Doula Assistance During Labor Reduces Cesarean and Epidural Rates

A new study has found that the continued presence of a doula--an experienced non-medical female companion who provides continuous labor support--during labor has significant beneficial effects for middle and upper class women in childbirth.

Researchers at Case Western Reserve University (Cleveland, OH, USA) studied women in their third trimester of an uncomplicated pregnancy who have never given birth before and who were enrolled at childbirth education classes in Cleveland (OH, USA) from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. Of these, 224 women were randomly assigned a doula who arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner. The other 196 women served as controls and did not receive doula support.

The researchers found that in the women accompanied by a doula, when compared with the group without one, cesarean delivery rates decreased by 12%, the need for an epidural dropped by 11%, and the need for a cesarean after induced labor decreased by 46%. On questionnaires administered the day after delivery, 100% of couples with doula support rated their experience with the doula positively. The study was published in the June 2008 issue of the journal Birth.

"The assistance provided by new fathers, while extremely important for other reasons, does not have the same positive impact on perinatal outcomes as does that of experienced doulas,” concluded study authors Susan K. McGrath, Ph.D, and John H. Kennell, M.D., of the department of pediatrics. "Continuous support by a doula during labor is a risk-free, low-cost method of reducing cesarean delivery rates that should be available to all women.”

Labor and birth support doulas attend to the emotional and physical comfort needs of laboring women to smooth the birth process. They do not perform clinical tasks such as heart rate checks, or vaginal exams but rather use massage, aromatherapy, reflexology, positioning suggestions, etc., to help labor progress as well as possible. The doula joins a laboring woman either at her home or in hospital or and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported. In addition to emotional, physical, and informational support, doulas often work as advocates of their client's wishes and may assist in communicating with medical staff to obtain information for the client to make informed decisions regarding medical procedures.


Related Links:
Case Western Reserve University