"It's About the Patient" : Perspectives of Intrapartum Nurses on Working in Collaborative Practice with Birth Doulas

Abstract

Birth doulas offer continuous physical, emotional, and informational support before, during, and after birth. There is strong evidence of the maternal health benefits associated with continuous labour support. Nurses are the most common intrapartum care provider and navigate the overlapping labour support role with doulas. While there is evidence of mutual respect, conflicts can occur with negative consequences. This study aimed to explore collaborative practice between nurses and doulas from the perspective of intrapartum nurses in Ontario, Canada. Thorne's qualitative interpretive description (ID) methodology was used. Nurses experienced in working with doulas were recruited via email invitations and postings on a nursing online forum. Semi-structured 1:1 interviews were conducted with six nurses. Experience ranged from 4 to 35 years across nine hospitals. Interviews were recorded and transcribed verbatim. Data analysis was informed by the ID approach. Findings comprised two main themes, each with four sub-themes. First, participants described influences on nurses' readiness to collaborate with doulas. These influences include the culture clash between medicalized and natural birth, support from management and hospital policies and previous professional experiences. These led to the nurses' approach, "it's about the patient". Second, participants' responses reflected a continuum of nurse-doula collaboration, beginning with being open-minded, a necessity for getting on the patient's team, building trust and working together towards shared goals. These findings provide a framework for interventions to facilitate collaborative practice, including in-service training and enactment of appropriate institutional policies. Improved collaboration enhances both nurses' and doulas' practice while promoting better childbirth outcomes.