Enhancing the quality of care for expectant families

For centuries, women have given birth with the support and care of other women in an experience that focused on the psychosocial and emotional aspect of this remarkable life event.

In a unique partnership, The Scarborough Hospital (TSH) and Discover Birth Inc. have modified this age-old concept by integrating Doula Services into the hospital’s Maternal, Newborn and Childcare Program to enhance patient care for expectant mothers and their families.

“It’s an excellent service in the hospital,” says Nadine Doueiry, a patient who included a doula in the birth of her second daughter. “A doula is something every woman should have when she delivers a baby.”

The Doulas at TSH work in collaboration with the interprofessional health care team to provide non-medical physical and emotional care to families during childbirth. The care provided by doulas includes relaxation, positioning and other techniques to focus on the health and well-being of the mother.

“We provide a woman and her partner with ongoing comfort, encouragement and respect,” says Rean Cross, Doula and Executive Director of the Doula Program at TSH. “Family support is certainly important, but a third-party person with extensive knowledge and experience in the birthing process can improve the overall satisfaction families have with their childbirth experience.”

The specialized focus on a woman’s emotional and non-medical needs during childbirth enables the clinical team to more efficiently administer medical care and safely deliver the baby. This interprofessional team approach can lead to reduced complications, Cesarean Sections and interventions.

In fact, data released by the Canadian Institute for Health Information (CIHI), which measures the performance of 600 acute care hospitals across Canada in 30 clinical and financial areas, indicated that TSH’s rate for Vaginal Birth after Caesarean Section (VBAC) was the best in the GTA, by a considerable margin. Part of the reason is the emphasis on multi-disciplinary practice.

“It is an excellent example of collaboration among health care professionals that truly enhances the quality of care for our patients,” says Barbara Scott, Patient Care Director of Maternal, Newborn and Childcare at TSH. “The additional care and expertise provided by doulas throughout the childbirth process helps to alleviate any fears or uncertainties the mother and her partner may be experiencing.”

She added that cost is determined on a sliding scale, based on a family’s ability to pay. This is to ensure that everyone in the community has an equal opportunity to access this remarkable service as well as supports the hospital’s vision to provide the best healthcare for our global community.

Doulas generally become involved with the family during the last trimester, and when a woman goes into labour, her family contacts the doula on-call who provides 24/7 support from beginning to end. Even if a woman arrives at the hospital in labour and requests a doula, the nurses can refer to the on-call schedule and arrange for a doula to attend the birth.

“Continuous support is the cornerstone of doula care,” says Stefanie Antunes, Doula and Chief Operating Officer of Discover Birth Inc. “We come in with the client and we leave after the baby is born and the family is at ease.”

There are 18 doulas currently enrolled in the program at TSH from many different cultural backgrounds who can address patients’ needs in a variety of languages such as French, Portuguese, Spanish, Vietnamese, Hungarian, Hindi, Urdu and Punjabi, to name a few. They support the woman’s labour and delivery as well as provide immediate post birth care.

Families who need or want comfort measures for a few hours after their child is born benefit from the expertise of a doula who can answer questions, such as how to manage visitors, or help the family understand and appreciate the amazing event they just experienced. They also offer breastfeeding and diaper changing support. The additional care following a birth has been shown to decrease the incidence of post-partum depression.

Another valuable service provided by doulas is the support they provide to a woman’s partner during childbirth, whether it’s her husband or another loved one.

“There is a misconception that doulas should only be involved in the birthing process if a woman has no other supports,” explains Rean. “In reality, doulas can help a woman’s partner be more effective in their support strategies, which leads to a better experience for everyone.”

Historically, women gave birth with the help of an extended family member such as a grandmother, mother or older sister who gained experience by being involved in many births throughout their lives. In modern times, people do not witness many births and so doulas provide that same level of comfort and a reassuring presence to guide the woman through her labour and delivery.

“People don’t witness births as much as they used to,” says Stefanie. “So for a husband or partner, it’s like watching football all year then being asked to coach the Superbowl.”

Many women enlist the support of a doula in the births of their second or third child because they are looking for a different and more engaging experience. The additional care provided by a doula enhances childbirth and improves the quality of care received by families as they make the major transition into parenthood.

Nadine certainly agrees. She provided glowing accolades about TSH when compared to the hospital she delivered her first child at in Dubai. She stated that while the hospital in Dubai was “five-star” in terms of resources, TSH staff and her doula were more knowledgeable, qualified, caring and supportive. In fact, she was so thrilled with her experience that she and her husband have decided to have a third child.