University of Miami Miller School of Medicine, Miami, Florida; the University of North Carolina School of Nursing, UNC Medical Center, Chapel Hill, North Carolina; Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; and the University of Michigan, Michigan Medicine, Ann Arbor, Michigan.
Obstet Gynecol. 2023 Oct 1;142(4):886-892. doi: 10.1097/AOG.0000000000005337.
Doulas are community perinatal professionals trained in pregnancy health, childbirth preparation, labor support, lactation counseling, and postnatal care. Doulas serve as patient advocates and provide laboring patients with continuous one-to-one support including informational, physical, and emotional support. Research shows that access to continuous labor support contributes to positive health outcomes such as increasing rates of spontaneous vaginal delivery, shorter labor, less need for analgesics, and increased satisfaction with the birthing process. However, despite their benefits, socioeconomic, structural, and systemic factors limit doula accessibility and manifest in low utilization among patients who could benefit from doulas the most. Given the positive health implications of doula support and the need for these services in underserved populations, there is an urgency to increase the accessibility of doulas. Several health centers in the United States have created successful doula programs to meet the needs of their patient populations. To better understand these programs, we interviewed and collaborated on this paper with program representatives from Boston Medical Center's Birth Sisters and DREAM: Delivery Resources, Education, and Advocacy for Moms; UNC Health's Birth Partners; and Michigan Medicine's Dial-A-Doula. Because many health centers serve as large public safety-net hospitals, having more health center-affiliated doula programs nationwide could be a positive step in bridging disparities and improving maternal and child health.
导乐是经过社区围产期培训的专业人士，擅长于妊娠健康、分娩准备、产时支持、哺乳咨询和产后护理。导乐作为患者的权益倡导者，为产妇提供一对一的持续支持，包括信息、身体和情感支持。研究表明，获得持续的产时支持有助于改善健康结果，例如提高自然分娩率、缩短产程、减少镇痛需求以及提高对分娩过程的满意度。然而，尽管导乐有诸多益处，但社会经济、结构和系统性因素限制了导乐的可及性，导致最需要导乐的患者利用率较低。鉴于导乐支持对健康的积极影响，以及服务不足人群对这些服务的需求，增加导乐的可及性迫在眉睫。美国的一些医疗中心已经创建了成功的导乐项目，以满足其患者群体的需求。为了更好地了解这些项目，我们采访了波士顿医疗中心 Birth Sisters 和 DREAM（为妈妈提供分娩资源、教育和倡导）、北卡罗来纳大学健康中心 Birth Partners 以及密歇根大学医学中心 Dial-A-Doula 的项目代表，并合作撰写了这篇论文。由于许多医疗中心作为大型公共安全网医院，在全国范围内增加更多与医疗中心相关的导乐项目可能是弥合差距、改善母婴健康的积极步骤。
