Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Natividad Medical Center, Salinas, California.
Birth. 2019 Jun;46(2):355-361. doi: 10.1111/birt.12420. Epub 2019 Feb 8.
A birth doula provides continuous informational, physical, and emotional support during pregnancy, labor, and immediately postpartum. Existing data on the benefits of doulas, especially for low-resource, high-need patients, do not address how and why individual practitioners decide to recommend this model of care. This project aims to describe best practices of integrating doulas into hospital-based maternity care teams to facilitate access to this evidence-based service for improving maternal health outcomes.
Semi-structured interviews using open-ended questions were conducted in person with 47 maternity care practitioners-OB/GYNs, family medicine physicians, RNs, and nurse-midwives-across three hospitals. Interview analysis was conducted using the Template Organizing Style qualitative analysis approach.
Results demonstrated varied support for doula care given practitioners' experiences. Positive experiences centered on doulas' supportive role and strong relationships with patients. Some conflicts between practitioners and doulas may stem from a cross-cultural divide between mainstream obstetric/physician culture and a natural birth "counter culture." Suggestions to facilitate good working relationships centered on three overlapping themes: mutual respect between doulas and hospital staff, education about doulas' training, and clarification of roles on maternity care teams especially among staff with overlapping roles.
Among maternity care practitioners, some frustration, anger, and resentment persist with respect to work with doulas. Adequate staff training in the doula model of care, explicit role definition, and increasing practitioner exposure to doulas may promote effective integration of doulas into hospital maternity care teams.
导乐在孕妇、分娩和产后立即期间提供持续的信息、身体和情感支持。现有的关于导乐益处的数据，特别是针对资源匮乏、高需求患者的，并没有说明个体从业者如何以及为何决定推荐这种护理模式。本项目旨在描述将导乐整合到医院产妇护理团队中的最佳实践，以促进获得这种基于证据的服务，改善产妇健康结果。
使用开放式问题对来自三家医院的 47 名产妇护理从业者（妇产科医生、家庭医生、注册护士和执业护士）进行了面对面的半结构式访谈。使用模板组织风格定性分析方法对访谈进行分析。
结果表明，从业者的经验导致对导乐护理的支持程度存在差异。积极的体验集中在导乐的支持角色和与患者的紧密关系上。从业者和导乐之间的一些冲突可能源于主流产科/医师文化与自然分娩“反文化”之间的跨文化分歧。促进良好工作关系的建议集中在三个重叠主题上：导乐和医院工作人员之间的相互尊重、导乐培训方面的教育，以及特别是在角色重叠的工作人员中，明确产妇护理团队的角色。
在产妇护理从业者中，对于与导乐合作，仍然存在一些挫折感、愤怒和怨恨。在导乐护理模式方面进行充分的员工培训、明确角色定义以及增加从业者与导乐的接触，可能会促进导乐有效融入医院产妇护理团队。
