Abstract
Problem
Volunteer doula support has achieved favourable outcomes for socially disadvantaged
women around the world. There is limited explanatory understanding of how, why and when doula support programs improve outcomes.
Background
A community organisation is providing free doula support for women experiencing socioeconomic
disadvantage in Melbourne, Australia. The program aims to complement the mainstream
maternity care system, to promote equity in women’s care, and experiences of pregnancy,
birth and early parenting. This program is the first of its kind in Australia and
has not previously been evaluated.
Aim
To develop hypothesised program theories for the realist evaluation of an Australian
doula program.
Methods
As the first stage of a realist evaluation, three key informant interviews and rapid
realist review of literature were conducted in December 2017 - January 2019.
Findings
Seven theories were developed in four categories: critical elements of implementation
(Attracting and activating the right doulas, and Good matching); outcomes for women (Being by her side, and Facilitating social connection), outcomes in maternity care system (Complementing or enhancing maternity care, and Doula as a witness — demanding accountability in others), and outcomes for doulas (Doulas as beneficiaries). These theories were framed in accordance with a realist understanding of causation,
as Context – Mechanism – Outcome (CMO) configurations.
Discussion and conclusion
The development of theories from multiple sources of evidence provides a strong theoretical
base for program evaluation. The theories hypothesise how, why, for whom and when
the doula program works. Subsequent stages of the evaluation will test and refine
the theories.
Keywords
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References
- The Marmot Review: Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post-2010.UCL Institute of Health Equity, London2010
- Early childhood development and the social determinants of health inequities.Health Promot. Int. 2015; 30: ii102-ii115
- A conceptual framework for action on the social determinants of health.Social Determinants of Health Discussion Paper 2. World Health Organization, Geneva2010
- Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries.BMC Pregnancy Childbirth. 2014; 14: 152
- WHO Recommendations Intrapartum Care for a Positive Childbirth Experience.World Health Organization, Geneva2018
- Antenatal care: a case of the inverse care law?.Aust. J. Public Health. 1993; 17: 95-103
- Stressful life events, social health issues and low birthweight in an Australian population-based birth cohort: challenges and opportunities in antenatal care.BMC Public Health. 2011; 11: 196
- Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures.BMC Pregnancy Childbirth. 2015; 14: 393
- Aboriginal and Torres Strait Islander women’s experiences accessing standard hospital care for birth in South Australia — a phenomenological study.Women Birth. 2016; 29: 350-358
- Women’s views and experiences of maternity care: a study of immigrant Afghan women in Melbourne, Australia.Midwifery. 2012; 28: 198-203
- ‘We both just wanted to be normal parents’: a qualitative study of the experience of maternity care for women with learning disability.BMJ Open. 2017; 7e015526
- Socially disadvantaged women’s views of barriers to feeling safe to engage in decision-making in maternity care.Women Birth. 2014; 27: 132-137
- Maternity services are not meeting the needs of immigrant women of non-English speaking background: results of two consecutive Australian population based studies.Midwifery. 2015; 31: 664-670
- Drivers of maternity care in high-income countries: can health systems support woman-centred care?.Lancet. 2016; 388: 2282-2295
- Evaluation of trained volunteer doula services for disadvantaged women in five areas in England: women’s experiences.Health Soc. Care Commun. 2017; 25: 466-477
- Impact of doulas on healthy birth outcomes.J. Perinat. Educ. 2013; 22: 49-58
- Parents 1st independent evaluation. ‘someone in my corner’: a volunteer peer support programme for parenthood, birth and beyond.Final Evaluation Report. Gillian Granville Associates, Middlesex2012
- Foreign-born women’s experiences of community-based doulas in Sweden — a qualitative study.Health Care Women Int. 2012; 33: 833-848
- How do women with an intellectual disability experience the support of a doula during their pregnancy, childbirth and after the birth of their child?.J. Appl. Res. Intellect. Disabil. JARID. 2016; 29: 21-33
- What is a Doula?.2018 (. (Accessed 4 September 2018))
- Continuous support for women during childbirth.Cochrane Database Syst. Rev. 2017;
- Relational Spaces in Maternal Healthcare: A Qualitative Study of Young Mothers’ Experiences with Community-Based Doula Care. Publication No. AAT MR47544.Carleton University, Canada2009
- Promoting positive mother-infant relationships: a randomized trial of community doula support for young mothers: community doula randomized trial.Inf. Ment. Health J. 2013; 34
- Doula birth support for incarcerated pregnant women.Public Health Nurs. 2005; 22: 53-58
- Group Prenatal Care and Doula Care for Pregnant Women.Springer Publishing, 2011
- Birth for Humankind About Us.2018 (Accessed 20 August 2018)
- Emmel N. Greenhalgh J. Manzano A. Monaghan M. Dalkin S.M. Doing Realist Research. Sage, London2018
- Realistic Evaluation.Sage, London1997
- Department of Foreign Affairs and Trade Realist Impact Evaluation an Introduction. Overseas Development Institute, London2014 (September 2014 ed)
- The craft of interviewing in realist evaluation.Evaluation. 2016; 22: 342-360
- Realist Evaluation Interviewing — A ‘Starter Set’ of Questions.2017
- Data gathering in realist reviews.in: Emmel N. Greenhalgh J. Manzano A. Monaghan M. Dalkin S. Doing Realist Research. Sage, London2018
- A time-responsive tool for informing policy making: rapid realist review.Implementation Sci. 2013; 8: 103
- Towards a methodology for cluster searching to provide conceptual and contextual “richness” for systematic reviews of complex interventions: case study (CLUSTER).BMC Med. Res. Methodol. 2013; 13: 118
NCH Software. Express Scribe Professional software. NCH Software.
