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Evaluation of a Student‐Nurse Doula Program: An Analysis of Doula Interventions and Their Impact on Labor Analgesia and Cesarean Birth
Author(s) -
Paterno Mary T.,
Van Zandt Shirley E.,
Murphy Jeanne,
Jordan Elizabeth T.
Publication year - 2011
Publication title -
journal of midwifery and women's health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.543
H-Index - 62
eISSN - 1542-2011
pISSN - 1526-9523
DOI - 10.1111/j.1542-2011.2011.00091.x
Subject(s) - psychological intervention , medicine , odds ratio , odds , logistic regression , confidence interval , nursing interventions classification , obstetrics , pregnancy , obstetrics and gynaecology , nursing , biology , genetics
The aim of this study was to describe specific doula interventions, explore differences in doula interventions by attending provider (certified nurse‐midwife vs obstetrician), and examine associations between doula interventions, labor analgesia, and cesarean birth in women receiving doula care from student nurses. Methods: A secondary analysis of data from the Birth Companions Program at the Johns Hopkins University School of Nursing was conducted using t tests, chi‐square statistics, and logistic regression models. Results: In the 648 births in the sample, doulas used approximately 1 more intervention per labor with certified nurse‐midwife clients compared to obstetrician clients. In multivariate analysis, the increase in the total number of interventions provided by doulas was associated with decreased odds of epidural (adjusted odds ratio [AOR] 0.92; 95% confidence interval [CI], 0.86‐0.98) and cesarean birth (AOR 0.90; 95% CI, 0.85‐0.95). When examined separately, a greater number of physical interventions was associated with decreased odds of epidural (AOR 0.85; 95% CI, 0.78‐0.92) and cesarean birth (AOR 0.80; 95% CI, 0.73‐0.88), but number of emotional/informational interventions was not. Discussion: Student nurses trained as doulas have the opportunity to provide a variety of interventions for laboring clients. An increase in the number of interventions, especially physical interventions, provided by doulas may decrease the likelihood of epidural use and cesarean birth.