Postpartum doulas: motivations and perceptions of practice.

OBJECTIVE: To describe the perceptions of a US cohort of experienced birth doulas who were among the first in the country to be trained to provide postpartum support. DESIGN: A qualitative, longitudinal study using ethnographic methods; participant observation and semi-structured interviews. SETTING: Midwestern, urban, US; postpartum home care over three months. PARTICIPANTS: Four postpartum doulas; 13 families. MEASUREMENTS: Participant observation during six postpartum home visits per family; 13 semi-structured interviews with doulas at the completion of each family's care; four summative interviews with doulas at the end of the study. FINDINGS: When describing their postpartum practice, four themes emerged: supporting women, taking the mother's perspective, empowering women and empowering families. When speaking of the motivations, three themes emerged: being 'called' to practice, interest in preventing negative experiences, and career development. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In the US, new mothers see midwives and doctors sporadically after discharge from the hospital. Postpartum doulas fill this gap in continuity of care by providing support for families as they transition to life with their new infant. Understanding the beliefs, values and practices of these important paraprofessionals will help midwives effectively integrate postpartum doula care into the care of women and infants.

Contemporary childbirth education models.

Since the 1960s, childbirth education advocates have attempted to persuade pregnant women that educational preparation for labor and birth is an essential component of the transition to motherhood. Initially, pregnant women who were seeking unmedicated births as a refuge from the inhumane childbirth treatments of the mid-20th century embraced this view. However, with the changing childbirth climate, including a growing preference for medicated birth, scheduled inductions, and cesarean sections, attendance has diminished and childbirth education finds itself at a crossroads. Commonly used childbirth education models/organizations and several new emerging models along with the available research literature and recommendations for clinical practice and research are presented.

Domains of postpartum doula care and maternal responsiveness and competence.

OBJECTIVE: To describe the domains of postpartum doula care and illustrate how doulas facilitate development of maternal responsiveness and competence. DESIGN: Qualitative study using ethnographic method of participant observation. SETTING: Homes of mothers who received postpartum doula care. PARTICIPANTS: Thirteen women and their infants; 4 postpartum doulas. RESULTS: Eleven domains emerged: emotional support, physical comfort, self-care, infant care, information, advocacy, referral, partner/father support, support mother/father with infant, support mother/father with sibling care, and household organization. Emotional support was used consistently and in combination with the other domains. Activities in all of the domains were used to facilitate the development of maternal responsiveness and maternal competence with 3 issues: resolution of infant feeding, integrating the infant into the family, and supporting developmental care and attachment. CONCLUSIONS: Data suggest that by using 11 domains of care, postpartum doulas facilitate maternal responsiveness and competence. Development of a long-term relationship, mother-centered care, and education and support related to infant feeding, integrating the infant into family, and developmental care and attachment may contribute to these outcomes.

Midwifery data collection: options and opportunities.

Most midwives are aware of the need to collect clinical practice data and of its usefulness in supporting the care they provide, which contributes to healthy outcomes for mothers and babies. For the individual midwife, there is more than one easily accessible, standardized data collection instrument from which to choose. However, despite these choices, in an American College of Nurse-Midwives (ACNM) Division of Research (DOR) survey on midwifery clinical data collection (N = 263), the majority of member respondents (n = 135; 51%) reported using a self-designed data collection tool, and more than one-third did not know of the ACNM Nurse-Midwifery Clinical Data Sets (NMCDS). On a larger scale, the midwifery profession is also in need of an organized and consistent approach to data collection for the purpose of capturing midwifery practice and outcomes in order to provide data to support legislation, practice, and policy changes. However, the profession currently lacks a single common midwifery practice database. In order to facilitate data aggregation that captures a larger view of midwifery practice at the local, regional, and national levels, it is imperative that all midwives collect relevant data that are uniform and standardized, and that the midwifery professional organizations move forward with the development of a common electronic database. This article describes currently available data collection tools as well as their best uses, applications to practice, and future directions.