The system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United States
Abstract Background Doulas, non-clinical professionals who provide support throughout the perinatal period, can positively impact patient experiences and clinical outcomes during birth. Doulas often support hospital-based births without being employed by the hospital system, resulting in varied rela...
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| Format: | Article |
| Language: | English |
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BMC
2024-12-01
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| Series: | Implementation Science Communications |
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| Online Access: | https://doi.org/10.1186/s43058-024-00682-w |
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| author | Jeannette C. Myrick Lily Schneider Christina Gebel Kathleen Clarke Stephanie Crawford Lucy Chie Chloe Zera Karen M. Emmons Elysia Larson |
| author_facet | Jeannette C. Myrick Lily Schneider Christina Gebel Kathleen Clarke Stephanie Crawford Lucy Chie Chloe Zera Karen M. Emmons Elysia Larson |
| author_sort | Jeannette C. Myrick |
| collection | DOAJ |
| description | Abstract Background Doulas, non-clinical professionals who provide support throughout the perinatal period, can positively impact patient experiences and clinical outcomes during birth. Doulas often support hospital-based births without being employed by the hospital system, resulting in varied relationships with hospitals and clinicians. Systems-level changes are needed to maximize collaboration between hospitals and doulas to ensure facilitation of, and not barriers to, doula support. We implemented and evaluated a new program, called the "Supportive Birth Collaborative,” to maximize effectiveness of doula support in hospital settings. Methods We conducted a single-site feasibility study of the use of implementation mapping to make systemic changes to clinician-doula collaboration for labor and delivery. Implementation mapping consisted of five steps: developing a collaborative of program implementers and knowledge holders, conducting a needs assessment, developing a logic model, applying implementation strategies, and evaluating changes in outcomes. To evaluate change, process data were collected throughout, and implementation outcomes were measured in 2022 and again after one year of implementation via online surveys to all clinicians who provided labor and delivery care. Descriptive statistics were calculated and change over time was analyzed in Stata using log-binomial regression models with clustering to account for respondents who completed both surveys. Results The “Supportive Birth Collaborative” (SBC) was founded in November 2021. The first meeting included 19 people, who were obstetricians, anesthesiologists, nurses, doulas, students, social workers, administrators, researchers, and individuals who had given birth at the study hospital. From 2022–2023, the SBC adopted 11 implementation strategies and piloted or fully implemented 10 of them. Implementation strategies ranged from making training dynamic, to changes in the physical environment, to changes in formal policy. In 2022, 104 clinicians participated in the survey; 97 participated in 2023. There was significant improvement in clinician-reported trust in doulas (0.23, 95% CI: 0.12, 0.34) and doula-clinician communication (0.25, 95% CI: 0.12, 0.38). Clinicians had a limited understanding of the doula’s role, and that understanding did not significantly improve. Conclusions Using implementation mapping as a guide to collaborative work can lead to meaningful health system changes. Regular review of implementation outcomes could allow for adaptation and tailoring of implementation strategies. |
| format | Article |
| id | doaj-art-ca331d63a0534f52ad068fbb3990e4cc |
| institution | Kabale University |
| issn | 2662-2211 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj-art-ca331d63a0534f52ad068fbb3990e4cc2025-01-05T12:31:52ZengBMCImplementation Science Communications2662-22112024-12-015111210.1186/s43058-024-00682-wThe system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United StatesJeannette C. Myrick0Lily Schneider1Christina Gebel2Kathleen Clarke3Stephanie Crawford4Lucy Chie5Chloe Zera6Karen M. Emmons7Elysia Larson8Beth Israel Deaconess Medical CenterBeth Israel Deaconess Medical CenterAccompany Doula CareBeth Israel Deaconess Medical CenterBelle Joie Doula ServicesBeth Israel Deaconess Medical CenterBeth Israel Deaconess Medical CenterHarvard T.H. Chan School of Public HealthBeth Israel Deaconess Medical CenterAbstract Background Doulas, non-clinical professionals who provide support throughout the perinatal period, can positively impact patient experiences and clinical outcomes during birth. Doulas often support hospital-based births without being employed by the hospital system, resulting in varied relationships with hospitals and clinicians. Systems-level changes are needed to maximize collaboration between hospitals and doulas to ensure facilitation of, and not barriers to, doula support. We implemented and evaluated a new program, called the "Supportive Birth Collaborative,” to maximize effectiveness of doula support in hospital settings. Methods We conducted a single-site feasibility study of the use of implementation mapping to make systemic changes to clinician-doula collaboration for labor and delivery. Implementation mapping consisted of five steps: developing a collaborative of program implementers and knowledge holders, conducting a needs assessment, developing a logic model, applying implementation strategies, and evaluating changes in outcomes. To evaluate change, process data were collected throughout, and implementation outcomes were measured in 2022 and again after one year of implementation via online surveys to all clinicians who provided labor and delivery care. Descriptive statistics were calculated and change over time was analyzed in Stata using log-binomial regression models with clustering to account for respondents who completed both surveys. Results The “Supportive Birth Collaborative” (SBC) was founded in November 2021. The first meeting included 19 people, who were obstetricians, anesthesiologists, nurses, doulas, students, social workers, administrators, researchers, and individuals who had given birth at the study hospital. From 2022–2023, the SBC adopted 11 implementation strategies and piloted or fully implemented 10 of them. Implementation strategies ranged from making training dynamic, to changes in the physical environment, to changes in formal policy. In 2022, 104 clinicians participated in the survey; 97 participated in 2023. There was significant improvement in clinician-reported trust in doulas (0.23, 95% CI: 0.12, 0.34) and doula-clinician communication (0.25, 95% CI: 0.12, 0.38). Clinicians had a limited understanding of the doula’s role, and that understanding did not significantly improve. Conclusions Using implementation mapping as a guide to collaborative work can lead to meaningful health system changes. Regular review of implementation outcomes could allow for adaptation and tailoring of implementation strategies.https://doi.org/10.1186/s43058-024-00682-wDoulasImplementation mappingEvaluationPregnancyBirthCollaboration |
| spellingShingle | Jeannette C. Myrick Lily Schneider Christina Gebel Kathleen Clarke Stephanie Crawford Lucy Chie Chloe Zera Karen M. Emmons Elysia Larson The system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United States Implementation Science Communications Doulas Implementation mapping Evaluation Pregnancy Birth Collaboration |
| title | The system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United States |
| title_full | The system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United States |
| title_fullStr | The system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United States |
| title_full_unstemmed | The system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United States |
| title_short | The system can change: a feasibility study of a doula-clinician collaborative at a large tertiary hospital in the United States |
| title_sort | system can change a feasibility study of a doula clinician collaborative at a large tertiary hospital in the united states |
| topic | Doulas Implementation mapping Evaluation Pregnancy Birth Collaboration |
| url | https://doi.org/10.1186/s43058-024-00682-w |
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