Accompaniment models have been used globally to help address barriers to abortion access. Access to abortion is an important issue facing individuals in Canada today. In Canada, abortion doulas provide accompaniment services, even though they are not formally integrated into the abortion care system. This thesis explores the concept of accompaniment in the context of abortion care and provides insight into the experiences and perspectives of abortion doulas active in Canada. This is accomplished through a scoping review and in-depth interviews with abortion doulas across Canada. Results suggest that accompaniment models are beneficial to abortion care and can improve accessibility. Further, abortion doula support helps abortion seekers overcome barriers to care and empower those providing the support. Abortion doulas have many suggestions for improvements to the abortion care system in Canada and have valuable insights into the barriers which exist today. Abortion care can be improved by integrating abortion doula support into the abortion care system, but further research is needed to develop and evaluate interventions. This research is a starting point and aims to contribute to the literature in an under-researched area. -- Des modèles d'accompagnement ont été utilisés dans le monde entier pour aider à lever les obstacles à l'accès à l'avortement. L'accès à l'avortement est une question importante auquel les individus au Canada sont confrontés. Au Canada, les doulas spécialisées dans l'avortement fournissent des services d'accompagnement, même si elles ne sont pas officiellement intégrées au système de soins lié à l'avortement. Cette thèse explore le concept d'accompagnement dans le contexte des soins liés à l'avortement et donnera un aperçu des expériences ainsi que les points de vue des doulas spécialisées dans ce domaine au Canada. Afin de démontrer ceci, la thèse s'appuie sur un examen de la portée de l'étude et sur des entretiens approfondis avec des doulas spécialisées dans l'avortement au Canada. Les résultats suggèrent que les modèles d'accompagnement sont bénéfiques aux soins liés à l'avortement et peuvent en améliorer l'accessibilité. De plus, le soutien des doulas aide les personnes qui cherchent à se faire avorter à surmonter les obstacles aux soins et renforce l'autonomie de celles qui offrent ce soutien. Les doulas d'avortement ont de nombreuses suggestions pour améliorer le système de soins en matière d'avortements au Canada et ont des idées précieuses au sujet des obstacles qui existent aujourd'hui. Les soins liés à l'avortement peuvent être améliorés en intégrant le soutien des doulas dans le système de soins liés à l'avortement, mais d'autres recherches sont nécessaires afin de développer et évaluer les interventions. Cette recherche est un point de départ et vise à apporter une contribution à la littérature sur un domaine peu étudié.

