Doulas as Change Agents: My Doula and Me Project

Nicole Fazio


Background: A new member of the obstetrical health care team, known as the doula, has emerged.  A doula refers to a trained, experienced professional who provides continuous physical, emotional and informational support to a pregnant mother before, during, and after pregnancy.  Doulas do not provide nursing or medical care, nor do they take the place of a woman’s significant other or family members.  Research shows that the continuity of care, provision of human presence, and social support that doulas provide is linked to varied beneficial effects.  The advantages are seen in antepartal and labor events (e.g. decreased use of anesthesia/analgesia), through the delivery process (e.g. reduced Cesarean birth rate) and in long-term maternal outcomes (e.g. increase in exclusive breastfeeding).  An area of research that could be further explored is looking at the use of doulas as smoking cessation interventionists.  Overwhelming evidence exists showing that prenatal smoking has adverse effects on pregnant women and their unborn fetuses.  This study is looking to specifically evaluate the ability to train doulas to serve as smoking cessation interventionists.

Methods: Prospective study participants were recruited from a doula-based organization in the northeastern portion of the United States.  In order to be eligible for participation, the doulas had to have been certified within the last three years, and had to have at least four months of work experience. Five doulas participated in the pilot study. The doulas completed a 10-item pre-test prior to receiving any interventionist training.  The subjects then underwent two 2-hour long training sessions.  The sessions included a review of the Transtheoretical Model of Change and covered the smoking cessation interventionist protocol.  Immediately following training, the subjects completed a second 10-item post-test.

Results: The sample was predominantly white (80%) women (100%) who had been doulas for four or more months, and currently works as doulas (100%).  The mean pre-test score was 7.6 (± 1.52) and following training, the mean post-test score was 9.4 (± 0.89).  There was no obvious trend in questions missed on either the pre or post-tests.

Conclusions: The findings showed that doulas did increase their knowledge from the time of the pre-test for to the post-test.  The increase in test scores indicates that it is feasible to train doulas on interventionist protocol and smoking cessation.

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