Benefits of a Continuous Doula

Benefits of a Continuous Doula
compiled by Penny Simkin, PT, CD(DONA)

Obstetric Outcomes
In hospitals where intervention rates (epidurals, oxytocin, and cesarean deliveries) were very high, doula care lowered the intervention rates.1-6

The most dramatic improvements in obstetric outcomes came in those hospitals where:
• interventions were high
• women were not allowed to have a loved one present
• the doulas were not clinically trained (not nurses, midwives or students)

Psychological Outcomes
All six trials that investigated postpartum outcomes found that women who had doulas had these more positive outcomes 4 to 8 weeks later than those without doulas.1,7-11
• enhanced breastfeeding
• better maternal-infant interaction
• less postpartum depression, anxiety, and greater self-esteem
• higher maternal assessments of their baby when compared to the "standard baby"
• greater satisfaction with the birth experience

In summary, the doula is emerging as a positive contribution to the care of women in labor. By attending to the women's emotional needs, some obstetric outcomes are improved. Just as importantly, early mother-infant relationships and breastfeeding are enhanced. Women's satisfaction with their birth experiences and even their self-esteem appears to improve when a doula has assisted them through childbirth. 12 "Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement." 13
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1 Sosa R, et al. "The effect of a supportive companion on perinatal problems, length of labor. and mother-infant interaction," N Eng J Med, 303:597-600, 1980.
2 Klaus MH. et al. "Effects of social support during parturition on maternal and infant morbidity." Br Med J. 293:585-587, 1986.
3 Kennel] JH. et al. "Continuous emotional support during labor in a US hospital: a randomized controlled trial." JAMA 265:2197-2201, 1991.
4 Hodnett ED, et al, "Effects of continuous intrapartum professional support on childbirth outcomes.-- Res in Vi-sing and Health . 12: 289-287, 1989.
5 Kennell JH et al. "Labor support by a doula for middle-income couples: the effect on cesarean rates." Pediatric Res. 32:12A, 1993.
6 McGrath SK. et al. "Induction of labor and doula support." Pediatric Res. 43:13A. 1998.
7 Garcia C. "The eighth doula study: social support during birth in Mexico.- Conference proceedings of Doulas of North America. Austin. TX, June 20. 1997. 89-93‑
8 Hofmeyr J. et al. Companionship to modify the clinical birth environment: effects on progress and perceptions of labour and breastfeeding." Br J Obstet Gynaecol. 98 756-764. 1991.
9 Landry SH, et al. "The effects of doula support during labor on mother-infant interaction at two months," Pediatric Res. 43:13A_ 1998.
10 Walton D. et al. "The impact of a hospital based doula program in a health maintenance organization setting.- Ain J Obstet Gynecol. 11. 1998.
11 Wolman WL,. et al. postpartum depression and companionship in the clinical birth environment a randomized. controlled study." Am J Obstet Gynecol. 168. 1388-1393. 1993.
12. Hodnett E, Gates S. Hofmeyr G. Sakala C Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003 Issue 3. Art No CD003766 DOI: 10 1002/14651858 CD003766.
13 DONA International position Paper The Birth Doula's Contribution to Modern Maternity Care DONA International: Jasper. IN- 2005