Maternity Care Team Research Articles

"I didn't really fit into any boxes": understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum-a mixed-method systematic review.

Little is known about women's experiences of cancer during pregnancy and up to one-year postpartum. As the incidence of gestational cancer rises parallel to increasing rates of early onset cancers there is an imperative need to understand their experiences. The aim of this research is to understand women's experiences of gestational cancer during pregnancy and up to one-year postpartum. This systematic integrative review followed the JBI methodology for mixed method systematic reviews (MMSR) which integrates empirical data from qualitative and quantitative primary studies. The search strategy included electronic databases, APA PsycINFO, CINHAL, Medline, Scopus, and the Web of Science Core Collection. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive methodological quality assessment was undertaken using the Mixed Methods Appraisal Tool (MMAT). Thirteen studies were included, reporting on the experiences of 266 women. The findings represented the women's insight on the psychological impact of their gestational cancer, the impact on women's identity as a mother and a patient, and women's experiences of complex care. Gestational cancer reflects an emerging focus of clinical practice and an opportunity for much needed new research to explore woman-centered care exploring supportive care needs and models of maternity care. Women's experiences indicate that services are under-resourced to address the holistic and integrated supportive care needs of women affected by cancer across both maternity and cancer care teams.

Childbirth Doula Training and the Experiences of Those Who Train as a Childbirth Doula

Objective:The objective of this article was to gain a deeper understanding and insight into the training and characteristics of childbirth doulas on the maternity care team. The aim was to integrate knowledge obtained from two studies: an integrative review (IR) of doula education programs globally (Study 1) and the qualitative experiences of those training to become a doula (Study 2).Methods:For the IR (Study 1), the modified Whittemore and Knafl (2005) framework and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used. Five electronic databases were searched (CINAHL, ProQuest Education Databases, ERIC, MEDLINE, and Scopus) usingdoulaandeducation/trainingas key terms. Nineteen papers were included in the review. For the qualitative study (Study 2), semi-structured interviews with 10 student doulas were analyzed using inductive thematic analysis.Results:The results highlighted ambiguity around the education (review) and scope of practice (qualitative) of a childbirth doula. The review showed a variety in duration, content, learning, certificate/accreditation, and educator qualifications in doula training programs, globally. The variety in student doulas’ understanding of their role in the maternity care context emerged from the key themes: (a) what influenced the decision to become a doula, (b) personal attributes perceived as essential to be a doula, and (c) what constitutes the role of a childbirth doula.Conclusions:This article highlights a variability in doula training legislation and accreditation, as well as program content and length. This variation may be reflected in student doulas’ understanding of their role in the maternity context. A better understanding of doula training and a defined scope of practice can fill the current gap in continuity of care and improve communication within the maternity care health team.

The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review.

Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.

“I was able to take it back”: Seeking VBAC after experiencing dehumanizing maternity care in a primary cesarean

In this article, we present findings from a qualitative narrative analysis that examined the pregnancy, primary cesarean, and subsequent birth experiences of women in the United States. Using a maximal variation sampling strategy, we recruited participants via social media and networking to participate in semistructured interviews. Twenty-five women from diverse backgrounds and geographic locations across the U.S. participated, eight self-identified as racialized and seventeen as non-Hispanic, White. Data were analyzed iteratively using Clandinin and Connelly's approach to Narrative Inquiry. Across their narratives, participants described their experiences of maternity care that were either generally negative (dehumanizing care) or positive (humanized care). They further described how their experiences of dehumanizing or humanized care impacted their decision-making for subsequent births, mental health, relationships with the healthcare system, early parenting birth satisfaction, and family planning. Findings suggest that regardless of ultimate mode of birth, what was most important to women was how they are treated by their maternity care team. We suggest practice changes that may improve the experience of maternity care for primary cesarean and subsequent births, especially among those made marginal by systems of oppression.

