Training trainers for doula care in the Dominican Republic: a midwifery project to. mobilize volunteers to humanize hospital birth

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1 Training trainers for doula care in the Dominican Republic: a midwifery project to mobilize volunteers to humanize hospital birth Jennifer Foster, CNM, PhD and Annemarie Heath, CNM, MSN The University of Massachusetts Amherst School of Nursing Objectives: 1) Cite the evidence for decreased medical intervention with doula care. 2) Discuss the rationale for the implementation of doula care in public hospitals in the developing world. 3) Identify three reasons why midwives training doulas in the Dominican Republic may improve the quality of maternity care. I. Introduction Outline II. Brief history of Project ADAMES (Adelante Asegurando Maders e Infantes Sanos) a. Understanding maternal infant health care at Hospital San Vicente de Paul: How it all began b. Educational program for the nurses i. Creating a grassroots education program ii. Reaching out to the community iii. Labor support and humanization of care 1. Nurse as labor support

2 2. Family member as labor support c. A new look at the midwifery model i. Creation of nurses vision of care ii. Learning to midwife patients iii. Midwifing the nurses 1. Confidence in clinical care 2. Caring for nurses 3. Case Management: Ongoing relationships d. What did our research tell us? III. Emergence of the Comité de Apoyo y Seguimiento a. Dominican ownership of process b. Creation of goals IV. Doula care as an answer to humanization of birth a. Who is a doula at Hospital San Vicente? b. What do they do? c. How to train them? d. Complimentos y Cambios e. Doula graduation V. Implications for maternity care in the future a. Transferability b. Leadership skills c. Midwifery where there are no midwives

3 Bibliography American College of Nurse-Midwives. Core Competencies for Basic Midwifery Practice. In. Washington, DC: American College of Nurse Midwives; Ballen L, Fulcher A. Nurses and doulas: Complementary roles to provide optimal maternity care. JOGNN 2006; 35(2): Berg M, Terstad A. Swedish women's experiences of doula support during childbirth. Midwifery 2006; 22(4): Bianchi A, Adams E. Doulas, Labor Support, and Nurses. International Journal of Childbirth Education 2004; 19 (4): Campbell D, Lake M, Falk M, Backstrand J. A randomized control trial of continuous support in labor by a lay doula. JOGNN 2006; 35 (4): Craigin L. The theoretical basis for nurse-midwifery practice in the United States: A critical analysis of three theories. Journal of Midwifery & Women's Health 2004; 49 (5): Foster J, Regueira Y, Burgos RI, Sanchez AH. Midwifery Curriculum for Auxiliary Maternity Nurses: A Case Study in the Dominican Republic. Journal of Midwifery & Women's Health 2005; 50 (4):e Foster J, Regueria Y, Heath A. Decision making by auxiliary nurses to assess postpartum bleeding in a Dominican Republic maternity ward. JOGNN 2006; 35(6): Foster J, Heath A. Midwifery and the development of nursing capacity in the Dominican Republic: Caring, clinical competence, and case management. Journal of Midwifery & Women's Health 2007; 52(5): in press. Gordon N, Walton D, McAdam E, Derman J, Gina-Garrett L. Effects of providing hospital-based doulas in health maintenance organization hospitals. Obstetrics & Gynecology 1999: Jonsdottir H, Litchfield M, Pharris MD. The relational core of nursing practice as partnership. Journal of Advanced Nursing 2004; 47(3): Fullerton J, Severino R, Brogan K, Thompson J. The International Confederation of Midwives' study of essential competencies of midwifery practice. Midwifery 2003; 19(3):

4 Hodnett E, Gates S, Hofmeyr G, Sakala C. Continuous Support for Women during Childbirth. Cochrane Data Base of Systematic Reviews 2004; 2(CD000199):1-22. Kennedy H, Levi A, Kane Low L. An exploratory metasynthesis of midwifery practice. Midwifery 2003; 19: Lesser P, Maurer M, Stephens S, Yolkut R. Doulas for all. International Journal of Childbirth Education 2005; 20(3): MacLean GD. The challenge of preparing and enabling 'skilled attendants' to promote safer childbirth. Midwifery 2003; 19(3): Marshall M. Working with and through Midwives to Decrease Maternal Mortality. In: Diers D, editor. A Symposium on the Occasion of the Retirement from the Faculty of Yale University School of Nursing of Helen Varney Burst; 2005; New Haven, CT.: Yale University Press; Miller S, Cordero M, Coleman AL, Figuera J, Brito- Anderson S, Dabagh R, et al. Quality of care in institutionalized deliveries: the paradox of the Dominican Republic. International Journal of Gynecology and Obstetrics 2003; 82: Morton K. The irony of service: charity, project and social change in service learning. Michigan Journal of Community Service Learning 1995; Pettersson K, Stone K. Profiling Midwifery Services in the Americas. Washington, DC: Pan American Health Organization; 2005 May Proyecto ADAMES available at: Raisler J, Kennedy H. Midwifery Care of Poor and Vulnerable Women Journal of Midwifery & Women's Health 2005; 50 (2): Shaw D. Sexual and reproductive rights in action - obligations and opportunities. International Journal of Gynecology and Obstetrics 2004(84): Shaw D, Federation of International Gynecologists and Obstetricians. Women's sexual and reproductive rights - A social responsibility for obstetriciansgynecologists. International Journal of Gynecology and Obstetrics 2004(84):299. Simkin, P. Doulas of North America position paper: The doula s contribution to modern maternity care. Doulas of North America. 2001: Available at: Shelp A. Women helping women: the Somali doula initiative. International Journal of Childbirth Education 2004; 19 (4):4-7.

5 Stein M, Kennell J, Fulcher A. Benefits of a doula present at the birth of a child. Pediatrics 2004; 114: Wilder-Smith A. Current status of 'essential obstetric care' activities internationally: a literature review. Tropical Doctor 2003; 33(3): Yam N. Political issues. Doula care: An age-old practice meets the 21st century. International Journal of Childbirth Education 2003; 18 (4):18-21.

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