title: After praise and encouragement: emotional support strategies used by birth doulas in the USA and Canada.
abstract: OBJECTIVE
  to describe in detail the emotional support techniques employed by birth doulas during labour.
  
  
  METHODS
  grounded theory methodology was utilised in collecting and analysing interviews given by doulas and mothers who had doula care. By using both informants, a clearer picture of what constitutes emotional support by doulas emerged.
  
  
  METHODS
  10 mothers from three different states in the Midwestern USA and 30 doulas from 10 different states and two Canadian provinces were interviewed. Two doulas worked in hospital-based programmes whereas the others had independent practices. Doulas usually attended births in hospitals where medical attendants spent little focused time with the mother.
  
  
  RESULTS
  nine different strategies were distinguished. Four strategies (reassurance, encouragement, praise, explaining) were similar to those attributed to nurses in published research. Five were original and described as only being used by doulas (mirroring, acceptance, reinforcing, reframing, debriefing).
  
  
  CONCLUSIONS
  emotional support by professional birth doulas is more complex and sophisticated than previously surmised. Mothers experienced these strategies as extremely meaningful and significant with their ability to cope and influencing the course of their labour.
  
  
  CONCLUSIONS
  the doula's role in providing emotional support is distinct from the obstetric nurse and midwife. Professional doulas utilise intricate and complex emotional support skills when providing continuous support for women in labour. Application of these skills may provide an explanation for the positive 'doula effect' on obstetric and neonatal outcomes in certain settings.
authors.affiliation: Department of Human Development and Family Studies, University of Wisconsin-Madison, 1526 Vilas Avenue, Madison, WI 53711-2228, USA. amylgilliland@charter.net
authors.forename: Amy L
authors.initials: AL
authors.lastname: Gilliland
mesh_terms: D000328:Adult; D002170:Canada; D003142:Communication; D036861:Delivery, Obstetric / Q000451:nursing*; D059037:Doulas; D004645:Empathy; D005260:Female; D006379:Helping Behavior; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D017060:Patient Satisfaction; D011247:Pregnancy; D012944:Social Support; D014481:United States; D055815:Young Adult