Darwin Zoe, Green Josephine, McLeish Jenny, Willmot Helen, Spiby Helen
School of Healthcare, University of Leeds, Leeds, UK.
Department of Health Sciences, University of York, York, UK.
Health Soc Care Community. 2017 Mar;25(2):466-477. doi: 10.1111/hsc.12331. Epub 2016 Feb 25.
Disadvantaged childbearing women experience barriers to accessing health and social care services and face greater risk of adverse medical, social and emotional outcomes. Support from doulas (trained lay women) has been identified as a way to improve outcomes; however, in the UK doula support is usually paid-for privately by the individual, limiting access among disadvantaged groups. As part of an independent multi-site evaluation of a volunteer doula service, this study examined women's experiences of one-to-one support from a trained volunteer doula during pregnancy, labour and the post-natal period among women living in five low-income communities in England. A mixed methods multi-site evaluation was conducted with women (total n = 137) who received the service before December 2012, using a combination of questionnaires (n = 136), and individual or group interviews (n = 12). Topics explored with women included the timing and nature of support, its impact, the relationship with the doula and negative experiences. Most women valued volunteer support, describing positive impacts for emotional health and well-being, and their relationships with their partners. Such impacts did not depend upon the volunteer's presence during labour and birth. Indeed, only half (75/137; 54.7%) had a doula attend their birth. Many experienced volunteer support as a friendship, distinct from the relationships offered by healthcare professionals and family. This led to potential feelings of loss in these often isolated women when the relationship ended. Volunteer doula support that supplements routine maternity services is potentially beneficial for disadvantaged women in the UK even when it does not involve birth support. However, the distress experienced by some women at the conclusion of their relationship with their volunteer doula may compromise the service's impact. Greater consideration is needed for managing the ending of a one-to-one relationship with a volunteer, particularly given the likelihood of it coinciding with a period of heightened emotional vulnerability.
弱势育龄妇女在获取健康和社会护理服务方面面临障碍，并且面临更严重的不良医疗、社会和情感后果风险。导乐（受过培训的非专业女性）的支持已被视为改善结局的一种方式；然而，在英国，导乐支持通常由个人自行支付费用，这限制了弱势群体获得该服务的机会。作为对一项志愿者导乐服务进行的独立多地点评估的一部分，本研究调查了居住在英格兰五个低收入社区的女性在孕期、分娩期和产后接受受过培训的志愿者导乐一对一支持的经历。对在2012年12月之前接受该服务的女性（共137名）进行了混合方法多地点评估，采用了问卷调查（136份）以及个人或小组访谈（12次）相结合的方式。与女性探讨的主题包括支持的时间和性质、其影响、与导乐的关系以及负面经历。大多数女性重视志愿者的支持，描述了对情绪健康和幸福感以及她们与伴侣关系的积极影响。这些影响并不取决于志愿者在分娩期间的在场情况。实际上，只有一半（75/137；54.7%）的女性有导乐陪伴其分娩。许多女性将志愿者的支持体验为一种友谊，这与医疗保健专业人员和家人提供的关系不同。当这种关系结束时，这往往会使这些经常处于孤立状态的女性产生失落感。即使不涉及分娩支持，补充常规产科服务的志愿者导乐支持对英国的弱势女性可能也是有益的。然而，一些女性在与志愿者导乐的关系结束时所经历的痛苦可能会削弱该服务的影响。需要更多地考虑如何处理与志愿者一对一关系的结束，特别是考虑到这可能恰逢女性情绪高度脆弱的时期。
