, practical support, companionship and resource navigation. The positive impacts of engaging a death doula include continuous presence, holistic service and flexible payment regime. The negative aspects include role inconsistencies and confusion among healthcare professionals and the public. CONCLUSIONS: Death doulas can augment existing end-of-life care services by providing holistic and personalised care services at home or hospital settings. Their roles are still evolving and remain mostly unregulated, with little evidence about their impact. There is a need for more rigorous studies to explore healthcare professionals' views about this role and examine the clinical outcomes among dying persons and their families.

"Womanhood," a shared experience of participating in a lifestyle intervention with a focus on integration and physical activity to promote health among pregnant women: perspectives from pregnant women, midwives, and cultural interpreter doulas.

PURPOSE: Migrating women, have an overall increased risk of adverse outcomes and poorer health during pregnancy and childbirth. In addition, they do not participate in planned antenatal care to the same extent as natives. These disparities among migrants and native pregnant women point to the need for interventions to improve equal health and care during pregnancy and childbirth. This study aimed to explore the experiences of participating in a lifestyle intervention, named "Dancing for birth," focusing on integration and physical activity, from the perspectives of the participating pregnant women, midwives, and cultural interpreter doulas. METHOD: Qualitative interviews were conducted from March 2019 to December 2020, with ten women who participated in a lifestyle intervention in Sweden: four pregnant women, three midwives, and three cultural interpreter doulas. Thematic analysis was used to analyse the data. RESULTS: The lifestyle intervention "Dancing for birth" provided positive shared Health-promoting experiences among the participants with social inclusivness and a commitment to supporting each other. This seemed to encourage the sense of strength as a woman- a strengthboth for the individual woman and as a kind of women´s power. CONCLUSIONS: Interventions targeting physical activity, social inclusiveness, and health literacy are of utmost importance in promoting positive pregnancy experiences and equal healthcare during pregnancy. Further research is needed on how to implement antenatal education that includes all women in society.

Doulas from Cradle to Grave: Integration into Conventional Medical Care.

Doulas are becoming increasingly popular as support persons for the critical processes of birth and death. There is some evidence that their support reduces interventions such as Caesarean sections and instrumental deliveries as well as medicated pain relief. However, there are clear tensions in Australia between doulas and the professional obstetric staff such as midwives and obstetricians. Especially if they challenge proposed obstetric management on behalf of parturient women. Their role in managing the dying may also be open to malfeasance. At present Australian doulas are not regulated by the Australian Health Professionals Regulation Authority (AHPRA) but there is a need for them to be regulated at a local and State or Territory level.

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)

Putting them on a strong spiritual path: Indigenous doulas responding to the needs of Indigenous mothers and communities.

OBJECTIVE: In the past few years, increasing numbers of Indigenous doula collectives have been forming across Canada. Indigenous doulas provide continuous, culturally appropriate support to Indigenous women during pregnancy, birth, and the post-partum period. This support is critical to counter systemic medical racism and socioeconomic barriers that Indigenous families disproportionately face. This paper analyzes interviews with members of five Indigenous doula collectives to demonstrate their shared challenges, strategies, and missions. METHODS: Qualitative interviews were conducted with members of five Indigenous doula collectives across Canada in 2020. Interviews were transcribed and returned to participants for their approval. Approved transcripts were then coded by all members of the research team to ascertain the dominant themes emerging across the interviews. RESULTS: Two prominent themes emerged in the interviews. The first theme is "Indigenous doulas responding to community needs." Participants indicated that responding to community needs involves harm reduction and trauma-informed care, supporting cultural aspects of birthing and family, and helping clients navigate socioeconomic barriers. The second theme is "Indigenous doulas building connections with mothers." Participants' comments on providing care to mothers emphasize the importance of advocacy in healthcare systems, boosting their clients' confidence and skills, and being the "right" doula for their clients. These two inter-related themes stem from Indigenous doulas' efforts to counter dynamics in healthcare and social services that can be harmful to Indigenous families, while also integrating cultural teachings and practices. CONCLUSION: This paper illustrates that Indigenous doula care responds to a wide range of issues that affect Indigenous women's experiences of pregnancy, birth, and the post-partum period. Through building strong, trusting, and non-judgemental connections with mothers and responding to community needs, Indigenous doulas play a critical role in countering medical racism in hospital settings and advancing the resurgence of Indigenous birthing sovereignty.