Qualitative Study of the Experience of Caring for Women During Labor and Birth During the First Wave of the COVID-19 Pandemic

ObjectiveTo examine the experiences of labor and delivery (L&D) nurses and certified nurse-midwives who cared for women during labor and birth in the United States during the first wave of the COVID-19 pandemic. DesignSubgroup analysis of a larger study with a qualitative descriptive design. SettingTelephone interviews. ParticipantsThe parent study included 100 nurses across various specialty areas who provided patient care during the first wave of COVID-19 in the United States. Our subgroup analysis included 19 participants: L&D nurses (n = 11) and certified nurse-midwives (n = 8). MethodsSemistructured interview guide. ResultsParticipants described their experiences providing patient care in L&D settings during the first wave of the COVID-19 pandemic. We identified five major themes: Separation of COVID-19–Positive Mothers and Newborns, Isolation of Women in Active Labor, Disparities in Access to Care, Barriers to Communication, and Effect on the Mental Health of Members of the Care Team. ConclusionOur findings captured the experiences of maternity care team members who worked during the COVID-19 pandemic when standards of quality maternity care were compromised. The challenges of caring for COVID-19–positive mothers, including isolation during active labor and infant removal from mothers at birth, affected their psychological well-being and their mental health and must now be addressed to prevent burnout and turnover.

Changes in prenatal care and vaccine willingness among pregnant women during the COVID-19 pandemic

IntroductionConcerns about SARS-CoV-2 infection risk in health care settings have resulted in changes in prenatal care and birth plans, such as shifts to in-person visits and increased Cesarean delivery. These changes may affect quality of care and limit opportunities for clinicians to counsel pregnant individuals, who are at higher risk of severe COVID-19 disease and adverse pregnancy outcomes, about prevention and vaccination.MethodsWe conducted a cross-sectional online survey of United States adults on changes in prenatal care, COVID-19 vaccine willingness, and reasons for unwillingness to receive a vaccine. We summarized changes in access to care and examined differences in vaccine willingness between pregnant and propensity-score matched non-pregnant controls using chi-squared tests and multivariable conditional logistic regression.ResultsBetween December 15–23, 2020, 8481 participants completed the survey, of which 233 were pregnant. Three-quarters of pregnant women (n = 186) experienced a change in prenatal care, including format of care (n = 84, 35%) and reduced visits (n = 69, 24%). Two-thirds experienced a change in birth plans, from a hospital birth to home birth (n = 45, 18%) or vaginal birth to a Cesarean delivery (n = 42, 17%). Although 40% of pregnant women (n = 78) were unwilling to receive COVID-19 vaccination, they had higher, though non-significant, odds of reporting willingness to receive vaccination compared to similar non-pregnant women (aOR 1.38, 95% CI: 0.95, 2.00).ConclusionTo support pregnant women through the perinatal care continuum, maternity care teams should develop protocols to foster social support, patient-centered education around infection prevention that focuses on improved risk perception, expected changes in care due to COVID-19, and vaccine effectiveness and safety.

Midwifery Trained Registered Nurses' Perceptions of Their Role in the Labor Unit

Introduction: A Midwifery Trained Registered Nurse (MTRN) is a member of the multi-professional maternity health care team in Sri Lanka. Her contribution to the maternity care team is poorly understood, often undermined, and undefined. In the context of low- and middle-income settings where traditional midwives play a crucial role in domiciliary care, the MTRNs role as a member of the multi-professional hospital-based maternity care team has not been well-described. Objective: The study aimed to describe MTRNs' perceptions of their role in the Labor Unit within the multi-professional maternity health care team at five tertiary care hospitals in the Capitol Province of Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted among 186 MTRNs working in labor rooms in the study setting. All MTRNs in the selected hospitals were invited and included in the sample. A postal survey was carried out using a pre-evaluated, pretested self-administered questionnaire, and descriptive statistics were derived. Results: All respondents were females, aged 27 to 60 years (mean ±SD 40 ±8.3 years). The majority (66%)was less than 45 years old. Almost all (>96%) MTRNs perceived 12 tasks of the listed tasks as their primary responsibility. Regarding other tasks, they perceived a high degree of overlap between their role and those of the doctors and midwives. Although almost all MTRNs rated the level of interprofessional collaboration from registered nurses (RNs) and doctors as average to good, nearly half (49%) of them rated support from midwives ranging from very poor to average. Conclusion: A high degree of perceived overlap between MTRNs' tasks with those of the other members of the maternity care team can cause role confusion, conflicts, and poor patient care. MTRNs' role in the Labor Unit within the multi-professional maternity health care team was controversial. Clarifying the MTRNs scope of practice will help improve interprofessional understanding of roles and responsibilities and collaboration.

Knowledge and Attitudes of Maternity Nurses and Ancillary Team Members about Substance Addiction during Pregnancy and Postpartum.