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Syfte: Att belysa kulturdoulans erfarenheter av att möta nyanlända kvinnor före, under och efter förlossning. Design: En kvalitativ metod med induktiv ansats användes. Data insamlades genom kvalitativa semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys. Omgivning: Kvinnokliniken i en stad i norra Sverige. Deltagare: Kulturdoulor som kontinuerligt medverkade vid förlossningar. Resultat: Analysen resulterade i tre huvudkategorier: Kulturens inflytande, En drivkraft att hjälpa och att vilja utveckla sig själv, Kulturdoulan är en länk mellan språk och känslor Slutsats: Enligt kulturdoulan är hon en länk mellan språk och kultur. En kulturdoula har oftast fött barn själv samt bistått andra som fött barn. Genom sina egna erfarenheter och utbildning har hon goda kunskaper om förlossningsvård. Detta kombinerat med att kunna flera språk och att vara närvarande under hela förlossningen skapar enligt kulturdoulan en känsla av trygghet för kvinnan. Hon står alltid på kvinnans sida och gör sitt yttersta för att hon ska få en positiv upplevelse. Kulturdoulan kan ofta fylla rollen som en nära kvinnlig släkting eller vän. Kliniska implikationer: Antalet personer som söker asyl i Sverige förväntas vara fortsatt högt. Detta innebär att barnmorskor kommer att möta många kvinnor födda utanför Norden från olika kulturer. I Sverige är mödradödligheten låg men av dem som drabbas är utlandsfödda kvinnor i majoritet, vilket har visats till stor del bero på språkförbistringar. Kulturdoulaprojektet är relativt nytt och lokalt men förhoppning finns att projektet utökas till att i större utsträckning innefatta mödrahälsovården och tiden efter förlossningen samt få en större utbredning nationellt. / Objective: To illuminate the cultural doula’s experiences of meeting newly arrived women before, during and after childbirth. Design: A qualitative method with inductive approach was used. Data was collected through qualitative semistructured interviews and analyzed by qualitative content analysis. Settings: The womens clinic in a city in northern Sweden. Participants: Cultural doulas who continuously participated in childbirth. Findings: The analysis resulted in three main categories: The influence of culture, A driving force to help and wanting to develop oneself, The cultural doula is a link between language and emotions Key conclusions: According to the cultural doula, she is a link between language and culture. It is common that the cultural doula has given birth her self as well as assisted other in childbirth. Through her own experience and education she has good knowledge of care during childbirth. This combined with being able to talk several languages and being present throughout the the childbirth creates a sense of safety for the woman according to the cultural doula. She always take sides with the woman and does the utmost for her to have a positive experience. The cultural doula can often fill the role of a close female relative or friend. Implications for practice: The number of asylum seekers in Sweden is expected to remain at a high level. This will mean that midwives will meet many women born outside of Nordic countries from different cultures. The maternety mortality in Sweden is low, however, of those affected, women born abroad are in majority, which has been shown to be caused mostly by language barriers. The cultural doula project is relatively new and local but will hopefully expand to include the antenatal care and the period after the childbirth and to be more widely distributed nationally.

This dissertation is an investigation of doulas as agents of social change through the lens of feminist theory. Doulas are nonmedical health care workers who provide physical, emotional, and informational support during pregnancy, childbirth, and/or the postpartum period. Because of doulas' willingness to work within the structures of the hospital setting, some have questioned the effectiveness of doulas as change-makers. While much feminist scholarship on the politics of birth centralizes the issue of medicalization, I demonstrate that expanding this line of analysis aids in better understanding the cultural impact of doula care as part of a larger picture of reproductive health advocacy. Through discourse analysis, participant observation, face-to-face ethnographic interviews, and online surveys, I track the goals and effects doulas ascribe to their work, both activist and professional, and on both an individual and group level. Rather than asking whether doulas can successfully challenge the medicalization of birth, I seek to understand how the doula movement contributes to social justice through challenging various overlapping axes of inequality, related to race, class, gender, and sexuality. This analysis highlights the work of doulas in marginalized communities that is, as yet, under-researched and under-appreciated, while also illuminating the multifaceted effects of the dominant medical model of birth. I observe that doulas are increasingly working to empower people in multiple facets of their lives, beyond the birthing room. Rather than being incapable of, or uninterested in, creating social change, doulas are increasingly bringing a new political consciousness into birth work, as evidenced by the emerging designations of "radical doula" and "full spectrum doula." I argue that this movement among doulas represents a new paradigm in birthing rights activism, which connects childbirth choices to a larger reproductive justice agenda and forges connections between birthworkers and activists for causes such as LGBT rights, abortion rights, prisoners' rights, and economic and racial justice. By reimagining the reach of their work, many doulas are drawing necessary connections to social justice issues that are often overlooked in the childbirth reform movement, which tends to focus on medicalization as the primary issue.

