Virginia Commonwealth University VCU Scholars Compass School of Nursing Publications School of Nursing 2015 Virginia Commonwealth University Volunteer Doula Program Training Manual Kathleen M. Bell Virginia Commonwealth University, [email protected] Susan L. Linder Virginia Commonwealth University, [email protected] Follow this and additional works at: http://scholarscompass.vcu.edu/nursing_pubs Part of the Maternal, Child Health and Neonatal Nursing Commons Copyright © 2015 The Authors Downloaded from http://scholarscompass.vcu.edu/nursing_pubs/16 This Curriculum Material is brought to you for free and open access by the School of Nursing at VCU Scholars Compass. It has been accepted for inclusion in School of Nursing Publications by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. Virginia Commonwealth University Volunteer Doula Program Training Manual “Empowerment, advocacy and support for one of life’s greatest journeys.” 1 Reflection and Discussion Why are you here? Why did you decide to do this doula training? What experiences do you have with birth, and how have they shaped your desire to participate in this program? What does it mean to be a doula with the VCU School of Nursing? What other reflections do you have? 2 Table of Contents 1. An overview of birth: Statistics and trends………………page 4-6 2. Birth workers and their roles………………...……………pages 7-10 3. You are a doula! Your birth-bag and preparation………..pages 11-14 4. Anatomy and Physiology of birth………………………...pages 15-18 5. Hormonal regulation of labor and birth…………………..pages 19-21 6. Pharmacologic management of labor…………………….pages 22-26 7. Non-pharmacologic management of labor……………….pages 27-34 8. Labor: latent, active and the transition phase……………pages 35-46 9. Second stage……………………………………………...pages 47-50 10. Operative vaginal delivery: Forceps & vacuum…………page 51 11. Caesarean section birth……………………………….......pages 52-54 12. Postpartum physiology & maternal/newborn care……….pages 55-58 13. Breastfeeding ……………………………………………pages 59-63 14. Psychosocial concerns in childbearing………………….. pages 64-69 15. Care of the special needs family………………………….pages 70-72 16. The next chapter in your professional career……………..pages 73-75 This curriculum is dedicated to all of the determined, beautiful mothers who shared their most intimate and proud moments with us as doulas and nurses. We are forever grateful for this honor and hope that by continuing our work, we are giving other mothers and families the same opportunities to grow and thrive through positive birth experiences. 3 Chapter 1: An overview of birth: Statistics and trends Who are we and what do we do? A doula is a woman who cares for a pregnant and laboring woman. In serving, doulas help expectant women learn about their pregnancy, their changing body, and their impending birth. Topics of education often include non-pharmacologic management of pain in labor, achieving optimal emotional and spiritual health during pregnancy, breastfeeding education, and garnering postpartum support for the woman and her As you research birth statistics for family.23 Virginia, what do organizations such as the Virginia Department of Health If you ask many women who have experienced childbirth, and the March of dimes say about they will tell you that their experience ran a full gamut of these statistics? emotions. People may describe their birth with positive language such as “joyful”, “amazing”, “empowering”, “magical” and “perfect.” Other women, however, have a different experience. Due to medical or psychosocial complications or deviation from their birth plan, some women use words such as “terrifying”, “upsetting”, “disappointing”, “painful”, and “horrible.” As women’s health care providers, we certainly don’t wish the later on our patients. We want them to emerge from their birth experience with feelings of accomplishment and empowerment, no matter the route of delivery, the type of anesthesia, or the feeding wishes of the mother for her newborn child. A doula is in such a powerful and wonderful position to assist women and childbearing families during their labor and birth journey. As you read further, you will see why your participation in this program plays a significant role in the health of the mother and her newborn, but more importantly, how it will serve to enact change in the culture of birth in Richmond, Virginia. Scope of the Problem An analysis of data specific to the state of Virginia demonstrates a caesarean section (c-section) rate of 34.5% in 2010 as reported by the March of Dimes20. The United States c-section rate was 32.8% in 2011.9,19 In additional to c-section data, only 15.8% of infants are exclusively breastfeeding at six months of age in Virginia.4 This breastfeeding data is not meeting benchmarks set forth by Healthy People 2020.28 One answer to bettering birth data in our country and specifically in Virginia lies with doulas. Doula services can be expensive, however. Average support “just” 4 for