To describe knowledge and attitudes of maternity nurses and other ancillary direct caregivers about addictive substance use by pregnant women and new mothers and to evaluate their perceptions of role preparation, resources available, and educational needs. We surveyed maternity nurses and ancillary members of the maternity care team to assess knowledge and attitudes about caring for women with addictive substance use. Data were analyzed using descriptive, parametric, and nonparametric statistics. Respondents (N = 109) from a southwestern Magnet community hospital were 100% female, predominantly nurses (89%), and worked mostly on mother-baby or labor and delivery units. They had high average knowledge scores and most had positive attitudes. When asked about preparation to care for pregnant women and new mothers with addictive substance use, some perceived that they were not able to carry out their role due to lack of knowledge. Findings suggest most maternity nurses have the knowledge and skills they believe are needed to care for women who use addictive substances during pregnancy and postpartum. Most have positive attitudes, but approximately one third may need interventions to encourage and further support empathy and acceptance. Education and skill-building for maternity nurses and other team members related to caring for women using addictive substances may be worth consideration; however, there is minimal evidence of their efficacy. Evaluations of these types of programs are needed in maternity settings.

CCT: continuous care trial - a randomized controlled trial of the provision of continuous care during labor by maternity care assistants in the Netherlands

BackgroundIn 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor.MethodsA randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women’s satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992).DiscussionWe expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a cost-effective intervention.Trial registrationTrial Registration: Netherlands Trial Register, NL8065. Registered 3 October 2019 - Retrospectively registered.

Women Construct Their Birth Narratives and Process Unplanned Cesarean Births Through Storytelling

ObjectiveTo examine birth narratives of primiparous women who experienced unplanned cesarean births to improve nursing care. DesignDescriptive, qualitative. SettingThe family/newborn units of a large teaching hospital in the Northeast United States. ParticipantsFourteen women who experienced unplanned cesarean births of singleton infants at term. MethodsWe used semistructured interviews to analyze the participants’ birth narratives. Within 48 hours of birth, participants answered the prompt: “Tell us your birth story.” Four perinatal nurse experts in consultation with a qualitative research expert ordered, analyzed, and coded data into themes and subthemes. ResultsWe identified the following four themes: Changing Reality: Transition to Labor, Expectations Meeting Reality: Navigating the Unknown, Transition to Motherhood: The Cesarean Birth Experience, and Accepting the New Reality. ConclusionChildbearing women need time immediately after birth to process their experiences. Our findings highlight avenues for changes in clinical care to optimize women’s experiences of unplanned cesarean births. Participants wanted clearer communication with the maternity care team, voices in the decision-making process, and inclusion of support persons to optimize their birth experiences. Because negative birth experiences affect maternal and child well-being, it is important to understand women’s perceptions and develop strategies to assist them in the construction of their birth narratives.

Implementing E-Learning to Enhance the Management of Postpartum Hemorrhage

ObjectiveTo determine if perinatal outcomes related to postpartum hemorrhage could be improved by blending existing strategies with the use of an online, assessment-driven electronic learning (e-learning) platform. DesignThe Institute for Healthcare Improvement’s Model for Improvement provided a structure for this performance improvement project. Outcome evaluation was further supported by the Kirkpatrick model. Setting/Local ProblemReports of rising maternal morbidity and mortality in the United States prompted action within a multisite health system. Maternity care teams were determined to proactively support excellence in practice through enhancements to continuing education. ParticipantsMaternity providers and nurses practicing within the organization completed the training. Intervention/MeasurementsOnline, assessment-driven learning modules for maternity emergencies were blended with existing instructor-led courses, simulation, and Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) training in early 2017. In addition, a postpartum hemorrhage safety bundle was implemented. Outcome measures included rates of hemorrhage, massive transfusion, and intensive care unit admission for women admitted for childbirth. Outcome measures were tracked using retrospective chart review with baseline period October 1, 2016, through March 31, 2017, and performance period April 1, 2017, through March 31, 2018. ResultsImprovements in perinatal outcomes were observed. The average rate of hemorrhage decreased by 3% (from 56.4/1,000 to 54.7/1,000). Median massive transfusion rates decreased by 35% (from 2.3/1,000 to 1.5/1,000). Similarly, the median rate of maternal intensive care unit admissions decreased by 77% (from 3.1/1,000 to 0.7/1,000). A downward shift was supported with zero intensive care unit admissions for 6 of the last 7 months (n = 4,422 pregnant women or women who experienced birth during the current admission). ConclusionExcellence in the management of postpartum hemorrhage was supported through a multipronged approach that included the use of an online e-learning platform for maternity emergencies.

