Group 3: Exploring the impact of continuity of doula support for women with significant Fear of Birth

Topic: Fear of Birth.This is an innovative research project in which NHS-funded doulas (non-medical pregnancy and birth supporters) provide continuity of support to women with significant Fear of Birth (FoB). The aim is to... [ view full abstract ]

Topic: Fear of Birth.

This is an innovative research project in which NHS-funded doulas (non-medical pregnancy and birth supporters) provide continuity of support to women with significant Fear of Birth (FoB). The aim is to ameliorate morbidity associated with FoB through provision of holistic support, to positively impact the woman’s experience of pregnancy and birth.

Area for research

In High Income settings, around 1% of women suffer incapacitating FoB (Nilsson et al 2009). FoB is associated with prolonged labour, increased pain, and dissatisfaction with birth (Haines 2012, Adams 2012). An audit by Consultant Midwives within the Thames Valley in 2015 suggested that FoB was the primary reason for Maternal Request Caesarean Section. Beyond mode of birth, the long-term impact of untreated maternal antenatal anxiety for women with FoB is costly, particularly in terms of potentially detrimental psychological and neurodevelopmental effects on the woman’s offspring into adulthood (Poggi-Davis 2012). Perinatal illness affects 1/5th of childbearing women. 25% of maternal deaths in 2012-2014 were related to mental illness (MBRRACE 2015).

Discussion of Innovation

Midwifery continuity of carer has a positive impact on birth outcomes (Hodnett et al 2013, Sandall et al 2016), with particular benefits for women with FoB (Lyberg and Severinsson 2010). However, some women with FoB can struggle to build trusting relationships with their midwives (Hunter 2006), because the midwife may be viewed inextricably from the events the woman fears (Salomonsson et al 2010). Therefore, for women with FoB who are often fearful of loss of dignity, control and self-efficacy in birth, this fear may be actualized in this loss of trust and relational ‘reciprocity’ (Ortmann et al 2000). I theorize that (as Hodnett 2013 demonstrates), the non-professional nature of the doula confers merits above and beyond what can be offered by a midwife offering continuity of care for a woman with FoB.

Conclusion

The unique emotional and social nature of the non-professional support in the doula-woman relationship may be key to protecting the reciprocity of the supportive relationship in a way that may be positive, and even reconstructive, for women with FoB.

Preference: oral presentation. Study concepts, methods and initial findings will be explored.