2019 Research Forum

Mae Casabar RN, Vanessa Delgado RN, Jeanette Jaime RN Labor and Delivery Nurse Residency Evidence Based Practice Project The Implementation of Labor Coaches in Labor and Delivery

Introduction

On September 1, 2018, a day-long labor coach class was taught by the Perinatal Educator to four labor coach champions and five labor coach volunteers. The labor coach class was developed from the same curriculum as UC San Diego’s Hearts & Hands Program. The labor coach champions consisted of nurse residents while the labor coach volunteers consisted of current labor & delivery employees as well as a current Auxiliary volunteer. Course participants were given the Gift of Motherhood book, which is a book that is given to postpartum patients that includes information from pregnancy, labor, delivery, and postpartum, as a reference source. The Perinatal Educator also created a Labor Coach Handbook that included the labor coach’s roles, labor positions, peanut ball positions, and ways to assist with difficult labor. After the class, labor coach volunteers were asked to provide dates that they were available to precept with a labor coach. Materials and Methods

Recommendations 1. Assign/hire staff member who is solely responsible for facilitating the labor coach program. This person would be responsible for overseeing the recruiting, training, and scheduling of volunteer labor coaches. 2. Develop and implement a policy that outlines the roles for volunteer labor coaches 3. Include staff in the education of the potential benefits that labor coaches provide. In our experience during this project, we experienced that the staff were not as receptive to the implementation of the labor coach program. 4. Clarification of roles – the labor coach champion was still expected to perform their duties as a registered nurse as well as precept a labor coach champion which we felt hindered the development of the program. Our recommendation would be that if a labor coach champion is precepting a volunteer, the champion should only act as a labor coach, without adding the responsibilities of a registered nurse. 5. Recruit additional labor coach champions. Training more labor coach champions can open up availability for labor coach volunteers to train with. References University California of San Diego . (2019). Doula services . Retrieved from https://health.ucsd.edu/specialties/obgyn/maternity/facilities/doula/Pages/ default.aspx University of San Diego Health System. (2018). Hearts and hands. Retrieved from http://sandiegodoulas.org Wolfe, K. (2015). Birthing doulas and and stratification in the united states maternity care. Retrieved from https://digitalcommons.bowdoin.edu/cgi/viewcontent.cgi?article=1041&con text=honorsprojects Gurber, K. J. PhD, Cupito, S. H. MA, and Dobson, C. F. Med, (2013) Impact of Doulas on Healthy Birth Outcomes. The Journal of Perinatal Education. 22(1): 49–58 “Having a Doula: Their Benefits and Purposes.” American Pregnancy Association, 22 July 2017, July, americanpregnancy.org/labor-and- birth/having-a-doula/ . Dekker, R. PhD, RN, APRN. “Evidence on: Doulas.” Evidence Based Birth®, 30 Mar. 2018, evidencebasedbirth.com/the-evidence-for-doulas/. Digitale, Erin. April 28, 2016. Avoiding first time cesareans: Stanford- based center releases new guidelines. https://scopeblog.standford.edu/2016/04/28/new-recommendations-out- today-for-avoiding-first-time-cesareans/

• Assessment of cesarean rates, Normal Spontaneous Vaginal Delivery (NSVD) rates and epidural usage Our goal with this project is to attempt to decrease cesarean rates, decrease the use of labor epidural and increase normal spontaneous vaginal deliveries by implementing the continuous support of labor coaches • The importance of continuous labor support Continuous labor support has been shown to decrease cesarean rates, epidural usage and increase NSVD. Many patients either do not have an emotional support at bedside or often times the support partner is going through a life changing event as well and is at a loss for what to say or do that would benefit the patient and her labor. • The purpose of our project The purpose of our project is to implement a labor coach volunteer program in our facility while simultaneously educating our coworkers and staff on the multifaceted role that a labor coach plays such as : positional changes, implementing peanut balls, guided imagery, massage therapy and pressure points, as well as that the implementation of continuous labor support can “empower women to achieve the best birth outcome possible, and all outcomes-for births, infants, and mothers- seem to be affected more positively if support is provided by a labor coach in addition to a medical personal.” Research also states that there is a lower percentage of cesarean rates, epidural usage rates and an increase of NSVD as we will demonstrate further with graphs. • Model Volunteer Doula Program – Hearts & Hands Program UC San Diego Health has a successful volunteer doula program called Hearts & Hands Program that has been in effect for the past 17 years. Any woman delivering at UC San Diego Health can request an on-call volunteer doula to remain with them until the birth of their baby and it is a free service provided. beneficial breathing techniques. • What does research tell us? Research suggests • To remain below the national average of overall cesarean section rate of 32.2% • To remain below the national average rate NTSV cesarean section rate of 23.9% • To improve the health outcome for both mother and baby; “women who have cesareans are more likely to experience complications such as hemorrhage and are also at greater risk for problems in subsequent pregnancies including uterine rupture and placenta accreta.” • Decrease the use of labor epidurals from 42.9% to 40% • Educate staff and coworkers on the role of labor coaches to reduce the negative stigma surrounding labor coaches • Implement a volunteer-based labor coach program at Kern Medical Objectives

Acknowledgments

Of the five volunteers that attended the class, only two volunteers continued on to precept with a labor coach champion. The two labor coach champions completed a few hours of preceptorship with a labor coach champion. Due to scheduling conflicts, the labor coach volunteer presence was insufficient. We are therefore unable to provide data of reduced cesarean section rates or epidural rates. We were, however, able to start the process of the implementation of a volunteer labor coach program, identified labor coach champions, and able to recruit labor coach volunteers. Results

Monette Hoburn BSN RNC, c-EFM| Perinatal Clinical Educator and NRP L&D Facilitator Vivian Cervantes RNC-OB| Maternal Child Quality Coordinator Marinda DuToit RNC | Clinical Director - Maternal Child Services Kyisha Clay-Roby BSN, RNC-MNN| Clinical Supervisor Perinatal Services

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