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Midwifery Students as Volunteer Doulas

The Journal of Midwifery and Women’s Health published an article about a program utilizing student nurse-midwives as volunteer doulas.  I’ve seen programs similar to this, using nursing students or midwifery students.  The program in the article combined the use of community doulas and midwifery students.

Having run a volunteer doula service myself I’m usually skeptical of the long term success of such a program. Being a volunteer is not the same as being paid (or getting class credit) for attending a birth. The volunteer has to feel as if the commitment benefits the women being served, and to some extent benefits the doula (or at least doesn’t disrupt life too much).

After the first birth or two it can be difficult to get volunteers to commit the time and effort needed for a busy service. Why? Because many volunteers do so because they think they want to be a doula, and after a birth or two they either decide it isn’t for them or they start their own practice.

You can make the commitment easier by scheduling on call days instead of assigning a doula or team to a woman, but there will be one or two volunteers who don’t get to be at a birth in the first few months and so feel as if the program offers them nothing to participate and neither the volunteer nor the women are benefiting because they are there. It’s tricky to work with volunteers.

This type of program has the benefit of using students – which means you have a regular supply of new, excited volunteers.  But that also means they will quickly become overwhelmed with a busy schedule and may not want to attend births as a volunteer after they start attending births as a student–a potential benefit of using student nurses instead of using student midwives.

Another benefit is that this  allows new midwives (and nurses) to learn about the doula role, and how to best work as a team at a birth.  I’ve also seen volunteer doula programs work well to get new doulas valuable experience as they learn to attend births.

What do you think about using students as volunteer doulas?  Do you have another way to bring volunteer doulas to your community?

 

References

  • Munoz EG, Collins M. Establishing a Volunteer Doula Program Within a Nurse-Midwifery Education Program: A Winning Situation for Both Clients and Students. J Midwifery Womens Health. 2015 May 7. PMID: 25953010.

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Understanding Fear of Childbirth

A study published in the June edition of Acta obstetricia et gynecologica Scandinavica explored fear of childbirth through maternal surveys.  While the study question was about the effect of counseling for fear of childbirth, several interesting things are revealed in the descriptive statistics (the part of the study where the researchers tell you about the individuals in the study). The authors report this counseling was generally from midwives either with or without specialized training in counseling, or from an obstetrician, and the counseling is never really described as an intervention.  For that reason we won’t dwell too much on the effects of the counseling.

Out of 936 women who completed questionnaires two months post-partum, 70 women reported having counseling due to childbirth fear. This is just over 7% of the women.  But when you break the women into those having their first delivery and those who gave birth before, you find only 6% of the women having their first delivery reported having counseling while 9.5% of the women who gave birth before.  I find this interesting because it runs counter to what I’ve been told about fear and childbirth.

I’ve been told that women fear childbirth because they don’t have experience with it anymore, and because the media portrays birth as something horrible.  But this data turns that around, women with personal experience giving birth were more likely to have fear so extreme they needed counseling.

If we keep exploring the data we learn something interesting about those multips.  Most of the women had normal vaginal births for the previous experience, as we might expect.  If the woman had any instrumental birth or an emergency cesarean, she was more likely to receive counseling. If the woman had an emergency cesarean her odds of having counseling for fear were 5 times higher than a woman who had a normal vaginal delivery. This effect did not exist with planned cesarean.

There are some problems with this study – a big one is that about 1/3 of the women who reported receiving counseling stated they had little or no fear of childbirth.  As far as I can tell, there was no adjustment for this in the analysis (which is another reason why we won’t think too much about their main outcome). If you want to know if counseling reduces fear, you need to start with a group who has fear.  If this had been my data, I would have only analyzed the 100 or so women who reported fear.  But the question for us to ponder now is might we see something different in terms of multip vs. nullip being more afraid if only those who reported fear were reported?

 

References

  • Larsson B1,2, Karlström A3, Rubertsson C1, Hildingsson I1,3,4. The effects of counseling on fear of childbirth. Acta Obstet Gynecol Scand. 2015 Jun;94(6):629-36. PMID: 25772528.

