On Dec. 8, 1999, Emily Seay's pager went off at 8 a.m. Was this showtime, she wondered, or another false alarm? Seay, a student in the accelerated degree program at the School of Nursing, had been paged the previous day--1 a.m. actually-- by M., her pregnant "client." That prior morning, M.'s contractions had sped up, and she had to be rushed to Bayview Hospital. However, by the time Seay arrived an hour later, M.'s contractions had stopped. She was later released at 7 a.m., but Seay stood by her side the entire span. Seay is M.'s birth companion, a role that requires her to rush to her client's side when she goes into labor and then stay with her until she either gives birth or is sent home.Giving birth is perhaps the most trying and emotional event a woman will go through in her lifetime. At no other time is there such a compelling need for someone to utter the words, "It's going to be OK. I'm on your side."
Observing this need, the School of Nursing in 1997 established its Birth Companion Program, a free service that matches nursing students with expectant mothers in their third trimester. The program, based on the doula method, focuses on "vulnerable populations" including teens, poor and single women, and women with special language, cultural or educational needs.
The word doula comes from the ancient Greek word for the most important female slave in the household, a woman who probably helped the lady of the house through her childbearing. The doula's role is to provide physical, emotional and informational support to women and their partners during labor and birth.
Likewise, the nursing student's role as a birth companion is not to offer medical advice but rather to provide continuous emotional reassurance and comfort. The service includes a prenatal visit, attendance at the birth and a postpartal home visit. Expectant mothers, referred to as clients, are given a beeper so they can keep in touch with their birth companions during their pregnancy.
The program was so successful that nursing students appealed for it to become an elective course, and last year the Birth Companion Program was formalized as part of a two-credit course titled Community Perspectives in the Childbearing Process. This course, offered in the spring and fall, combines the theoretical and experiential components of the Doulas of North America certification requirements with selected maternal, child and community health nursing theories and practices.
The course requires the students to attend at least one birth, although many students attend more since three are required for doula certification.
Elizabeth Jordan, director of the Birth Companion Program and an instructor in the school's Professional Education Programs and Practice, says the course has been "tremendously successful." Jordan says that nurses today find themselves further from the bedside because of staffing and technology, and as birth companions they have an opportunity to provide care on a continuous basis. The course has typically drawn between 20 and 25 students each semester, Jordan says, and currently 48 are serving as birth companions.
"That tells me that the School of Nursing is attracting many students with an interest in women's health and a holistic approach to health care," Jordan says. "I think the students really like it because it is different for them in terms of their nursing education. As a nursing student, one might find it difficult to come across another course where she can provide such personal care."
Before being assigned clients, the students must receive 20 hours of didactic classroom training where they role play, practice their interviewing skills and get further review of the physiology of pregnancy and birth. A prerequisite is that each student must have gone through the clinical maternal newborn nursing course, which entails seven weeks spent in labor delivery and newborn nursing areas of a hospital.
The clients are women from throughout the Baltimore area. The Birth Companion Program currently has a relationship with 14 local community organizations including the Baltimore County Health Department, Planned Parenthood, Healthy Start and the Center for Addicted Pregnancy. Students in the program monitor a dedicated phone line that people can call to request a birth companion.
The 90-minute prenatal visit consists of the student and client meeting at a neutral site where they can discuss the birth companion contract and get to know one another.
"This is when they get to know their clients and their fears and hopes about their pregnancy," Jordan says. "The student also gets an idea of how the client wants her birth to go, and our role is to educate them on their options."
Jordan says it's during the prenatal visit that the clients also are told of the limitations of their birth companions. Clients may share their health problems or concerns with the students, but it is their own responsibility to contact their health care provider.
The students emphasize the importance of prenatal care and help their clients identify community resources. Shirley Van Zandt, an instructor who assists Jordan with the program, helps the students navigate these appropriate resources.
Birth companions are not allowed to make home visits unless cleared through Jordan. "I am on call, and I tell all our students to contact me whenever they are paged to meet with their clients or attend a birth," Jordan says.
To that end, each birth companion is also assigned a partner who serves as a backup in case the primary birth companion has a scheduling conflict or is otherwise unavailable to attend the birth. "Somebody ultimately needs to be responsible to the client," Jordan says.
Partners often attend the birth and provide additional support to the mother. In the delivery room the birth companion's role is to provide direct service to the mother, which typically entails offering advice on comfort measures such as breathing, relaxation, movement and positioning. However, the service could include something as simple as pressing "play" on a CD player and singing along with the music.
"When it works at its best is when both the birth companion and the backup partner are providing the service to the mom, "Jordan says. "One might be rubbing the back and the other will be talking to Dad to make him more comfortable."
"That is, unless Dad is passed out on the floor," jokes Seay, who has another client expecting in a few days.