A. I am proposing to translate evidence on the benefits of continuous labor support (physical, emotional and informational) on labor and delivery outcomes, for both mother and infant, into practice.
A1. A Cochrane Systematic Review was updated and released in July of 2013 summarizing results of 22 randomized controlled trials with data from 15,288 women. These review found strong results of the many benefits of continuous labor support, including reduced likelihood of cesarean section, lower likelihood of using analgesia, lower likelihood of patient dissatisfaction, shorter labors, and lower likelihood of instrumental vaginal birth. Subgroup analyses suggest that continuous support is most effective when the provider is not part of the woman's social network.
A2. The single, key behavior change target for my translational activity would be to get hospitals in San Francisco to routinely offer doula services to their clients - ideally, to introduce them in the prenatal period, but if not, to offer when woman arrives in labor (modeled after SFGH program).
A3. To the best of my knowledge, SFGH is the only hospital in SF that offers doula services to all patients. Several other hospitals will allow a woman to have a doula present, but do not facilitate these services and are at times resistant to them.
B. Per above, the performance gap is that only one hospital in the Bay Area routinely offers doula services to all patients - regardless of ability to pay. There are many other hospitals in the area that could be providing these services.
C. The outcome gap is that right now, roughly 30% of women deliver via cesarean section. The WHO and numerous other organizations feel that the maximum proportion of births ending in c-section should be 15%, and generally closer to 5-10%. Doula continuous labor support has been shown to dramatically reduce the rate of cesarean sections - by up to half - and this could result in much improved outcomes for both the mother and child, as well as an enormous reduction in hospital costs/expenses.
D. Yes, there is strong evidence that changing performance would improve outcomes. Again, the Cochrane review cites 22 RCTs looking at this question, consistently showing the benefit of continuous labor support.