April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: Aiding in the Sacred Space: An Examination of Social Support, Advocacy, and Barriers among Birthing Doulas
The assistance of a doula before, during, and after childbirth can reduce infant mortality, improve birth outcomes, and assure a mother’s physical and emotional needs are met. However, doula care remains underutilized in the U.S. and many expectant mothers are unaware of the support roles doulas fulfill. At the heart of much of a doula’s work is discerning the most appropriate type of social support for the situation and the mother (Gilliland, 2002, p. 769). Doulas must determine how to give advice without taking over any part of the birth. They often provide support that is appropriate to the mothers’ culture while serving as a medical interpreter without being a medical professional themselves (Akhavan & Lundgren, 2012). “The doula sees the woman in childbirth and uplifts her. She knows the language, acts as a bridge, translates and explains and provides security” (p. 82). The many forms of support provided by doulas underline their value in this very unique context--this “sacred space.” The goal of this study was to investigate and characterize the ways doulas assist in childbirth as well as the barriers they experience in providing different forms of support. With a bit more understanding of their role, doula’s work may be seen as a cost-effective intervention that can save lives and improve the birthing experience for parents and health care providers.
In-depth interviews with 10 doulas showed evidence of the 5 types of social support outlined by Cutrona and Suhr (1992): informational, esteem, tangible, network, and emotional support. Advocacy was identified as a sixth, complicated form of support. Doulas explained how they use network support (particularly through “presence,” or being with mother throughout the pregnancy/birth) and emotional support (displaying care and listening to the mother’s wants and needs, especially prior to the birth) to build trust with mothers. The resulting bond then allows doulas to provide effective esteem support (validating and complimenting mothers, especially when they are struggling or in pain), tangible support (knowing when to help mothers create space when needed; but also when to provide massages, ice, materials as requested), and informational support (providing information and suggestions, helping mothers identify choices and assess the situation differently, and teaching). Regarding advocacy, many doulas relayed the delicate nature of providing support for the mother while simultaneously minimizing disruption to the plans and processes of midwives or healthcare providers.
Three barriers were identified that impede doulas’ work: limitations of the setting or environment, balancing time limits with compensation, and financial constraints. Some doulas have considered leaving the profession due to stressors such as not feeling respected by health care professionals, being on-call 24/7, and difficulties balancing family and work. Balancing the need for financial compensation and providing ongoing “on call” support was another barrier discussed. Last, doulas mentioned the barrier of insurance policies that rarely cover their services. Thus, doula care is less accessible to some vulnerable populations of mothers who need it most. Our hope is that this study can clarify doulas’ support role and cast light on the ways their assistance can be optimized and even expanded to save money and lives.
In-depth interviews with 10 doulas showed evidence of the 5 types of social support outlined by Cutrona and Suhr (1992): informational, esteem, tangible, network, and emotional support. Advocacy was identified as a sixth, complicated form of support. Doulas explained how they use network support (particularly through “presence,” or being with mother throughout the pregnancy/birth) and emotional support (displaying care and listening to the mother’s wants and needs, especially prior to the birth) to build trust with mothers. The resulting bond then allows doulas to provide effective esteem support (validating and complimenting mothers, especially when they are struggling or in pain), tangible support (knowing when to help mothers create space when needed; but also when to provide massages, ice, materials as requested), and informational support (providing information and suggestions, helping mothers identify choices and assess the situation differently, and teaching). Regarding advocacy, many doulas relayed the delicate nature of providing support for the mother while simultaneously minimizing disruption to the plans and processes of midwives or healthcare providers.
Three barriers were identified that impede doulas’ work: limitations of the setting or environment, balancing time limits with compensation, and financial constraints. Some doulas have considered leaving the profession due to stressors such as not feeling respected by health care professionals, being on-call 24/7, and difficulties balancing family and work. Balancing the need for financial compensation and providing ongoing “on call” support was another barrier discussed. Last, doulas mentioned the barrier of insurance policies that rarely cover their services. Thus, doula care is less accessible to some vulnerable populations of mothers who need it most. Our hope is that this study can clarify doulas’ support role and cast light on the ways their assistance can be optimized and even expanded to save money and lives.