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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Nitrous Oxide | Research article

Community-based bilingual doulas for migrant women in labour and birth – findings from a Swedish register-based cohort study

Authors: Ulrika Byrskog, Rhonda Small, Erica Schytt

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

Community-based bilingual doula (CBD) services have been established to respond to migrant women’s needs and reduce barriers to high quality maternity care. The aim of this study was to compare birth outcomes for migrant women who received CBD support in labour with birth outcomes for (1) migrant women who experienced usual care without CBD support, and (2) Swedish-born women giving birth during the same time period and at the same hospitals.

Methods

Register study based on data retrieved from a local CBD register in Gothenburg, the Swedish Medical Birth Register and Statistics Sweden. Birth outcomes for migrant women with CBD support were compared with those of migrant women without CBD support and with Swedish-born women. Associations were investigated using multivariable logistic regression, reported as odds ratios (aORs) with 95% confidence intervals (CI), adjusted for birth year, maternal age, marital status, hypertension, diabetes, BMI, disposable income and education.

Results

Migrant women with CBD support (n = 880) were more likely to have risk factors for adverse pregnancy outcomes than migrant women not receiving CBD support (n = 16,789) and the Swedish-born women (n = 129,706). In migrant women, CBD support was associated with less use of pain relief in nulliparous women (epidural aOR 0.64, CI 0.50–0.81; bath aOR 0.64, CI 0.42–0.98), and in parous women with increased odds of induction of labour (aOR 1.38, CI 1.08–1.76) and longer hospital stay after birth (aOR 1.19, CI 1.03–1.37). CBD support was not associated with non-instrumental births, perineal injury or low Apgar score. Compared with Swedish-born women, migrant women with CBD used less pain relief (nulliparous women: epidural aOR 0.50, CI 0.39–0.64; nitrous oxide aOR 0.71, CI 0.54–0.92; bath aOR 0.55, CI 0.36–0.85; parous women: nitrous oxide aOR 0.68, CI 0.54–0.84) and nulliparous women with CBD support had increased odds of emergency caesarean section (aOR 1.43, CI 1.05–1.94) and longer hospital stay after birth (aOR 1.31, CI 1.04–1.64).