Made available in DSpace on 2016-07-27T14:20:14Z (GMT). No. of bitstreams: 1 Livia Kunz Sebba Vasconcelos Pitaluga.pdf: 1284255 bytes, checksum: cf3c336ed67b107cd178fba590bec5f3 (MD5) Previous issue date: 2014-02-11 / This work aims to identify, describe and analyze the perception of Doula s monitoring on Quality of Life of parturients users of a public maternity hospital in Goiânia. The material was organized into an introduction, two theoretical chapters, method, and finally two products drafted in the form of a scientific article. It ends by final considerations. The papers feature a quantitative and qualitative review on the subject. For both analyzes were assessed Quality of Life of 30 women, being 15 with the accompaniment of a Doula and 15 without such monitoring, with na age range between 18 and 40 years, and up to 24 hours postpartum. The quantitative evaluation (Article 1) was taken from the instrument WHOQOL Bref and has as its results that, the Doula s monitoring reduces the rate of cesarean sections and leads to more natural births. This study also concluded that Doula s monitoring generates bigger and better rates in the psychological dimension of the parturient. The qualitative assessment (Article 2) was taken from semi -structured interview and was analyzed by the method of Laurence Bardin. It was evaluated the perception of quality of life and labor with all the patients. The results understands that pregnant women, with and without the accompaniment of a Doula positively assessed the Quality of Life. However, the group of women without the accompaniment of a Doula diverged from the group with a Doula, due to understand that the absence of such assistance contributes negatively on their overall assessment of Quality of Life, but this result may have been minimized by the presence of distinct protective factors, possibly happening a process of compensation. This study understands that the presence of the Doula tends to increase the protection condition of pregnant women, bringing a positive perception of labor. / Este trabalho visa identificar, descrever e analisar a percepção do acompanhamento da Doula na Qualidade de Vida de parturientes usuárias de uma maternidade pública de Goiânia. O material foi organizado em uma introdução, dois capítulos teóricos, método e, por fim, dois produtos redigidos em forma de artigo científico. Encerra-se pelas considerações finais. Os artigos científicos apresentam uma avaliação quantitativa e outra qualitativa sobre o tema. Para ambas as análises foram avaliadas a Qualidade de Vida de 30 parturientes, sendo 15 com o acompanhamento da Doula e 15 sem o referido acompanhamento, com faixa etária de 18 a 40 anos, e em até 24 horas pós-parto. A avaliação quantitativa (artigo 1) foi feita a partir do instrumento Whoqol Breve e tem como resultados que, o acompanhamento da Doula diminui o índice de cesarianas e conduz a mais partos naturais. Este estudo, ainda, concluiu que o acompanhamento da Doula gera maior e melhores índices na dimensão psicológica da parturiente. A avaliação qualitativa (artigo 2) foi feita a partir de entrevista semi-estruturada e foi analisada pelo método de Laurence Bardin. Avaliou-se a percepção da Qualidade de Vida e do trabalho de parto com todas as parturientes. Os resultados compreendem que as parturientes, com e sem acompanhamento de Doula, avaliaram positivamente a Qualidade de Vida. Porém, o grupo de mulheres sem o acompanhamento da Doula diferiu do grupo com Doula por entender que a ausência dessa assistência contribui de forma negativa na sua avaliação geral da QV, mas tal resultado pode ter sido minimizado pela presença de distintos fatores de proteção, possivelmente ocorrendo um processo de compensação. Assim, este estudo compreende que a presença da Doula tende a aumentar a condição de proteção das parturientes, trazendo uma percepção positiva do trabalho de parto.

Background: Immigrant women are at risk for not receiving the same support and security during childbirth as native-born women. When the woman speaks little or nothing of the language in the country she is in, difficulties may arise in the communication between healthcare staff and the pregnant woman. If the woman has access to a cultural doula, adequate information can be provided and the risk of medical injuries can probably be reduced.  Purpose: The purpose was to describe the importance of a cultural doula for women with other ethnic background during childbirth.  Method: A general literature review. A total of ten original articles published between 2009-2021 were used in the literature review. The databases that were used: PubMed, CINAHL, Scopus and Web of Science. The articles were quality reviewed with SBU:s template.  Results: Three categories emerged in the analysis of the results: 1) Cultural doula - a bridge between two cultures, 2) Feeling safe before a birth and 3) Cultural doula as an opportunity but also an obstacle. The result is based on opinions and experiences from healthcare staff, immigrant women and cultural doulas. The opinion was that cultural doulas contributed to increased communication. The presence and an early contact before delivery were seen as reassuring for the pregnant woman. Healthcare staff, cultural doulas and the woman herself felt that the pregnant woman lacked information about the country's healthcare system and what she could expect during pregnancy and childbirth. Loneliness was considered to decrease with a cultural doula being present. The informants believed that thanks to the support of the cultural doula, the chance for integration also increased. Conclusion: The availability of a cultural doula for women with other ethnic backgrounds was shown to provide several benefits. Among other things, the cultural doula contributed to increased security for women, improved communication between women and healthcare staff, a greater understanding of healthcare and the country, and an increased chance of integration into society. Promoting cultural competence in healthcare can contribute to equal care for all individuals.

