Here is a sample of what the medical
literature says about doulas: Over 15
studies have been carried out around the
world, demonstrating the many benefits of
hiring a doula. Here is the latest review
and a few others.
Continuous
support for women during childbirth
(Cochrane Review) Hodnett ED, Gates S,
Hofmeyr G J, Sakala C. Continuous support
for women during childbirth (Cochrane
Review). In: The Cochrane Library, Issue 3,
2003.
Main results: Fifteen trials involving
12,791 women are included. Primary
comparison: Women who had continuous
intrapartum support were less likely to have
intrapartum analgesia, operative birth, or
to report dissatisfaction with their
childbirth experiences. Subgroup analyses:
In general, continuous intrapartum support
was associated with greater benefits when
the provider was not a member of the
hospital staff, when it began early in
labour, and in settings in which epidural
analgesia was not routinely available.
Reviewers' conclusions: All women should
have support throughout labour and birth.
The
obstetrical and postpartum benefits of
continuous support during childbirth.
Scott KD, Klaus PH, Klaus MH. J Womens
Health Gend Based Med 1999 Dec;8(10):1257-64
Division of Public Health, County of Sonoma
Department of Health Services, Santa Rosa,
California 95404, USA.
The purpose of this article is to review the
evidence regarding the effectiveness of
continuous support provided by a trained
laywoman (doula) during childbirth on
obstetrical and postpartum outcomes. Twelve
individual randomized trials have compared
obstetrical and postpartum outcomes between
doula-supported women and women who did not
receive doula support during childbirth.
Three meta-analyses, which used different
approaches, have been performed on the
results of the clinical trials. Emotional
and physical support significantly shortens
labour and decreases the need for Cesarean
deliveries, forceps and vacuum extraction,
Oxytocin augmentation, and analgesia.
Doula-supported mothers also rate childbirth
as less difficult and painful than do women
not supported by a doula. Labour support by
fathers does not appear to produce similar
obstetrical benefits. Eight of the 12 trials
report early or late psychosocial benefits
of doula support. Early benefits include
reductions in state anxiety scores, positive
feelings about the birth experience, and
increased rates of breastfeeding initiation.
Later postpartum benefits include decreased
symptoms of depression, improved
self-esteem, exclusive breastfeeding, and
increased sensitivity of the mother to her
child's needs. The results of these 12
trials strongly suggest that doula support
is an essential component of childbirth. A
thorough reorganization of current birth
practices is in order to ensure that every
woman has access to continuous emotional and
physical support during labour.
Continuous
emotional support during labour in a US
hospital. A randomized controlled trial.
Kennell J, Klaus M, McGrath S, Robertson
S, Hinkley C. JAMA 1991 May
1;265(17):2197-201 Department of
Paediatrics, Case Western Reserve
University, Cleveland, OH.
The continuous presence of a supportive
companion (doula) during labour and delivery
in two studies in Guatemala shortened labour
and reduced the need for Cesarean section
and other interventions. In a US hospital
with modern obstetric practices, 412 healthy
nulliparous women in labour were randomly
assigned to a supported group (n = 212) that
received the continuous support of a doula
or an observed group (n = 200) that was
monitored by an inconspicuous observer. Two
hundred four women were assigned to a
control group after delivery. Continuous
labour support significantly reduced the
rate of Cesarean section deliveries
(supported group, 8%; observed group, 13%;
and control group, 18%) and forceps
deliveries. Epidural anaesthesia for
spontaneous vaginal deliveries varied across
the three groups (supported group, 7.8%;
observed group, 22.6%; and control group,
55.3%). Oxytocin use, duration of labour,
prolonged infant hospitalization, and
maternal fever followed a similar pattern.
The beneficial effects of labour support
underscore the need for a review of current
obstetric practices.
The doula:
an essential ingredient of childbirth
rediscovered Klaus MH, Kennell
JH. University of California at San
Francisco, USA. -Acta Paediatr 1997 .
Eleven randomized control trials examined
whether additional support by a trained lay
person (called a doula), student midwife or
midwife, who provides continuous support
consisting of praise, encouragement,
reassurance, comfort measures, physical
contact and explanations about progress
during labour, will affect obstetrical and
neonatal outcomes. The women were healthy
primigravidas at term. Meta-analysis of
these studies showed a reduction in the
duration of labour, the use of medications
for pain relief, operative vaginal delivery,
and in many studies a reduction in Cesarean
deliveries. At 6 weeks after delivery in one
study a greater proportion of
doula-supported women were breastfeeding,
reported greater self-esteem, less
depression, a higher regard for their babies
and their ability to care for them compared
to the control mothers. Observations during
labour showed that fathers remained farther
away from mothers than doulas, talked and
touched less. When the doula was present
with the couple during labour the father
offered more personal support. The
father-to-be' s presence during labour and
delivery is important to the mother and
father, but it is the presence of the doula
that results in significant benefits in
outcome.
Benefits of
massage therapy and use of a doula during
labour and childbirth. Keenan
P. Altern Ther Health Med 2000
Jan;6(1):66-74 Potomac Massage Training
Institute, USA.
This article reviews the most recent
literature on touch support and one-to-one
support during labour and childbirth. The
positive and negative aspects of the
traditional birth attendant are presented.