Countervailing powers in the labor room: The doula-doctor relationship in the United States.

How do health professionals with fundamentally different philosophies toward health, and different status levels, manage power in their work relationships? This paper argues that taking a negotiated order interactionist approach, which contends that the social order shapes behavior but is continuously negotiated through social interactions, and synthesizing it with a countervailing powers perspective can yield insight into the power dynamics between health professionals. It focuses on the birth field, with attention to the relationship between two very different types of birth professionals: obstetricians and doulas. Unlike doctors, who maintain a dominant place in health care and subscribe to a biomedical perspective of birth, doulas hold a low-status position and take a holistic approach toward birth, which may cause conflict in the labor room. In-depth interviews with 43 birth doulas based in the US (May-July 2018) found that the doula-doctor relationship is a complex story of power, deference, and countervailing responses. Doulas reported that doctors are more receptive to them now than in the past but that this is an outcome of creative countervailing responses involving deferential maneuvers and direct challenges to physician authority. Doulas' strategic management of their relationships with health professionals has allowed them entry to the hospital, permitting them to represent a holistic voice in the labor room. A minority of doulas have begun to develop relationships with doctors that constitute a collaborative approach toward birth care, indicating that changes in standard care are possible. By revealing how a subordinate actor can challenge physicians and effect change in care, this study contributes to scholarship seeking to understand the nature of unequal relationships between health professionals in a context of biomedical dominance.

Being an end-of-life doula.

This article describes what an end-of-life doula is, the training involved and how these individuals can help someone achieve the death they want, reflecting on a role that has existed traditionally in communities for centuries without formal recognition. How end-of-life doulas work holistically but also practically will be considered, outlining how keeping the dying person's preferences and wishes at the heart of their care is the primary aim. Recent issues such as advance care planning, digital legacy and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) will be reflected on through the lens of the end-of-life doula, with the aim of encouraging open discussion and death oracy as a life skill and creating a space to make choices about the end of life. Also explored is how an end-of-life doula works within an integrative model of healthcare, working in partnership with health professionals.

The community-based bilingual doula - A new actor filling gaps in labour care for migrant women. Findings from a qualitative study of midwives' and obstetricians' experiences.

OBJECTIVES: To explore midwives' and obstetricians' views about community-based bilingual doula (CBD) support during migrant women's labour and birth and their experiences of collaborating with CBDs. STUDY DESIGN: A qualitative study with semi-structured individual interviews with 7 midwives and 4 obstetricians holding clinical positions in labour care in Stockholm, Sweden, who all had experiences of working with a CBD. Data analysis followed the framework of thematic analysis. RESULTS: The overarching theme was A new actor filling gaps in labour care - With appropriate boundary setting, CBDs can help improve care for migrant women. One year after the introduction of CBDs, the midwives and obstetricians had mainly positive experiences of CBDs who were considered to fill important gaps in maternity care for migrant women, being with the woman and simultaneously being part of the care team and this made providing high quality care easier. The CBDs' main contribution was to help migrant women navigate the maternity care system, to bridge language and cultural divides, and guarantee continuous labour and birth support. However, midwives and obstetricians sometimes experienced CBDs interfering with their professional assessments and decisions and the role of the CBD was somewhat unclear to them. CONCLUSIONS: Community-based bilingual doula support was viewed as improving migrant women's well-being during labour and birth and as increasing the possibilities for midwives and obstetricians to provide good and safe care, however, some ambivalence remained about the CBD's role and boundaries.