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Advocate for Lactation

May 14th, 2015 Advocacy, Raising Awareness

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The Friendly Airports for Mothers (FAM) Act has been introduced into congress.  The Act, if made into law, would require airports to provide accessible, safe, clean, and convenient lactation rooms for travelers.

The United States Breastfeeding Committee needs your help. By sharing your airport lactation experience you will be providing valuable evidence to lawmakers about the importance of this issue.

If you are willing to contribute your story, visit the United States Breastfeeding Committee website and complete the submission form.

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Be a Research Subject

May 13th, 2015 Research

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Here is an opportunity for you to participate in research that helps us understand what it is like to become a mother.  Researchers at the University of Michigan are investigating the pregnancy-related experiences that are unique to sexual minorities to help minimize the effect of these stressors on prenatal and postnatal outcomes.

If you are a lesbian couple, aged 18-45 and expecting your first child, they want to talk to you.  Here is a flier that provides general information:

Flyer (pdf)

And a few more specifics if it helps you decide:

For this study, we are recruiting lesbian couples ages 18 to 45 who are expecting their first child. If couples decide to participate, both partners will be asked to come to our laboratory between two and four times to complete questionnaires related to their thoughts, feelings, and behaviors concerning the transition to parenthood. Participants can also complete the sessions at home if they live outside of the Ann Arbor area In order to better understand physiological processes, we will also ask permission to collect saliva samples. All couples will be compensated monetarily for their participation in the study, up to $300 if they complete all sessions.

 Interested?  Contact the researchers here: Edelstein Lab

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Balancing Family and Training

May 13th, 2015 Jennifer's Training, Paths

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My semester has ended, which is good because so many things on the website have been neglected during this round of classes.  For those who are new to the blog, I’ve just completed my second year in a PhD Program in Nursing.  The second year is a bit more intense.  In addition to classes I have the expectation that I will have a grant submitted for my dissertation research and my dissertation proposal accepted this summer.  I’m progressing well on both fronts, so no worries.  But I wanted to share a few reflections for those who have not yet begun their training.

One of the reasons I frequently hear individuals putting off training in midwifery is the belief that balancing family and training will be easier once the children are older.  I believed this too, until this past year when I finished a year of school with two teenagers. I can honestly tell you it was not as easy as balancing nursing school with two elementary aged children.  Why?

In elementary school I set the schedule because the options for the children were limited.  They wanted to play with neighbors, attend the infrequent movie nights and activities in school, and the school band/orchestra only had two concerts per year.  The children in the church had activities during Sunday service times. My children did not hold leadership positions anywhere.

But now my children have their own goals because they are aware of more opportunities.  Scouting is no longer just one night a week, instead there are monthly camp-outs and extra meetings for the youth leaders.  Playing an instrument involves the district honor band with weekly rehearsal and three performances each year; or the marching band with multiple after school practices and weekend game performances.  The larger schools mean friends are not limited to the neighborhood, and hanging out with friends involves rides to malls, movies, or other venues. The church youth group meets one evening a week — and adds additional activities on weekends.

All of this means either I or my husband must drive my children somewhere almost every day.  To accomplish all the goals of all the people who live in this household, I must plan that my schooling is essentially a job with very specific hours of work.

Your family situation may be different, but it wouldn’t be fair if I didn’t mention that this seems to be the norm among the families I know with teen age children.  There is relief when one of the children begins to drive because the workload is distributed.

When my children were in elementary school I used to shake my head at the families that ate in the car on the way to softball practice; or would go from dance class straight to chess club in the evening. I used to think I could prevent my family from becoming that busy, but the reality is limiting it didn’t fit with who I was as a parent.  I want my children to set goals and try new things, to not be afraid of being committed to something. The difference is that when children are teenagers, that commitment to any group, organization, or team is a bigger time commitment than what it was in elementary school.

