Studies of Doulas and Their Impact on Families

A review by Cochrane (a prestigious international organization that prepares and keeps up-to-date systematic reviews in many areas of health and medicine) on the effect of "Continuous Support for Women During Childbirth*" has drawn astonishing conclusions. The primary objective of this review was to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support as compared to usual care.

Fifteen trials involving 12,791 women were included. After review and analysis of the data, the researchers offered the following synopsis: Continuous labor support reduces a woman's likelihood of having pain medications, increases her satisfaction and chances for 'spontaneous ' birth, and has no known risks. Supportive care during labor may involve emotional support, information and comfort measures. Such care may enhance normal labor processes and thus reduce need for obstetric intervention. The reviewer's offered the following conclusion: All women should have support throughout labor and birth.

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library*, Issue 3, 2003. Oxford: Update Software.

The Benefits of Labour Doula Support:

Effects on Birth Outcomes:

	Women request less pain medication and epidurals
	There are fewer complications
	Reduced chances of having a cesarean section
	Reduced epidural or other painkiller use
	Reduced use of artificial oxytocin to speed labour
	Reduced duration of labour
	Reduced use of forceps
	Reduced use of vacuum extraction
	Increased chance of spontaneous vaginal birth

Effects on the Mother:

	Greater satisfaction with their childbirth, resulting in a more positive birth experience
	More positive assessments of their babies
	Reduced chances of maternal fever and infection
	Mothers feel more secure
	Mothers feel more in control
	Reduced levels of anxiety
	Reduced maternal bleeding following birth
	Mothers have higher regard and increased sensitivity towards babies
	Reduced incidence of postpartum depression

Effects on the Baby:

	Babies have shorter hospital stays and fewer admissions to special care nurseries
	Mothers are more affectionate to their babies postpartum
	Reduced chances of health complications and hospitalizations of baby
	Increased chances of successful breastfeeding
	Found to be superior to Lamaze

Effects on the Health Care System:

	The cost of obstetrical care is dramatically reduced
	Women are pleased with the personalized care doulas offer

The Benefit of Continuous Support in Labor is Recognized by:

	The Society of Obstetricians and Gynecologists of Canada
	The World Health Organization
	The Medical Leadership Council (an organization of over 1200 U.S. hospitals)

References (by date):

Marya Ostrowski, ed. Patricia Newton. The doula's role during L&D. RN Mar. 1, 2004;67:34.

Hodnett ED. Caregiver support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 4 2002. Oxford: Update Software.

Hodnett ED. Continuity of caregivers for care during pregnancy and childbirth (Cochrane Review). In: The Cochrane Library, Issue 4 2002. Oxford: Update Software.

Female Comforter During Labor Benefits Both Mother and Infant, SAN FRANCISCO (Reuters Health) Feb 16, 2001.

Keenan P. Benefits of massage therapy and use of a doula during labor and childbirth. Altern Ther Health Med 2000 Jan;6:66-74.

Scott KD, Klaus PH, Klaus MH. The obstetrical and postpartum benefits of continuous support during childbirth. J Womens Health Gend Based Med 1999 Dec;8:1257-64.

Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol 1999 May 180:5 1054-9.

Gordon NP, Walton D, McAdam E, Derman J, Gallitero G, Garrett L. Effects of providing hospital-based doulas in health maintenance organization hospitals. Obstet Gynecol 1999 Mar 93:3 422-6.

Langer A, Campero L, Garcia C, Reynoso S. Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial. Br J Obstet Gynaecol 1998 Oct 105:10 1056-63.

Campero L, García C, Díaz C, Ortiz O, Reynoso S, Langer A. ''Alone, I wouldn't have known what to do'': a qualitative study on social support during labor and delivery in Mexico. Soc Sci Med 1998 Aug 47:3 395-403.

Manning-Orenstein G. A birth intervention: the therapeutic effects of Doula support versus Lamaze preparation on first-time mothers' working models of caregiving. Altern Ther Health Med 1998 Jul 4:4 73-81.

McCourt C, Page L, Hewison J, Vail A. Evaluation of One-toOne Midwifery: Women's Responses to Care. Birth June 1998;25(2):73-80.

Vehvilainen-Julkunen K, Liukkonen A. Father's experiences of childbirth. Midwifery March 1998;14(1):10-7

Germano E, Bernstein J. Home Birth and Short-Stay Delivery - Lessons in Health Care Financing for Providers of Health Care. J Nurse Midwifery November/December 1997;42(6):489-98.

Hundley VA, Milne JM, Glazener CM, Mollison J. Satisfaction and the three C's: continuity, choice and control. Women's views from a randomized controlled trial of midwifery-led care. Br J Obstet Gynaecol 1997 Nov;104(11):1273-80.

Wang D, Mao X, Qian S. Clinical observation on Doula delivery. Chung Hua Fu Chan Ko Tsa Chih 1997 Nov 32:11 659-61.

Klaus MH, Kennell JH. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatr 1997 Oct 86:10 1034-6.