Preterm Labor and Birth: A Clinical Review.

When caring for women experiencing preterm labor and birth, nurses play a significant role as bedside experts, advocates, patient educators, and key members of the maternity care team. Enhanced expertise on clinical and professional knowledge of preterm labor and birth is crucial in prevention and treatment. As preterm birth rates continue to rise, perinatal nurses as well-informed clinical experts have the opportunity to offer innovative education, holistic assessments, and communication through shared decision-making models. Educating pregnant women about early recognition of preterm labor warning signs and symptoms allows for timely diagnosis, interventions, and treatment. Informed and collaborative nursing practice improves quality of clinical care based on individualized interactions. A clinical review of preterm labor and preterm birth is presented for perinatal nurses.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Explaining the (Over)Use of Electronic Fetal Monitoring: Evidence From a Study of Work Flow on the Unit [14O

INTRODUCTION: Guidelines from ACOG, AWHONN, and ACNM recommend against the routine use of electronic fetal monitoring (EFM) for low risk, healthy labors, recognizing the limited evidence of improved outcomes and its contribution to cesarean births. Yet the vast majority of healthy labors continue to be monitored with EFM rather than intermittent auscultation (IA). We explore the reasons for this disjuncture, going beyond the untested assumption that liability concerns drive EFM use to examine the place of EFM in the workflow of maternity care units. METHODS: A mixed methods study, at a large medical center, using 1) observations on the unit (121 hours), 2) interviews and focus groups with nurses, midwives, obstetricians, and administrators (n=47), 3) chart review, and 4) a short survey of care providers (n=140). RESULTS: Four areas favor EFM use: The work environment (incorrect assumptions about what others on the care team want; EFM as default order; economic and time efficiency); Patients (limited knowledge of monitoring options); Technology (emphasis on EFM training over other approaches); Fear (of missing something, of blame from colleagues, of litigation). CONCLUSION: In light of the recognition – by ACOG and other professional societies – of the role of EFM in the overuse of cesarean sections – it is imperative that we understand continued reliance on this technology. Our study – the first of its kind – points to practical steps needed to reduce this reliance, including open communication among maternity care team members, change in EHR order sets, training in use of IA, and patient education.

Reducing Primary Cesarean Births via a Multidisciplinary Learning Collaborative Using Targeted Bundles [32P

INTRODUCTION: The American College of Nurse Midwives Healthy Birth Initiative: Reducing Primary Cesareans is now entering its third year of operation. The initiative focuses on reduction of nulliparous, term, singleton vertex (NTSV) cesareans by engaging multidisciplinary teams from participating hospitals across the United States (U.S.) in a quality collaborative. The multidisciplinary teams participate in quality focused monthly educational webinars augmented by coaching sessions, that include faculty and peer coaches. Each hospital team initiates quality improvement efforts using one of three change bundles; labor progress, comfort and coping or intermittent auscultation which align with the National AIM Reducing Cesareans bundle. METHODS: Teams collect patient level data, and submit aggregated data on key variables to a central registry which produces individual hospital outcomes and process measures and benchmarks for the collaborative. RESULTS: Midwives, obstetricians, nurses and administrators from 25 hospitals around the US have engaged in the project. The hospitals represent public, community and academic medical centers in both urban and rural settings. The majority of the hospitals receive over 40% of their payments from public insurance, with at least one participant having 95% of its payments from public insurance. The decrease from baseline for participating hospitals overall was 7% with a range of 0 to 18% NTSV cesarean rate with no change in the balancing measures. CONCLUSION: A learning collaborative with data registry support for key outcomes and process measures is an effective way to promote reduction of NTSV cesareans and engage all maternity care team members in quality improvement.

Maternity Providers' Perspectives on Barriers to Utilization of Intermittent Fetal Monitoring: A Qualitative Study.

