Doula is a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth. Doulas can advise laboring women on comfort measures such as breathing, relaxation, massage, movement, and positioning. They do not offer medical diagnoses or advice but may facilitate positive communication between provider and client, helping both partners and providers address the woman's emotional needs, questions and fears. Doulas respect patient self-determination and do not impose personal values on patients. They follow a code of ethics and are committed to patient confidentiality. Doulas are trained to offer support during C sections as well as vaginal births.
The doulas at the San Francisco General Hospital and Trauma Center (SFGH) work on a voluntary, no-cost basis, and many speak Spanish. Their shifts are 12 hours long and they may provide continuous coverage if requested in advance. All of the doulas at SFGH have attended a doula workshop or training class series and some are working towards certification by professional doula organizations. They have all completed orientations, are regularly supervised, and attend monthly doula meetings. All doulas receive health clearance, fingerprinting and ID badges through the SFGH volunteer department.
The SFGH Volunteer Doula Program enhances education and support services for pregnant women that reduce disparities in birth outcomes. There are approximately 1,200 births per year at SFGH. Women who give birth are medically underserved and high risk, 62% Latina, 14% Black, and 3% adolescent. They face a multitude of challenges including poverty, HIV infection, domestic violence, mental illness, homelessness, incarceration, and substance abuse. Doula services are offered by private providers at the cost of $900-$1,200 making them largely inaccessible to pregnant women who already face a multitude of issues related to day-to-day survival.
Several studies have shown that use of doulas result in shorter labors, less use of pain medications, fewer medical interventions and a reduction of cesarean sections. In 2007-2008, the cesarean section rate at SFGH was 20%; Cesarean operations during this same period for women utilizing doula services was 13%. Doula care also impacts the future health and well-being of mother and child by improving breastfeeding rates and enhancing long-term parenting competency and bonding. The implications of these outcomes for the population served at SFGH are profound.