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      The greatest feeling you get, knowing you have made a big difference’: survey findings on the motivation and experiences of trained volunteer doulas in England

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          Abstract

          Background

          Support from a doula is known to have physical and emotional benefits for mothers, but there is little evidence about the experiences of volunteer doulas. This research aimed to understand the motivation and experiences of volunteer doulas who have been trained to support women during pregnancy, birth and the postnatal period.

          Methods

          A postal questionnaire survey was sent to volunteer doulas at five volunteer doula projects working in low-income areas in England. Quantitative and qualitative data were analysed in parallel using summary statistics and content analysis respectively.

          Results

          Eighty-nine volunteer doulas (response rate 34.5 %) from diverse backgrounds responded to the survey. Major motivators for volunteering included a desire to help others and, to a lesser extent, factors related to future employment. Most reported that the training was effective preparation for their role. They continued volunteering because they derived satisfaction from the doula role, and valued its social aspects. Their confidence, skills, employability and social connectedness had all increased, but many found the ending of the doula-mother relationship challenging. For a minority, negative aspects of their experience included time waiting to be allocated women to support and dissatisfaction with the way the doula service was run.

          Discussion and conclusions

          Most respondents found the experience rewarding. To maintain doulas’ motivation as volunteers, services should: ensure doulas can start supporting women as soon as possible after completing the training; consider the merits of more flexible endings to the support relationship; offer opportunities for ongoing mutual support with other doulas, and ensure active support from service staff for volunteers.

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          Most cited references18

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          'Weighing up and balancing out': a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries.

          In high-resource settings around 20% of maternal deaths are attributed to women who fail to receive adequate antenatal care. Epidemiological evidence suggests many of these women belong to marginalised groups often living in areas of relative deprivation. Reasons for inadequate antenatal attendance have yet to be fully evaluated. To identify the factors affecting access to antenatal care for marginalised pregnant women living in developed countries. We included qualitative studies from developed countries published in English language journals (1980-2007). Qualitative studies exploring the views of marginalised women living in developed countries who either failed to attend for any antenatal care or did so late or irregularly. Eight studies fulfilled the selection criteria and were synthesised in accord with the techniques derived from meta-ethnography. Initial access is influenced by late pregnancy recognition and subsequent denial or acceptance. Continuing access appears to depend on a strategy of weighing up and balancing out of the perceived gains and losses. Personal resources in terms of time, money and social support are considered alongside service provision issues including the perceived quality of care, the trustworthiness and cultural sensitivity of staff and feelings of mutual respect. A nonthreatening, nonjudgemental antenatal service run by culturally sensitive staff may increase access to antenatal care for marginalised women. Multiagency initiatives aimed at raising awareness of, and providing access to, antenatal care may also increase uptake.
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            Peer support during pregnancy and early parenthood: a qualitative study of models and perceptions

            Background Peer support is a flexible concept used in healthcare across diverse areas to describe the activities of individuals acting in a non-professional capacity offering support to others with whom they have some experience in common. There is little research on peer supporters and women supported in the context of the transition to parenthood and disadvantage. This study particularly focuses on peer support for women experiencing a range of vulnerabilities during pregnancy and the postnatal period, in projects which assigned trained volunteers to individual pregnant women. There were three core elements to the volunteers’ support in these projects: active listening, providing information, and signposting to local services in the area. Many also offered practical support. Methods This was an descriptive qualitative study, informed by phenomenological social psychology, exploring experiences and perceptions of giving and receiving voluntary peer support during pregnancy and early parenthood in England, with a particular focus on disadvantaged women. Participants took part in semi-structured, audio-recorded interviews, the transcripts of which were analysed using thematic analysis. Results Forty-seven volunteers and 42 mothers were interviewed, from nine peer support projects. The overarching themes identified were (1) ‘What is peer support?’, containing two themes: ‘befriending or mentoring’, and ‘responding to the individual’; (2) ‘Who is a peer supporter?’, containing two themes: ‘someone like me’, and ‘valuing difference’; (3) ‘The peer support relationship’, containing five themes: ‘a friend or a ‘professional friend’, ‘building relationships of trust’, ‘avoiding dependency’, ‘managing endings’, and ‘how peer supporters differ from professionals’. Conclusion A variety of models of volunteer peer support have been offered to pregnant women and new mothers in England. All create a structure for meaningful relationships of trust to occur between volunteers and vulnerable women. In the absence of agreed definitions for the nature and boundaries of peer support during pregnancy and early parenthood, it is important that projects provide clear information to referrers and service users about what they offer, without losing the valued flexibility and individuality of their service.
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              Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review.

              The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.
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                Author and article information

                Contributors
                helen.spiby@nottingham.ac.uk
                jenny.mcleish@npeu.ox.ac.uk
                jo.green@york.ac.uk
                z.j.darwin@leeds.ac.uk
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                29 September 2016
                29 September 2016
                2016
                : 16
                : 289
                Affiliations
                [1 ]Division of Midwifery, Faculty of Medicine and Health Sciences, University of Nottingham, 12th Floor, Tower Building, Nottingham, NG7 2RD UK
                [2 ]Policy Research Unit for Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, OX3 7LF UK
                [3 ]Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
                [4 ]Midwifery, Social Work and Counselling & Psychotherapy, School of Healthcare, University of Leeds, Leeds, LS2 9JT UK
                Article
                1086
                10.1186/s12884-016-1086-6
                5041283
                27680500
                eeae2e26-6644-4120-ad07-52582d485466
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 30 October 2015
                : 16 September 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Obstetrics & Gynecology
                trained volunteer doulas,social disadvantage,doulas’ experiences,maternity,peer support

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