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

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.

Options for improving low birthweight and prematurity birth outcomes of indigenous and culturally and linguistically diverse infants: a systematic review of the literature using the social-ecological model

“…The aim of this systematic review was to identify options for improving the low birthweight, and prematurity birth outcomes of Indigenous and CALD infants using the social-ecological model to classify intervention types. Overall, the results identified a limited number of interventions that targeted reducing preterm birth and low birthweight in infants of Indigenous and CALD women, though over half (seven of nine) produced statistically significant improvements in these outcomes [ 15 , 16 , 25 – 29 ]. The greatest improvements in outcomes were seen in interventions that targeted the organisational level of the social-ecological model.…”

“…The interventions that were identified in this review that did provide evidence for improving outcomes took the form of an Aboriginal Maternity Group Practice Program (including Aboriginal grandmothers, Aboriginal Health officers and midwives) (Bertilone, 2015), the use of bilingual doulas [ 25 ], a multidisciplinary service alongside culturally appropriate midwifery care for Aboriginal and Torres Strait Islander mothers and infants [ 29 ], a home visiting program [ 26 ], an Aboriginal Community Controlled Health Organisation “Birthing in Our Community”, which also involved continuity of midwifery carer [ 23 ], a mobile medical van (MOMmobile) that provides on-site care before, during and after pregnancy to CALD women in Miami-Date Country in the United States [ 24 ], and expansion of universal healthcare policies [ 27 ].…”

Midwives’ communication with non-Swedish-speaking women giving birth: A survey from a multicultural setting in Sweden

“…Another idea proposed by the midwives to facilitate communication during labor, was to cooperate with community-based bilingual doulas (CBDs) who accompany and support women in labor. Support in labor, both physical and emotional, from a doula has been associated with positive experiences of care and for migrant women, improved communication and information-sharing [30][31][32] . Interviews with women and doulas have also revealed that doulas can have a positive impact on maternal emotional wellbeing, by reducing anxiety, sadness and stress, and increasing self-esteem and self-efficacy 33 .…”

Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study

“…Previous studies have shown that language barriers are associated with a higher risk of caesarean section [ 29 , 30 ]. We did not have information on language proficiency.…”