1. Hinde, Tori A. RN, BSN
  2. Lanning, Rhonda K. DNP, CNM, LCCE, IBCLC, RN

Article Content

Prelicensure nursing students generally have limited opportunities to provide care to patients and families during labor and birth. For many students, the clinical practicum on a labor and delivery unit is their first exposure to childbirth. Providing opportunities for students to engage in labor and birth support practices before they begin experiences in maternity nursing may increase their level of preparedness and self-confidence. This article explores a strategy to prepare nursing students for their first hospital-based clinical practice in labor and delivery by utilizing birth doulas to teach students labor support through interactive learning strategies.



Continuous labor support is an evidence-based practice1 and is recommended by professional organizations including the American College of Obstetricians and Gynecologists (ACOG) and Association of Women's Health, Obstetric and Neonatal Nurses.2,3 Labor support includes emotional support, physical comfort, advocacy, and offering of information.4 Labor support is associated with improved maternal and neonatal outcomes including increased rate of spontaneous vaginal birth, decreased rate of cesarean birth, higher 5-minute Apgar scores, and fewer negative feelings about childbirth.1 In a 2017 committee opinion, ACOG concluded that continuous emotional support, such as doula care, is associated with improved outcomes for women in labor.2 Additionally, it suggested offering women a variety of nonpharmacological techniques to help them cope with labor pain such as water therapy, relaxation techniques, and massage.2



With the increased acuity of patients, nurses today often have less time to provide the important role of labor support.5 Nursing students are well positioned to provide labor support during clinical practice as they traditionally are paired with 1 patient and are able to stay with the laboring person throughout their shift, whereas RNs often care for multiple patients simultaneously. However, prelicensure nursing students preparing for their first obstetric clinical practicum lack knowledge and confidence in providing labor support.6 Most nursing students have limited exposure to childbirth prior to their first clinical practice.


Birth doulas are trained professionals who provide continuous physical, emotional, and informational support throughout the birthing process.7 As experts in labor support, birth doulas have the knowledge and experience to lead students in small group discussions, demonstrations, and role plays to prepare them to provide support to patients during labor and birth.


Teaching Strategy

Birth doulas from Birth Partners, a hospital-based volunteer doula program,8 worked with groups of 7 to 10 prelicensure nursing students in their second semester of a BSN program. The doulas led students through demonstrations, discussions, and role playing. The doulas used 4 different stations: introductions, engaging the senses, upright and active, and complications. Each station lasted 25 minutes. The small-group design allowed students to ask questions, interact with one another and with the doulas, practice hands-on techniques, and take turns role playing as the birthing person and nursing student.


The introduction station discussed how to initiate conversation with a birthing person and their companion(s) and how to build rapport. The doulas in this station also shared sample birth plans and introduced topics that students might expect to see on a birth plan. Students then practiced introducing themselves and asking about birth preferences and patient wishes. In the engaging the senses station, doulas demonstrated hand massage, shared sample words of affirmation, and discussed creating a calm space and water therapy in labor. Students practiced hand massage on one another. In the upright and active station, doulas discussed the importance of position changes during labor and led students through various positions including the use of an exercise ball and bed sheet as tools to help provide comfort and assistance with supportive positioning. Students had the opportunity to role play and practice using these new skills. In the final station, common labor and birth complications were discussed. Doulas used a stretcher to demonstrate patient positioning during an epidural placement and how to support a family during emergent situations, including cesarean birth.


Throughout the 4 stations, doulas shared personal stories of supporting families in childbirth. Students were able to ask questions and practice the interventions the doulas discussed. Seeing demonstrations and then role playing them were designed to prepare students for their upcoming clinical practice by demystifying birth and giving them concrete tools to use in their maternity clinical practicum.


This educational intervention was approved by the authors' university institutional review board. Surveys were collected before and after the 2-hour learning activity. Students evaluated their level of comfort in the labor and delivery setting and their confidence in providing labor support prior to their first clinical practicum. Six Likert-type survey questions were included in the presurvey and 7 in the postsurvey. All questions were created by the authors. One hundred two presurveys and postsurveys were collected.



Most students (n = 102 [85%]) had not attended a birth prior to the training. Survey responses indicated a dramatic increase in comfort level being in a labor and delivery setting after the intervention. Prior to the labor support training, 21.5% of students reported feeling comfortable or extremely comfortable. After the training, 82.4% of students reported feeling comfortable or extremely comfortable. Students also reported increased confidence in all 5 areas of labor support: (1) introducing themselves to patients increased from 80.6% of students feeling confident or extremely confident to 95.1% after the training; (2) discussing birth preferences increased from 24.3% to 76.7%; (3) recommending safe and appropriate positions for labor increased from 5% to 84%; (4) using touch to support a patient in labor increased from 35% to 85%; and (5) providing emotional support to a laboring patient increased from 38% to 87%.


Nearly all students (98%) were satisfied with the training. Among open-ended comments, students reported that they appreciated learning different techniques and having an opportunity to have hands-on practice before beginning patient care experiences. Students also appreciated hearing labor and birth stories and patient care experiences from the doulas. Additionally, students reported that it was helpful to see the demonstrations of techniques before practicing through role-playing.



Working in small groups with experienced doulas as facilitators substantially improved students' confidence and comfort in providing labor support prior to their first obstetric clinical practicum. Using discussions, demonstrations, and hands-on practice met the needs of learners, and students responded favorably to the experience. The intervention also served as an opportunity for interprofessional collaboration with birth workers through which students learned to understand and appreciate the role of birth doulas.




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