THE UNIVERSITY of NORTH CAROLINA at CHAPEL HILL SCHOOL of NURSING

The Power of Presence: Utilizing a Volunteer

Doula Program to Improve Birth Experience
Birth Partners-UNC Medical Center's Volunteer Doula Program

Rhonda Lanning, DNP CNM LCCE IBCLC RN

Assistant Professor, School of Nursing UNC Chapel Hill
Program Coordinator for Birth Partners

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Plans for this session
Describe the birth doula role and implications of continuous labor support
Overview of Birth Partners program
Discuss the unique role of the doula in the OR setting
Tips for initiating a hospital-based volunteer doula program

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What is a doula?
A doula is a professionally trained labor support person
who provides continuous physical, emotional and
informational support to individuals and families before,
during and just after birth (DONA)

Unique role à No clinical duties

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 Doula Support Measures
Continuous support for ALL involved
in birth

Verbal Affirmations

Provides massage techniques

Skin-to-skin support

Breastfeeding support

Continuous Presence

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Why is continuous support important?
Birth experiences create powerful memories!
Satisfaction with birth is directly correlated with the parent
feeling a sense of control during their birth and having a
feeling of accomplishment

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 Power of Presence

Call to action ACOG and SMFM

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“Increasing women’s access to nonmedical interventions during
labor, such as continuous labor and delivery support, also has been
shown to reduce cesarean birth rates.”

“Published data indicate that one of the most effective tools to

improve labor and delivery outcomes is the continuous presence of
support personnel, such as a doula.”

“…the presence of continuous one-on-one support during labor and

delivery was associated with improved patient satisfaction and a
statistically significant reduction in the rate of cesarean delivery.”
(ACOG & SMFM, 2014)
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Doula support associated with improved birth
outcomes
Increased spontaneous vaginal births
Shortened labor
Decreased cesarean births
Decreased instrumental and analgesia interventions
Infant Outcomes
»Improved 5-minute APGAR scores
- Cochrane Review, 2017

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Clients also much less likely to be dissatisfied
with their childbirth experience

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UNC Birth Partners
A volunteer-based doula program
Mission: To provide physical, emotional, and educational support
during pregnancy, birth, and the immediate postpartum period to
those giving birth at UNC.
Provide equal access to compassionate doula care to promote
increased confidence in birth and parenting.
Our program develops future healthcare professionals and
community members who value the philosophy of patient and
family-centered care.

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Birth Partners are professionally trained
Training
»Minimum of 14 hours (including childbirth and breastfeeding
education)
»Mentoring program with experienced volunteer doulas
»Additional OR training and monthly continuing education
Commitment to the program
»Minimum of 12 hours each month and one year of service
»Medical Center Volunteers

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Operating Room Doula Role
Birth Partner Doulas are now part of the OR care team for
cesarean births
Present during OR prep and surgery
Trained in OR guidelines and protocol
Their role:
»Offer physical and emotional support
»Help facilitate skin-to-skin immediately after birth
»Offer support and guidance during breastfeeding

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Doulas in the OR

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THE UNIVERSITY of NORTH CAROLINA at CHAPEL HILL SCHOOL of NURSING
Birth Partners--Populations Served
The Department of Corrections
UNC Horizons program
Adolescents (through Orange Co Schools and others)
Perinatal Inpatient Psychiatric Unit
Hi-risk antepartum inpatients
Health dept. and community health center patients
Local (international) community including refugee women
And many more…..

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How Do Clients Access Our Services?
Nurse or provider advocacy in labor
Prenatal education
Website inquiries

Prenatal arrangements

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 Growth of Birth Partners
600

500

400

300

200

100

0
2012 2014 2016 2018
# doulas # clients

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Preliminary analysis (2017-2018 data)
Comparison of characteristics of doula vs non-
doula clients
Identity/demographics race/ethnicity
Primary language: English or other
Insurance status: about 45% MCD
Pregnancy risk (hi/low) slightly > hi risk

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Patient Testimonials from Birth Partners
“Additional sense of security, comfort, and calm.”
“Rock solid support through one of the toughest days of my life.”
“Casual conversation helped get my mind off the upcoming
surgery fears.”
“Their genuine compassion and ability to provide proactive and
reactive physical and emotional support.”

Parents highly satisfied with Birth Partners

Overall satisfaction with doula care 3.95 (scale of 1-4, #410 parent surveys)

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Want to start a program?
Consider the needs of your community
and the potential for volunteers to meet
needs

Form a dedicated, interdisciplinary team

of champions

Include all stakeholder groups

Consider initiation with a small program

and develop long-term goals for the
future

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Contact us!

Check out our website

www.uncmedicalcenter.org/doulas

Email Rhonda at

Rhonda.lanning@unchealth.unc.edu

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