Gagnon AJ, Waghorn K, Covell C. A Randomized Trial of One-to-one Nurse Support of Women in Labor. Birth June 1997;24(2):71-7

Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labor support from labor attendant for primiparous women: a meta-analysis. Obstet Gynecol 1996 Oct 88:4 Pt 2 739-44

Waldenström U, Borg I-M, Olsson B, Sköld M, Wall S. The Childbirth Experience: A Study of 295 New Mothers. Birth September 1996;23(3):144-53.

Hallsdersdottir S, Karlsdottir SI. Journeying through labour and delivery; preceptions of women who have given birth. Midwifery June 1996;12(2):48-61.

Hodnett E. Nursing Support of the Laboring Woman. J Obstet Gynecol Neonatal Nurs March/April 1996;25(3):257-64.

Gagnon AJ, Waghorn K. Supportive Care in Maternity Nurses: A Work Sampling Studin in an Intrapartum Unit. Birth March 1996;23(1):1-6

Chalmers B, Wolman W-L, Nikodem VC, Gulmezoglu AM, Hofmeyr GJ. Companionship in Labour; do the personality characteristics of labour supporters influence their effectiveness. Curationis December 1995; 18(4):77-80

Nolan M. Supporting women in labour: the doula's role. Mod Midwife 1995 Mar 5:3 12-5.

Bryanton J, Fraser-Davey H, Sullivan P. Women's perceptions of nursing support during labour. J Obstet Gynecol Neonatal Nurs Oct 1994; 23(8):638-44

Clamers B, Meyer D. Companionship in the Perinatal Period - A Cross-Culteral Survey of Women's Experiences. J Nurse Midwifery July/August 1994; 39(4):265-72

McKay S, Smith SY. "What are they talking about? Is something wrong?" Information sharing during the second stage of labor. Birth 1993 Sep;20(3):142-7.

Fleissig A. Are women given enough information by staff during labor and delivery? Midwifery 1993 Jun;9(2):70-5.

Wolman W-L, Chalmers B, Hofmeyr GJ, Nikodem VC. Postpartum depression and companionship in the clinical birth environment: A randomized, controlled study. Am J Obstet Gynecol May 1993;168(5):1388-93.

Chalmers B, Wolman W. Social support in labor - a selective review. J Psychosom Obstet Gynaecol 1993 Mar;14(1):1-15.

McNiven P, Hodnett E, O'Brien-Pallas LL. Supporting Women in Labor: A working Sampling Study of the Activities of Labor and Delivery Nurses. Birth March 1992;19(1):3-9.

Simkin P. Just Another Day in a Woman's Life? Women's Long-term Perceptions of Their First Birth Experience. Part I Birth Dec 1991;18:4 Part II Birth June 1992;19:2.

Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991 May 1 265:17 2197-201

Hofmeyer GJ, Nikodem VC, Wolman WL. Companionship to modify the clinical birth environment: Effects on progress and perceptions of labour and breastfeeding. Br J Obstet Gynaecol 1991 ;98:756-64.

Bertsch TD, Nagashima-Whalen L, Dykeman S, Kennell JH, McGrath SK. Labor support by first time fathers: direct observations with a comparison to experienced doulas. J Psychosom Obstet Gyn 1990;11:251-60

Mackey MC, Lock SE. Women's Expectations of the Labor and Delivery Nurse. J Obstet Gynecol Neonatal Nurs Nov/Dec 1989;18(6):505-12.

Hodnett ED, Osborn RW. Effects of Continuous Intrapartum Professional Support on Childbirth Outcomes. Res Nurs Health Oct 1989;12(5):289-97

Raphael D. Support and variation, the needs of the breast-feeding woman. Acta Paediatr Jpn 1989 Aug 31:4 369-72.

Shearer B. Birth Assistant: new ally for the parents-to-be. Childbirth Educator Spring 1989;26-31.

May K. Is it time to fire the coach? Childbirth Educator Winter 1988-89;30-5.

Barron SP, Lane HW, Hannan TE, Struempler B, Williams JC. Factors influencing duration of breast feeding among low-income women. J Am Diet Assoc 1988 Dec 88:12 1557-61.

Berry LM. Realistic Expectations of the labor coach. J Obstet Gynecol Neonatal Nurs Sept/Oct 1988;354-55.

Lozoff B, Jordan B, Malone S. Childbirth in cross-cultural perspective. Marriage Fam Rev 1988;35-60.

Copstick SM, Taylor KE, Hayes R, Morris N. Partner support and the use of coping techniques in labor. J Psychosom Res 1986;30(4):497-503.

Klaus MH, Kennell JH, et al. Effects of social support during parturition on maternal and infant morbidity. Br Med J 1986;193:585-87.

Taylor K, Copstick S. Psychological care in labour. Nurs Mirror July 24, 1985;161(4):42-3.

Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J. The effect of a supportive companion on perinatal problems, length of labor, and mother-infant bonding interaction. N Engl J Med Sept. 11, 1980;303(11):597-600.