Conclusions

CBD support appears to have potential to reduce analgesia use in migrant women with vulnerability to adverse outcomes. Further studies of effects of CBD support on mode of birth and other obstetric outcomes and women’s experiences and well-being are needed.
Literature
1.
Small R, Roth C, Raval M, Shafiei T, Korfker D, Heaman M, et al. Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries. BMC Pregnancy Childbirth. 2014;14:152.CrossRef
2.
Schytt E, Wahlberg A, Eltayb A, Small R, Tsekhmestruk N, Lindgren H. Community-based doula support for migrant women during labour and birth: study protocol for a randomised controlled trial in Stockholm, Sweden (NCT03461640). BMJ open. 2020;10(2):e031290.CrossRef
3.
Gagnon AJ, Zimbeck M, Zeitlin J, Collaboration R, Alexander S, Blondel B, et al. Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med. 2009;69(6):934–46.CrossRef
4.
Urquia ML, Glazier RH, Blondel B, Zeitlin J, Gissler M, Macfarlane A, et al. International migration and adverse birth outcomes: role of ethnicity, region of origin and destination. J Epidemiol Community Health. 2010;64(3):243–51.CrossRef
5.
Juarez SP, Small R, Hjern A, Schytt E. Caesarean Birth is Associated with Both Maternal and Paternal Origin in Immigrants in Sweden: a Population-Based Study. Paediatr Perinat Epidemiol. 2017;31(6):509–21.CrossRef
6.
Vik ES, Nilsen RM, Aasheim V, Small R, Moster D, Schytt E. Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: a population-based study. BMC Health Serv Res. 2020;20(1):540.CrossRef
7.
Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7:Cd003766.PubMed
8.
Dundek LH. Establishment of a Somali doula program at a large metropolitan hospital. J Perinat Neonatal Nurs. 2006;20(2):128–37.CrossRef
9.
Mottl-Santiago J, Walker C, Ewan J, Vragovic O, Winder S, Stubblefield P. A hospital-based doula program and childbirth outcomes in an urban, multicultural setting. Matern Child Health J. 2008;12(3):372–7.CrossRef
10.
McLeish J, Redshaw M. “Being the best person that they can be and the best mum”: a qualitative study of community volunteer doula support for disadvantaged mothers before and after birth in England. BMC Pregnancy Childbirth. 2019;19(1):21.
11.
Wint K, Elias TI, Mendez G, Mendez DD, Gary-Webb TL. Experiences of Community Doulas Working with Low-Income, African American Mothers. Health equity. 2019;3(1):109–16.CrossRef
12.
Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien M. Doula care, birth outcomes, and costs among Medicaid beneficiaries. American journal of public health. 2013;103(4):e113-21.CrossRef
13.
Steel A, Frawley J, Adams J, Diezel H. Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review. Health Soc Care Commun. 2015;23(3):225–41.CrossRef
14.
McGrath SK, Kennell JH. A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates. Birth. 2008;35(2):92–7.CrossRef
15.
Lanning RK, Oermann MH, Waldrop J, Brown LG, Thompson JA. Doulas in the Operating Room: An Innovative Approach to Supporting Skin-to-Skin Care During Cesarean Birth. J Midwifery Women Health. 2019;64(1):112–7.
16.
Kozhimannil KB, Attanasio LB, Jou J, Joarnt LK, Johnson PJ, Gjerdingen DK. Potential benefits of increased access to doula support during childbirth. Am J Manag Care. 2014;20(8):e340-52.PubMed
17.
Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7(7):Cd003766.PubMed
18.
Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. Journal of obstetric, gynecologic, and neonatal nursing. JOGNN. 2006;35(4):456–64.CrossRef
19.
Akhavan S, Edge D. Foreign-born women’s experiences of Community-Based Doulas in Sweden - a qualitative study. Health Care Women Int. 2012;33(9):833–48.CrossRef
20.
Akhavan S, Lundgren I. Midwives’ experiences of doula support for immigrant women in Sweden - a qualitative study. Midwifery. 2012;28(1):80–5.CrossRef
21.
The Swedish Society of Obstetrics and Gynecology (SFOG). and The Swedish Association of Midwives. Modrahalsovard, Sexuell och Reproduktiv Halsa. ARG report 76. Stockholm; 2016.
22.
23.
Swedish National Board of Health and Welfare (Socialstyrelsen). Graviditeter, förlossningar och nyfödda barn. Medicinska födelseregistret 1973–2011. Assisterad befruktning 1991–2010. Stockholm: Socialstyr.; 2013. 48 p.
24.
25.
Swedish National. Board of Health and Welfare (Socialstyrelsen). Medicinska Födelseregistret 2019.
26.
Statistics Sweden. (Statistiska Centralbyrån) 2018.
27.
Källén B, Källén K, Lund U, Tornbladinstitutet, Tornblad I. The Swedish Medical Birth Register - a summary of content and quality 2003. Lunds University, Sweden.
28.
Cnattingius S, Ericson A, Gunnarskog J, Kallen B. A quality study of a medical birth registry. Scand J Soc Med. 1990;18(2):143–8.CrossRef
29.
Statistics Sweden. Statistiska centralbyråns föreskrifter om utvärdering av den officiella statistikens kvalitet; SCB-FS 2017:8, SCB-FS 2017:8 (2017).
30.
31.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2013;7:Cd003766.PubMed
32.
Ekéus C, Cnattingius S, Hjern A. Epidural analgesia during labor among immigrant women in Sweden. Acta obstetricia et gynecologica Scandinavica. 2010;89(2):243–9.CrossRef
33.
Råssjö EB, Byrskog U, Samir R, Klingberg-Allvin M. Somali women’s use of maternity health services and the outcome of their pregnancies: a descriptive study comparing Somali immigrants with native-born Swedish women. Sexual reproductive healthcare. 2013;4(3):99–106.CrossRef
34.
Aasheim V, Nilsen RM, Skirnisdottir Vik E, Small R, Schytt E. Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration related factors. Sexual Reproductive Healthcare. 2020;26:1005532.CrossRef
35.
Waldum Henning Å, Flem Jacobsen A, Lukasse M, Staff AC, Sørum Falk R, Vangen S. Krarup Sørbye I. The provision of epidural analgesia during labor according to maternal birthplace: a Norwegian register study. BMC Pregnancy and Childbirth. 2020; 20;321.
36.
Kozhimannil KB, Hardeman RR, Alarid-Escudero F, Vogelsang CA, Blauer-Peterson C, Howell EA. Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery. Birth (Berkeley Calif). 2016;43(1):20–7.CrossRef
37.
Goedkoop V. Side by side - a survey of doula care in the UK in 2008. MIDRIS Midwifery Digest. 2009;19:217–9.
38.
Thomas M-P, Ammann G, Brazier E, Noyes P, Maybank A. Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Matern Child Health J. 2017;21(1):59–64.CrossRef
39.
Macfarlane A, Blondel B, Mohangoo A, Cuttini M, Nijhuis J, Novak Z, et al. Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG: An International Journal of Obstetrics Gynaecology. 2016;123(4):559–68.CrossRef
40.
Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990–2014. PLOS ONE. 2016;11(2):e0148343.CrossRef
41.
Bakken KS, Skjeldal OH, Stray-Pedersen B. Immigrants from conflict-zone countries: an observational comparison study of obstetric outcomes in a low-risk maternity ward in Norway. BMC Pregnancy Childbirth. 2015;15:163.CrossRef
42.
Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC Med. 2018;16(1):89.CrossRef
43.
Sentell T, Chang A, Ahn HJ, Miyamura J. Maternal language and adverse birth outcomes in a statewide analysis. Women Health. 2016;56(3):257–80.CrossRef
44.
Socialstyrelsen. Öppna jämförelser jämlik vård 2016. Kvinnors hälso-och sjukvård fördjupningsrapport. 2016.
45.
Small R, Gagnon A, Gissler M, Zeitlin J, Bennis M, Glazier R, et al. Somali women and their pregnancy outcomes postmigration: data from six receiving countries. BJOG: an international journal of obstetrics gynaecology. 2008;115(13):1630–40.CrossRef
46.
Haugaard A, Larsson Tvedte S, Stene Severinsen M, Henriksen L. Norwegian multicultural doulas’ experiences of supporting newly-arrived migrant women during pregnancy and childbirth: A qualitative study. Sexual Reproductive Healthcare. 2020;26:100540.CrossRef
47.
O’Rourke M, Yelland J, Newton M, Shafiei T. An Australian doula program for socially disadvantaged women: Developing realist evaluation theories. Women Birth. 2020;22:e438–46.CrossRef
Metadata
Title
Community-based bilingual doulas for migrant women in labour and birth – findings from a Swedish register-based cohort study
Authors
Ulrika Byrskog
Rhonda Small
Erica Schytt
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Nitrous Oxide
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03412-x

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