 

We have an early dinner together as a family 5-6 nights a week, and generally have only one place to go three to four nights a week. I know there are families that are busier, and other families do less. How your family balances it will depend on the number of children you have, differences in ages, and differences in their interests.

My point is, if you are putting off your training because you believe the logistics of being in school with a family is easier with teens, you might want to reconsider your assumptions.

 

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Birth – hobby or work?

Feb 23rd, 2015 Paths

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I am in the process of trying to decide what role the website will have in my future life (let’s face it, 15 years is a long time to keep it going). As part of the process I’ve starting thinking about what it takes to make birth a job rather than a hobby.

To start with, I don’t think hobby’s are bad things.  I have a few I enjoy very much.  But hobbies are done for our pleasure, not to meet the needs of others.  Hobbies and jobs occupy different spaces in our lives, and demand different responsibilities. Jobs we do to earn money, again not a bad thing, and generally involve providing a service or product for others. Because a job is a way to generate income you have to think about the things you do differently. Continue reading

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How not to compare statistics

Feb 5th, 2015 Research

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I’ve spent the last five years learning how to interpret research, I know it isn’t easy.  I didn’t always know this.  I used to think I could read the conclusions of a paper, check out a few things and either incorporate it or ignore it.  The problem was, just like all humans, my trust in a paper was more related to how closely it resembled what I already believed than anything within the design of the study.

Now when I read a paper I go through a long process of making decisions;

  • What exactly is the research question?
  • What theory does this study build from?
  • What assumptions does the underlying theory make?
  • Is this design appropriate for this framework?
  • Is this population appropriate for this question?
  • Have they designated outcomes a priori?
  • Are they using appropriate statistical tests?
  • What are the sources of bias?
  • Will the biases move the estimate away from the null?
  • Do the results answer the research question?
  • Do the results indicate a clinically relevant difference?
  • Do the conclusions make sense given the framework and underlying theory?
  • What does this study add to what is known on this topic?

No, this list is not complete.  No, I can’t teach you to do this…remember this is a process of learning I’ve been working on for over five years.  I’ve learned to read as a clinician, as an epidemiologist, as a policy maker, and as a designer of research.

But there are some simple mistakes you can learn to recognize when you see them on your social media feed or in blogs.  I want to show you one I saw this week. The specific numbers do not matter, we will be looking at the concept of an unequal comparison.

The comparison I saw was this:

The number of deaths/injuries from a specific vaccine in the # years:  X

The number of deaths/injuries from the illness in the # years: 0

The comments on this post were evidence that people thought the appropriate comparison should be: because X > 0, people should not get the vaccine.

Why is this an unequal comparison?  Because this pretends to be comparing the risks of being vaccinated to the risks of not being vaccinated; but it only shows the total risks to being vaccinated.

What do I mean?

To compare vaccination to no vaccination you need to compare the total number of deaths/injuries in a vaccinated population (which the post in question included); to the total number of deaths/injuries in the same population if they were not vaccinated (which the post in question did not include).

So the comparison should read:

The total number deaths/injuries in a vaccinated population in # years: X

The total number deaths/injuries in a non-vaccinated population in # years: Y

It is only from this comparison that you can determine the risks of vaccination vs. no vaccination. You cannot have both the protection of being vaccinated (0 injuries/death), and avoid the risks of being vaccinated (X) because you can only be vaccinated or not vaccinated.  You either accept the full risk and benefit of vaccination, or you accept the full risk and benefit of not being vaccinated.

Now you are armed with one more technique for decision making, and you can apply it to all types of scientific comparisons.  Next time you read a social media post or a blog that gives a comparison, take a step back and figure out if it is unequal. If it is unequal, find the numbers to make it equal and then decide if you would make the same conclusions about that decision.

 

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Midwife as Coach

Jan 18th, 2015 Working With Clients

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I want to share a wonderful line I heard recently.

“I am going to remind her of the goals she set for herself.  As her coach, that is my job.”