Objective: To analyze factors that lead nurses and doulas to have positive views of each other. Design: A multivariate analysis of a cross-sectional survey, the Maternity Support Survey. Setting: Online survey with labor and delivery nurses, doulas, and childbirth educators in the United States and Canada. Participants: A convenience sample of 704 labor and delivery nurses and 1,470 doulas. Methods: Multiple regression analysis was used to examine five sets of hypotheses about nurses' and doulas' attitudes toward each other. Scales of nurses' attitudes toward doulas and doulas' attitudes toward nurses included beliefs that nurses/doulas enhance communication, are collaborative team members, enhance a woman's birth experience, interfere with the ability to provide care, or interfere with relationships with the women for whom they care. Results: For nurses, exposure to doulas in their primary hospitals was associated with more positive views, whereas working more hours, feeling overworked, and a preference for clinical tasks over labor support were associated with more negative views of doulas. For doulas, working primarily in one hospital and certification were associated with more positive views of nurses. Nurses with more positive attitudes toward common obstetric practices had more negative attitudes toward doulas, whereas doulas with more positive attitudes toward common obstetric practices had more positive attitudes toward nurses. Conclusion: Our findings show factors that influence mutual understanding and appreciation of nurses and doulas for each other. These factors can be influenced by educational efforts to improve interprofessional collaboration between these maternity care support roles.

This dissertation explores the knowledge systems that doulas use to legitimate their work to the medical community, and to clients. "Doula" comes from a Greek word that means "a woman who serves." In contemporary English, doulas are women who provide other women with support during labor and childbirth. Although research shows that doula support can have positive physiological and psychological effects, doulas' lower social status in the birth fields constricts their reach to those who know about and can hire them privately. In the United States, obstetricians have authoritative knowledge over birth, and all others fall beneath them in the hierarchy of medicine. Doulas serve as a case for exploring the importance of certification and science, versus alternative forms of knowledge for legitimating their expertise within the field of childbirth. This research uses a mixed methods approach to explore the roles that authoritative versus alternative sources of knowledge play in doulas' attitudes and approaches to childbirth. Data come from the Maternity Support Survey, an original, cross-national survey of nurses, doulas, and childbirth educators in the United States and Canada. I also rely on content analysis of five large doula organizations' websites, and interviews with twenty-five doulas, and twenty-five mothers who hired or considered hiring a doula to support them during labor and delivery. This mixed methods research looks at how doulas can legitimate their role in order to better serve women.Results suggest that both authoritative knowledge systems (such as certification) and alternative knowledge systems (such as feminism) influence doulas' approach to legitimating their work. Scientific evidence serves as both an authoritative and alternative source of knowledge, depending on the context. This research has important implications for the future of doula support; while alternative knowledge systems allow doulas to empower women and challenge the dominance of medicalized birth, authoritative knowledge systems allow doulas greater access to the women who need them most. In order to reach a greater population of women, doulas need to find a balance between challenging authoritative medicine and working within it to best serve women.

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Made available in DSpace on 2015-03-05T20:06:23Z (GMT). No. of bitstreams: 0 Previous issue date: 13 / Nenhuma / Esta proposta de pesquisa vem ao encontro das propostas de saúde do Ministério da Saúde no que se refere à humanização da assistência obstétrica que preconiza a atenção humanizada com promoção do parto e nascimento saudáveis, com uma equipe de saúde que realize procedimentos benéficos para a mãe e o bebê, evitando intervenções desnecessárias, preservando a privacidade e autonomia desse binômio.