APPLES service-learning class and volunteer doulas partner on better births

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An APPLES service-learning class at Carolina partners with volunteer doulas at N.C. Women’s Hospital to enhance students’ educational experiences and better serve women delivering babies at UNC.

From UNC Department of Obstetrics & Gynecology

Joya Bland’s dream is to deliver babies.

A recent Carolina graduate, she’s getting a master’s degree in physiology at North Carolina State University and preparing to apply to medical school. After that, she’ll seek a residency in obstetrics and gynecology.

And though there are years between Bland and those babies, she’s no stranger to what a birthing mother needs. As a volunteer doula at UNC Hospitals, Bland has supported women through 12 hours of nonstop labor, held their hands through contractions and explained increasingly intense stages of labor with words of comfort and encouragement.

Learning how to dial into the patient side of childbirth before becoming a physician was Bland’s mission when, as a women’s and gender studies major at UNC in 2014, she signed up for an innovative APPLES service-learning class at the UNC School of Nursing that matches volunteer doulas at UNC Hospitals with Carolina students to offer a unique experience in patient-centered care.

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Having the opportunity to attend births as part of her undergraduate curriculum is something Bland describes as “life-enhancing.”

For the first birth Bland attended as a student, she stepped in for the last 12 hours of a labor already 36 hours long. By the time Bland entered the room, the mother was tired and weary, exhausted and worried. The family needed support, too.

“While the doctor and nurse treated her, I was there to remind her that she was doing fine, to help her change position in bed, breathe with her, help her get comfortable and encourage her to rest so she would have strength to push,” said Bland. “I didn’t leave her side. I kept reminding her that soon she’d be holding her baby, and I helped her keep going.”

A unique model of education and care

Birth doulas aren’t clinicians – they are professionally trained birth companions who can offer physical and emotional support to the woman laboring and her family. Their presence can help women cope with pain, provide non-medical assistance to the mother and her family and take some of the burden off nurses who are providing treatment and might not have time to stop and soothe.

Doulas provide educational and emotional support during labor and birth, helping mothers navigate their way through the unique experience of childbirth. They offer suggestions to help labor progress – walking, the use of a birthing ball, relaxing in the tub. If the patient has had an epidural, a doula can help her change position to help the baby move down the birth canal.

And, at N.C. Women’s Hospital, laboring women can benefit from the support and care of a doula free of charge, courtesy of the Birth Partners volunteer doula program. More and more women are choosing to request their support.

“Not a lot of hospitals have this. It’s pretty unique to have doulas in a public hospital environment,” said Rhonda Lanning, a certified nurse midwife and faculty member at the School of Nursing who runs Birth Partners, the growing volunteer doula program, and teaches “Supporting the Childbearing Family,” the APPLES service-learning course that brings together the doulas and students for an immersive hands-on educational experience. “This fall we tripled the number of families served in the Birth Partners program and this is largely due to our service-learning course.”

The class, made possible with a grant from the Carolina Center for Public Service, is offered once a year, and Lanning accepts between 12 and 16 students from a pool of nearly 60 applications. She builds the class with a diversity of academic disciplines, backgrounds, interests and experiences and spends the first few weeks of class on childbirth and breastfeeding education as well as formal doula training. When they’re ready, students are paired with one of the volunteer doulas and work under that mentor to begin attending births. As part of the APPLES requirements, the students must put in 30 hours of service as a volunteer.

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Brooklynne Travis is a senior in the School of Nursing who plans on pursuing training in a dual doctor of nursing practice and certified nurse midwife program following graduation in May 2016. She said Lanning’s class this past fall helped her focus her career goals by allowing her to explore how she felt about childbirth.

“This class was a great way for me to engage more specifically in women’s health in addition to the other maternity classes I took in nursing school,” said Travis. “It was a very good hands-on experience and helped me formulate concretely what I felt about birth and learn about birth from an evidence-based perspective.”

Travis has three children of her own and said that she’d not had positive birth experiences. By being a doula, she got a chance to see women’s bodies at work, something she said was healing for her and helped solidified her passion to become a midwife.

“Midwifery supports women’s bodies to do what they are designed to do, and being empowered to let your body do what it is designed to do is what I believe about birth. I was able to see that we can support and help advance that birth process as a doula in the hospital where, if there is a problem, modern medicine can very quickly come to the rescue.”

During one birth she attended as part of the class, Travis noticed fear in the husband’s eyes after his wife’s water had broken. She was able to calm him, telling him that the water breaking was a good sign – his wife’s body was progressing the way it should, and though it was intense, he didn’t need to be scared.

“Through this class, I’ve been able to see birth as something that is very hard, but can be very beautiful. I’d never experienced a peaceful birth until I was a doula,” said Travis. “Being a doula has given me back a lot of perspective, and now I know midwifery is what I’m called to do.”

Benefits based in evidence

People have undervalued the measures doulas provide, said Lanning, even though research shows that the use of a doula has clear benefits for families during childbirth and after, with no known risks.

A 2013 review published in The Cochrane Library revealed that women who have support from a companion who is neither a member of the hospital staff nor a friend or family member are less likely to have a cesarean section, use synthetic oxytocin to speed labor, use pain medication or report a negative childbirth experience than women who labor alone.

Birth Partners makes it part of their mission to reach out to vulnerable populations: women who are laboring alone, women with a long hospital stay prior to birth, women experiencing a loss or the incarcerated.

“Incarcerated women are giving birth alone, and they deserve that care,” said Lanning. Lanning has a letter from the Department of Corrections that affirms Birth Partners’ goal to offer that support to incarcerated women.

Lanning said there are always pros and cons with bringing students into a volunteer program, because they come and they go. But, “they come with such enthusiasm, passion, energy and optimism,” she said.

“This is an opportunity for future health care providers to think about the patient care environment and work with patients and families to provide comfort and support and education, which often takes a back seat to diagnosing, treating and medicating. Here, they really get the value of patient-centered care, and we hope they take that back to their medical or nursing school experiences.”