124 urban African-American women between the ages of 14 and 21 participated in a research project where they were randomized to receive services from a doula. During pregnancy doulas visited mothers weekly in their homes or in the prenatal clinic. They were also present in the hospital during labor and delivery. Doulas were former teenage mothers from the same communities as the pregnant mothers. Doulas had been trained as childbirth educators and trained to offer physical comfort, information, and emotional support during labor.
The first morning after birth, a research assistant visited each mother. Semi-structured interviews were conducted with mothers that asked them to recount their experiences of childbirth from the moments they first became aware of labor to the time when they first saw their infants. These “birth stories” lasted between ten and twenty minutes. They were tape recorded, transcribed, imported into a QSR data system, and content-coded for types of support provided by the doula.
The most common type of support mentioned by mothers was instrumental aid around the progression of the labor and the relief of pain: “she gave me a massage,” “she held my hand,” “she held me so I could push.” Emotional support was also mentioned frequently: “she made me believe I could do it,” “if it wasn't for her I would have been so scared.” Mothers also reported that doulas offered informational support, usually explaining ongoing medical procedures or interpreting statements made by physicians.
In addition to these traditional forms of support, mothers sometimes described the doula's actions as encouraging others present at the birth to support the mother. Doulas showed fathers and family members how to massage feet, put pressure on backs, or to support mothers as they pushed. Sometimes the doulas worked to resolve tensions between these different parties or took family members aside who were serving as a source of stress to the mothers. The doulas would let physicians know if they had not spent enough time explaining a procedure to a young mother.
Conclusions and Implications
In this demonstration project, the research team not only evaluated program outcomes, but provided ongoing feedback to supervisors about implementation of the program model. These birth stories provided insight into the mothers' valuing of the instrumental actions and emotional support that the doulas had been trained to provide. The stories complicated the picture however (in ways that were felt by the doulas themselves) with respect to the challenges and need for ongoing supervision about dealing with a broader network of relationships that included family members and medical providers.