a labor can range from $300-$1,000 depending on geographic location, and the experience level of the doula.27 Another confounding variable is that lower socioeconomic status (SES) women are often disproportionately affected by high risk pregnancies.9 Additionally, low SES and women experiencing high risk pregnancy are at greater risk for postpartum depression, or PPD.16 With increasing risk, rates of cesarean section and intervention during labor and birth rise. High risk obstetric clients can thus benefit greatly from the services and education doulas provide. The Answer Virginia Commonwealth University School of Nursing (VCU SON) is fortunate to have a compassionate and motivated cohort of students and student volunteers who want to improve prenatal care and birth outcomes for low socioeconomic status women. The first clinical cohort of student doulas began with eight nursing students serving four mothers and their families in January, 2011. Through discussions with certified nurse midwives (CNM) at the Virginia Commonwealth University Health System (VCUHS), and other vested community partners, it was discovered that the need for doula support was greater. Nursing students throughout the school became excited and interested in the doula program. A volunteer group was formed and these nursing students enrolled in the same training as the nursing students in the clinical group. The students continue to support laboring mothers in the Richmond community. Many deliver at the VCUHS, but may also deliver at other Richmond area hospitals. The program was modeled off of a “birth companions” program which was started at The Johns Hopkins University in 1999.23 Volunteer students functioned as doulas to identified women in the Maryland community, and provided non- pharmacologic pain relief and psychosocial support during labor and childbirth. Final analysis of their data suggest that, “…as birth companions provide more interventions to their clients, the risk of epidural use and cesarean birth goes down, particularly when additional physical interventions are incorporated” (Paterno, Van Zandt, Murphy & Jordan, 2011, p. 33). What a fantastic impact! Students in the VCU group have also had similar experiences, and we are quite proud of their accomplishments thus far. As a doula serving mothers on their labor journey, there are tenets surrounding women’s health care that should guide your practice and your decision making. 5 1. Promote safety and maternal/child wellbeing above all else. 2. Offer non-biased, truthful, evidence based information so that the mother and her partner may make an informed decision. 3. Meet the mother and her partner where they are on their birth journey. 4. Advocate for your patient’s wishes and desires, not what you believe to be her best option or best birth. 5. If the mother is happy, it was a “good birth.” It is our hope that at the conclusion of this training, you will have a framework with which to better enact these tenets of your practice as a volunteer doula. By empowering and educating women and their families, we can strive to eliminate disparities in birth among families in Richmond, Virginia. You are playing a tremendous role. Thank you for your enthusiasm and dedication. 6 Chapter 2: Birth Workers and Their Roles In our society, there are many ways to enter into nursing, medicine and midwifery. Women may experience confusion when trying to decipher ones title, education and preparation. There are vast differences in the types of providers who work in birth and with childbearing families. This chapter will serve as an introduction to the types of people with whom you may interact during your time as a doula. Medical Doctor (MD) Medical doctors are individuals who have a doctoral degree; they attended four years of medical school and an additional four years of residency in obstetrics and gynecology. If you are attending a birth at the VCUHS, you will work with resident and attending physicians. Resident physicians are, in fact, licensed medical providers; it is a misnomer that they are “not real doctors.” They have not, however, passed board certification exams, and this is why they are in residency building up their body of knowledge prior to sitting for this examination. They will be responsible for admitting patients, managing antepartum, intrapartum and postpartum care, and delivering babies vaginally or by cesarean section (c-section). Other specialty services as they relate to obstetrics include the placement of a cerclage, diagnostic ultrasound, and in-utero testing such as amniocentesis. Attending physicians, however, are board certified in obstetrics and gynecology. They are in charge of the labor and delivery unit at a hospital 24-7, and also supervise the residents. Some of the attending MDs with whom you will interact also went on to complete fellowship training in a specialty area; the most germane to labor and delivery is the fellowship in maternal fetal medicine, or MFM.