title: Evaluation of a student-nurse doula program: an analysis of doula interventions and their impact on labor analgesia and cesarean birth.
abstract: BACKGROUND
  The aim of this study was to describe specific doula interventions, explore differences in doula interventions by attending provider (certified nurse-midwife vs obstetrician), and examine associations between doula interventions, labor analgesia, and cesarean birth in women receiving doula care from student nurses.
  
  
  METHODS
  A secondary analysis of data from the Birth Companions Program at the Johns Hopkins University School of Nursing was conducted using t tests, chi-square statistics, and logistic regression models.
  
  
  RESULTS
  In the 648 births in the sample, doulas used approximately 1 more intervention per labor with certified nurse-midwife clients compared to obstetrician clients. In multivariate analysis, the increase in the total number of interventions provided by doulas was associated with decreased odds of epidural (adjusted odds ratio [AOR] 0.92; 95% confidence interval [CI], 0.86-0.98) and cesarean birth (AOR 0.90; 95% CI, 0.85-0.95). When examined separately, a greater number of physical interventions was associated with decreased odds of epidural (AOR 0.85; 95% CI, 0.78-0.92) and cesarean birth (AOR 0.80; 95% CI, 0.73-0.88), but number of emotional/informational interventions was not.
  
  
  CONCLUSIONS
  Student nurses trained as doulas have the opportunity to provide a variety of interventions for laboring clients. An increase in the number of interventions, especially physical interventions, provided by doulas may decrease the likelihood of epidural use and cesarean birth.
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland, USA. mpaterno@juno.com
authors.forename: Mary T
authors.initials: MT
authors.lastname: Paterno
authors.forename: Shirley E
authors.initials: SE
authors.lastname: Van Zandt
authors.forename: Jeanne
authors.initials: J
authors.lastname: Murphy
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Jordan
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002983:Clinical Competence; D059037:Doulas; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008880:Midwifery / Q000592:standards*; D009774:Obstetrics / Q000592:standards*; D016017:Odds Ratio; D011247:Pregnancy; D012579:Schools, Nursing; D013338:Students, Nursing; D055815:Young Adult