Estonian midwives’ opinion about birth doulas
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Department of Midwifery, Tallinn Health Care College, Tallinn, Estonia
Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
Publication date: 2023-10-24
Corresponding author
Katrin Klein   

Department of Midwifery, Tallinn Health Care College, Tallinn, Estonia
Eur J Midwifery 2023;7(Supplement 1):A67
We have evidence that all women should have continuous one- to one support throughout labour and birth as it is associated with a reduction in caesareans, instrumental births, epidurals1. Women who have continuous support from midwife, doula or lay support person are more likely to report positive experience of labour and birth2. Many healthcare facilities still do not permit women to have a companion during labour and childbirth, despite clear evidence and the emphasis on respectful care. Many countries do not yet have policies in favour of labour companionship3. To promote collaboration between midwives and birth supporters, the role of doula must be clarified4. Midwives and trained birth companions are not always positive about cooperation with each other. Problems arise between them due to often perceived overlapping roles5. There are misunderstandings and fears that the doulas would take over the role of midwife6. In Estonia, midwives are independent professional health care workers. Midwives are educated in BSc level, study time 4,5 year. The Curriculum of Midwife meets the requirements established by the European Parliament and Council Directives 2005/36/EC, ICM Essential Competencies for Midwifery Practice`s (2019). Midwives can provide full- scope of midwifery care7. In Estonia women can hire a professional doula to support her from pregnancy to new motherhood. Doulas training is not regulated by professional requirements and training program has been inconsistent through the years. Doulas competencies are not recognized by national policies.

To investigate the roles and expectations of doulas by Estonian midwives.

Material and Methods:
Qualitative research method. Semi-structured individual in-depth interviews were carried out among Estonian midwives in August and September of 2022. Sample inclusion criteria was previous work experience as midwife at least 5 years and work-related contact with doulas. Questions were prepared and divided into six subcategories, in each 5 questions. Data were transcribed into written script and analysed thematically.

Birth doula service is not widespread in Estonia. In general midwives have positive attitude towards doulas. Doulas training and education is not officially regulated and thus raises issues among midwives who work in a hospital. Some hospitals prohibit doulas to attend hospital births and doulas pretend to be lay support person or relative for the mother-to-be. Midwives have experienced some antagonistic behaviour towards them as doula took over the labour care. Midwives who provide home birth service have established collaboration with doulas and roles are clear. Collaboration must be improved to provide quality and continuous support during childbirth and postnatal period.

In Estonia, roles, and expectations of doulas in hospital setting are not clear. Midwives’ role and competencies are well regulated. Problems raise due to lack of policies that regulates the competencies and role of doula in labour care in hospital settings. The authors acknowledge that need for policies and clear regulation of doulas competencies must be clarified. Evidence is needed to understand the barriers that birth doulas face to provide service for women.

The authors declare that they have no competing interests.
The study is financed by Tallinn Health Care College, applied research fund.
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