This resonates so well with my philosophy of care.  As a midwife, it is not my job to set the goals.  It is my job to give  information and education, to lay out the options and the most likely outcomes.  It is the woman’s job to decide the goal.

Why?

Because she will never be committed to a goal she doesn’t set.

But if I can get her to share her goal, to tell me what she would like to accomplish, we can work on it together. She does still have to do the ‘work’, I cannot do that for her.  But I can giver her information and encouragement.

When she is discouraged and wants to give up, I can remind her of the goals she set for herself.  As her midwife, that is my job.

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What I learn from hosting a web directory – five things you should change

Jan 10th, 2015 Marketing

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If you have never looked at the Natural Childbirth Directory, you should.  This portion of the website is truly a labor of love.  While the rest of the pages need little work but annual review, these pages get updated often because the links change and people submit new websites.  It takes a lot of work and is part of the reason I regularly ask myself if all the work I put into the website is worth my time.

Keeping the directory gives me a chance to look at many childbirth professional websites.  I get to see what people are doing that is good, and what people are doing that they should probably change.  I thought I would take a minute to give you my top five things you should change about your website. They are all variations of the same theme — websites that give useful information build trust in the reader.

1. You don’t list your location

This is probably the most common problem I see with websites, and potentially the biggest.  Potential clients will be searching for childbirth professionals on the internet using the location in their search.  If your website doesn’t list that location, you won’t show up in search results.  This means your website isn’t working to bring you people who are actively searching for your services in your area.  Worse, families that search on the internet know links go bad.  If they are directed to your link from another website, but don’t find the service area listed, they may not be willing to contact you to verify you provide services in their area.  Websites that can tell the reader where they work build trust in the reader.

2. You don’t list your services

Just because you are a doula doesn’t mean I know what you do.  It doesn’t mean I know what I am purchasing if I hire you. If you teach childbirth education classes, can I tell from your website what your classes are like?  Does your website let me know I can participate in your classes without hiring you also as a midwife? This is especially a problem in areas where families have multiple choices for service providers because the other providers probably give me this information.  Providing this information builds trust in your business and prevents potential clients from walking away just because it was easier to get information from another provider.  Websites that can tell the reader what they do build trust in the reader.

3. You don’t list your availability

Your website should in some way let readers know if you are able to provide the services they need when they need them.  Why?  The first question your potential client has is if you are available when they are due. Midwives and doulas may want to add a blanket statement such as “Now Accepting New Families.” Or you may want to provide a more specific information such as, “Openings for families due in January and beyond.” This saves you time responding no to people, but also increases the likelihood someone who fits your time frame will contact you. One caveat, make sure you keep your availability updated or it will work against you (people will think you no longer work in that capacity). Websites that answer the most common question build trust in readers.

4. You don’t list a calendar of events

This is especially important for businesses that provide education.  A reader should be able to tell when your next class or series of classes begins and what will be covered in that class.  If you do drop-in information nights, be sure these are listed. This information needs to be easy for readers to find and understand, so give full date, time and location — remember, only the most invested will call or email to get more information. Websites that provide current information build trust in the reader.

5. You don’t give good contact information

Having a contact form may prevent your email from being spammed, and you may think it protects your phone number, but it doesn’t give a good impression of your business. It increases the chances you won’t get good contact information from the potential client (even in the submissions for the Natural Childbirth Directory people mis-type their URL and email address — and these submissions are for people trying to advertise a business which means a high investment in establishing contact). Readers expect legitimate businesses to have a legitimate email and a legitimate phone number to ask questions.  Websites that portray services as a legitimate business build trust in the reader.

 

OK, now go make any necessary changes to your website.

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End of the Year and Waterbirth

Dec 30th, 2014 Uncategorized

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When I wrapped up the last series I thought I could make weekly posts…I was ambitious.  I was correct in my suspicion that my workload would increase near the end of the semester. I am now in the midst of a working break between semesters and I don’t see an end to the heavy workload for a few months.  The trick is figuring out how to balance the blog with my “real” job.

I do have some things to show for my hard work. Continue reading

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