Research in one-to-one care and touch
support during labour is examined with
respect to husband/partner, nurses,
nurse-midwives, and doulas (trained labour
attendants). According to recent studies,
women supported by doulas or midwives
benefit by experiencing shorter labours and
lower rates of epidural anesthesia and
Cesarean section deliveries. Also, a smaller
percentage of their newborns experience
fetal distress and/or are admitted to
neonatal intensive care units. Women whose
husbands or partners massage them during
labour experience shorter labours. Nursing
one-to-one support results in no significant
obstetric outcomes. Antenatal perineal
massage was found to reduce the rates of
tears, Cesarean section, and instrumental
deliveries. Research in perineal massage
during labour has shown no benefit.
Effects of
psychosocial support during labour and
childbirth on breastfeeding, medical
interventions, and mothers' wellbeing in a
Mexican public hospital: a randomised
clinical trial.
Langer A,
Campero L, Garcia C, Reynoso S. Br J Obstet
Gynaecol 1998 Oct;105(10):1056-63 The
Population Council, Regional Office for
Latin America and the Caribbean, Colonia
Coyoacan, Mexico DF, Mexico.
OBJECT: To evaluate the effects of
psychosocial support during labour, delivery
and the immediate postpartum period provided
by a female companion (doula). DESIGN: The
effects of the intervention were assessed by
means of a randomised clinical trial. Social
support by a doula was provided to women in
the intervention group, while women in the
control arm received routine care. SETTING:
A large social security hospital in Mexico
City. PARTICIPANTS: Seven hundred and
twenty-four women with a single fetus, no
previous vaginal delivery, < 6 cm of
cervical dilatation, and no indications for
an elective caesarean section were randomly
assigned to be accompanied by a doula, or to
receive routine care. OUTCOME MEASURES:
Breastfeeding practices, duration of labour,
medical interventions, mother's emotional
conditions, and newborn's health. METHODS:
Blinded interviewers obtained data from the
clinical records, during encounters with
women in the immediate postpartum period,
and at their homes 40 days after birth.
Relative risks and confidence intervals were
estimated for all relevant outcomes.
RESULTS: The frequency of exclusive
breastfeeding one month after birth was
significantly higher in the intervention
group (RR 1.64; I-C: 1.01-2.64), as were the
behaviours that promote breastfeeding.
However, the programme did not achieve a
significant effect on full breastfeeding.
More women in the intervention group
perceived a high degree of control over the
delivery experience, and the duration of
labour was shorter than in the control group
(4.56 hours vs 5.58 hours; RR 1.07 CI (95%)
= 1.52 to -0.51). There were no effects
either on medical interventions, mothers'
anxiety, self-esteem, perception of pain and
satisfaction, or in newborns' conditions.
CONCLUSIONS:
Psychosocial support by doulas had a
positive effect on breastfeeding and
duration of labour. It had a more
limited impact on medical interventions,
perhaps because of the strict routine in
hospital procedures, the cultural background
of the women, the short duration of the
intervention, and the profile of the doulas.
It is important to include psychosocial
support as a component of breastfeeding
promotion strategies.
A birth
intervention: The therapeutic effects of
Doula support versus Lamaze preparation on
first-time mothers' working models of
caregiving G.
Manning-Orenstein Altern Ther Health Med
1998 Jul;4(4):73-81
CONTEXT: A working model of caregiving has
been defined as an internalized schema of
caregiving that guides a mother's behavior
with her infant. This schema is strongly
influenced by the mother's first attachment
relationship with her own mother, which
frequently operates outside her conscious
awareness. OBJECTIVE: To examine doula
support at birth as an intervention that
might correct distortions of a mother's
unconscious schema of caregiving, promoting
more secure caregiving following childbirth.
DESIGN: The effects of doula support versus
Lamaze birth preparation on the working
models of caregiving of 35 first-time
pregnant mothers were compared.
INTERVENTIONS: An interview was used to
assess the mothers' working models in the
third trimester of pregnancy and again 4
months after the mothers gave birth. Mood
state and self-esteem were measured at these
times. A post hoc analysis was performed on
the mothers' birth experiences, the quality
of their postpartum support, and their
evaluations of their infants' temperaments.
RESULTS: The prebirth to postbirth rating
analysis of the interviews revealed that the
mothers in the doula group were
significantly less rejecting and helpless in
their working models of caregiving
than were the mothers in the Lamaze group.
The mothers in the doula group also showed
greater security than did mothers in the
Lamaze group, a difference that approached
but did not reach significance. In addition,
the women in the doula group were less
emotionally distressed and had higher
self-esteem than did the women in the
Lamaze group, and the women in the doula
group rated their infants as significantly
less fussy than the mothers in the Lamaze
group rated their infants. CONCLUSIONS: When
viewed in the context of working models of
care giving, mothers who used a doula were
significantly less rejecting and helpless,
and approached significantly higher scores
on the secure scale, than did mothers who
used Lamaze birth preparation. Mothers rated
as secure showed significantly less
mood disturbance and higher prebirth and
postbirth self-esteem than did
mothers rated as insecure, providing
construct validity for the caregiving
interviews.