- NVivo Qualitative Data Analysis Software.QSR International Pty Ltd, 2018
- The Coding Manual for Qualitative Researchers.SAGE Publications, London2016
- What’s in a mechanism? Development of a key concept in realist evaluation.Implementation Sci. 2015; 10
- Realist review — a new method of systematic review designed for complex policy interventions.J. Health Serv. Res. Policy. 2005; 10
- “I didn’t think we’d be dealing with stuff like this”: a qualitative study of volunteer support for very disadvantaged pregnant women and new mothers.Midwifery. 2017; 45: 36-43
- Companion of Choice During Labour and Childbirth for Improved Quality of Care: Evidence to Action Brief.World Health Organization, Geveva2016
- Doulas could Improve Foreign-Born Women’s Perinatal and Postpartum Satisfaction and Increase Health Providers’ Cultural Competency in a Multicultural Urban Area of the United States.International Development, Community and Environment (IDCE), 2016
- The power of social connection and support in improving health: lessons from social support interventions with childbearing women.BMC Public Health. 2011; 11
- Social relationships and health: a flashpoint for health policy.J. Health Soc. Behav. 2010; 51: S54-S66
- “Being the best person that they can be and the best mum”: a qualitative study of community volunteer doula support for disadvantaged mothers before and after birth in England.BMC Pregnancy Childbirth. 2019; 19: 21
- Realist Evaluation: an overview.in: Westhorp G. Prins E. Kusters C. Guijt I. Brouwers J. Report from an Expert Seminar with Dr. Gill Westhorp. Centre for Development Innovation Wageningen University & Research centre, Wageningen, The Netherlands2011
- Midwives’ experiences of doula support for immigrant women in Sweden — a qualitative study.Midwifery. 2012; 28: 80-85
- Establishment of a Somali doula program at a large metropolitan hospital.J. Perinat. Neonatal Nurs. 2006; 20: 128-137
- Perceptions of social support from pregnant and parenting teens using community-based doulas.J. Perinat. Educ. 2005; 14
- Doulas as community health workers: lessons learned from a volunteer program.J. Perinat. Educ. 2006; 15
- A qualitative study of volunteer doulas working alongside midwives at births in England: Mothers’ and doulas’ experiences.Midwifery. 2018; 56: 53-60
- The Processes of Implementing and Sustaining an Intensive Volunteer One-to-One Support (Doula) Service for Disadvantaged Pregnant Women.2016
- The processes of implementing and sustaining an intensive volunteer one-to-one support (doula) service for disadvantaged pregnant women.Voluntary Sector Rev. 2016; 7: 149-167
- Attitudes towards doula support during pregnancy by clients, doulas, and labor-and-delivery nurses: a case study from Tampa, Florida.Hum. Organ. 2008; 67
- Swedish women’s experiences of doula support during childbirth.Midwifery. 2010; 26: 173-180
- “Going beyond the call of doula”: a grounded theory analysis of the diverse roles community-based doulas play in the lives of pregnant and parenting adolescent mothers.J. Perinat. Educ. 2010; 19: 24-40
- Parents 1st: Impact and Measurement: Evaluation Report Based on the Support of the Centre for Social Action Innovation Fund for Parents 1st.2016
- A qualitative study of volunteer doulas working alongside midwives at births in England: mothers’ and doulas’ experiences.Midwifery. 2017; 56: 53-60
- Evidence on Doulas Evidencebasedbirthcom.2017
- Intimate space within institutionalized birth: women’s experiences birthing with doulas.Anthropol. Med. 2012; 19: 315-326
- Influence of culture and community perceptions on birth and perinatal care of immigrant women: doulas’ perspective.J. Perinat. Educ. 2014; 23: 25-32
- Community health worker programs to improve healthcare access and equity: are they only relevant to low- and middle-income countries?.Int. J. Health Policy Manage. 2018; : 1-12
- Building capacity and wellbeing in vulnerable/marginalised mothers: a qualitative study.Women Birth. 2018; 31: e341-e347
- ‘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.BMC Pregnancy Childbirth. 2016; 16: 289
Article info
Publication history
Published online: November 24, 2019
Accepted:
October 26,
2019
Received in revised form:
October 25,
2019
Received:
July 2,
2019
Identification
Copyright
© 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