There are 2 approaches to fetal assessment during labor: continuous electronic fetal monitoring (EFM) and intermittent auscultation (IA). The vast majority of healthy labors in the United States use EFM, despite professional organization recommendations against its use for low-risk pregnancies. This qualitative investigation explores maternity care team members' perspectives on why EFM is the dominant approach to fetal assessment instead of IA. Focus groups comprised of nurses, midwives, and physicians were conducted using a semistructured interview guide. Transcripts were analyzed using directed content analysis to identify themes related to clinical and nonclinical factors influencing the type of fetal assessment employed during labor. Seven focus groups with a total of 41 participants were completed. Seven themes were identified: clinical environment; technology; policies, procedures, and evidence-based protocols; patient-centered influences; fear of liability; providers as members of healthcare team; and deflection of responsibility. All maternity care team members had knowledge of the evidence base supporting IA use for low-risk care. Nurses identified unique challenges in having agency over monitoring decision making and executing best practices. Improved communication among team members can facilitate evidence-based approaches to IA use, facilitating increased utilization for low-risk labor care.

Evaluation of an Innovative, Hospital-Based Volunteer Doula Program

ObjectiveTo evaluate program growth, doula characteristics, patient satisfaction, and characteristics and perceptions of labor and delivery nurses who work with volunteer doulas in a hospital-based volunteer doula program. DesignDescriptive quantitative. SettingAn academic health center in the southeastern United States with approximately 4,000 births per year. ParticipantsParticipants (N = 519) included volunteer doulas (n = 80), labor and delivery nurses (n = 24), and women who were supported by doulas (n = 415). MethodsWe evaluated program growth by the number of doulas and women supported over time. We developed surveys to evaluate doula characteristics, patient satisfaction, and characteristics and perceptions of labor and delivery nurses who work with volunteer doulas. ResultsFrom 2012 to 2018, the number of Birth Partners doulas increased from 25 to 80. The annual number of women who received intrapartum care from doulas increased from 88 in 2012 to 477 in 2018. Doula characteristics included race, ethnicity, age, student or nonstudent status, and ability to speak Spanish. Of the 1,185 women who received doula support from 2015 to 2018, 415 (35%) responded to the patient satisfaction survey. Most were satisfied with the physical support (n = 379, 97.63%), emotional support (n = 384, 96.88%), doula care (n = 410, 96.34%), and support for family/friends (n = 346, 95.38%). All of the labor and delivery nurses who responded (n = 24, 100%) agreed or strongly agreed that doulas were important members of the maternity care team. ConclusionIn this evaluation, we highlight rapid program growth, expansion of services, and demographic characteristics of volunteer doulas; patient satisfaction with doula care; and acceptance of volunteer doulas among nursing staff. The data provided herein can be used to inform future development and guide the implementation of similar volunteer doula programs at other institutions.

Core and floor restore

We describe the experience of study circles on the theme ‘good obstetrics practices backed by scientific evidence’ and argue that they prepared midwifery students to dialogue with hospital staff and empowered them in the process of negotiating the implementation of practices put forward by the International Confederation of Midwives (ICM). We conclude that study circles are an efficient strategy of preparing midwifery students to be active participants in the maternity care team and lead discussions of evidenced-based practice.

Organisational interventions to reduce caesarean section: A systematic review and meta-analyses

We describe the experience of study circles on the theme ‘good obstetrics practices backed by scientific evidence’ and argue that they prepared midwifery students to dialogue with hospital staff and empowered them in the process of negotiating the implementation of practices put forward by the International Confederation of Midwives (ICM). We conclude that study circles are an efficient strategy of preparing midwifery students to be active participants in the maternity care team and lead discussions of evidenced-based practice.

Doulas and Nurses Partner to Support Skin-to-Skin Care in the Operating Room

To implement an innovative, collaborative approach to support the increased initiation of skin-to-skin care (SSC) after cesarean birth in an academic health center. Volunteer doulas in a well-established, hospital-based program were trained to partner with nursing staff to provide care during scheduled cesarean births in the operating and recovery rooms. Data collected included rate and time of SSC and client and nurse satisfaction with doula care. Sixty-six women received doula-supported care in the operating room over a 12-week period. All medically stable couplets with complete data (n = 58) initiated SSC in the operating room. Forty-eight women completed feedback surveys. Scores indicated that women agreed or strongly agreed that the doula was an important part of the birth experience. Nursing staff who participated in doula care in the operating room (n = 20) completed a survey and indicated a high level of satisfaction with their experience. This program demonstrates that doulas can successfully partner with nursing staff to provide supportive care to patients during and immediately after cesarean birth. Doulas can be perceived as important members of the maternity care team by patients and nurses.