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.

The perinatal nurse’s work is influenced by the particular needs of each labouring women as well as by institutional discourses and textually mediated work processes that guide obstetrical care in hospital. Institutional Ethnography (IE) was used to explore the work performed by perinatal nurses in relation to the pain management of women labouring with mobile labour epidural analgesia. The data collection process involved interviews with five perinatal nurses working in a tertiary care centre in British Columbia and an in-depth review of the institutional texts used by these nurses. The perinatal nurse’s work associated with the initiation and maintenance of the epidural involves a constant re-prioritizing of the nurse’s actions and interventions in order to attend to multiple demands associated with the care of a labouring woman. The nurse’s extensive knowledge work requires an awareness of the effects of the epidural on maternal and fetal wellbeing and the labour progress. The nurse’s work of promoting effective pain relief is managed separately from the process of supporting labour and birth. Once the epidural is inserted and the contraction pain alleviated, all manifestations of pain are perceived as problematic. Within the context of epidural management, the goal becomes taking every measure possible to alleviate the presence and re-occurrence of contraction pain. The nurse’s work of mobilizing a labouring woman with an epidural involves an additional layer of assessment and evaluations which require additional work on the part of the nurse. The nurse must choose and prioritize the care she provides to the labouring woman. Needing to focus more intensely on the safety of the labouring woman and her fetus, alongside ensuring the required epidural work processes are completed, results in mobility falling to the lowest priority level within the nurse’s epidural management work. The textually mediated work processes embedded in the intuitional policies and forms associated with epidural management reinforce this hierarchy of priorities and directly structure the nurse’s work time away from providing care that supports women to cope with labour pain and encouraging mobility to promote labour progress. The various hospital forms, policies and guidelines coordinate and organize the nurse’s epidural work so that promoting mobility is subsumed; potentially increasing the risk of labour dystocia and caesarean birth for women labouring with a mobile labour epidural analgesia. / Graduate / 0570 / 0380 / 0626 / isabelle@dccnet.com

Philosophiae Doctor - PhD / Childbirth is a multifaceted experience that is usually influenced by several factors that could result in an unsatisfactory or satisfactory childbirth experience. These factors include quality of support during labour of which Continuous Labour Support (CLS) is a part; it has been identified as a positive contributor to maternal health. Although CLS has been recommended by the World Health Organization (WHO), lack of a framework has also been an impediment to its implementation in Nigerian hospitals. The purpose of this study is to develop a culturally congruent Continuous Labour Support framework for women in Nigeria. The study adopted a concurrent mixed method design to gain information from various dimensions for the study. The study populations included pregnant women, nurse-midwives and health policy-makers in Ondo state, Nigeria, who were selected through simple random sampling using computer-generated tables for the quantitative strand of the study. For the qualitative strand, participants were selected using a purposeful sampling method. The study was conducted in two phases. Phase 1 focused on the assessment of the perceptions, attitudes and preferences of all groups of participants. Collected quantitative data was analysed using descriptive and inferential statistics through the use of the Statistical Package for Social Science (SPSS) Version 21. Qualitative data was analysed using Tesch's Method of Content Analysis. Findings the study shows that the pregnant women had positive perceptions and attitudes towards CLS from a familiar, close and trusted person, in public health facilities. Findings from the midwives revealed that pregnant women's family members are not usually involved in women's care during labour in public health facilities. However, nurse-midwives expressed satisfaction with the few occasional/discretional occasions on which the practice had been implemented, and the majority showed positive perceptions and attitudes to the introduction of CLS from a person of the woman's choice, in public health facilities. Findings from interviews with the policy-makers affirmed family support system during labour as a cultural expectation and a traditional practice at home but alien to the hospital. The policy-makers also expressed a positive standpoint on the introduction of CLS by persons of the woman’s choice from her social network, in the public hospital. Phase 2 of the study involved the development of the culturally congruent Continuous Labour Support framework for women in south-west Nigeria. The framework was developed using the Model Development Approach by Walker and Avant (2005, 2011). Findings from processes with all stakeholders in Phase 1 of the study were synthesised with literature review, using concept identification and classification. The concepts in this study were identified, described and developed through synthesis of data from questionnaire, the focus group and individual interviews of all stakeholders. Concept classification, description and validation was achieved through the six vantage points of surveying activity listed by Dickoff et al, (1968) in consultation the selected expert reviewers in maternal and child care. The developed framework was followed by a detailed description, and validation of the framework was done through consensus agreement with four experts.