December 3, 2008

New Study: Doula Care Lowers Cesarean Rate

I love when a study comes out that supports normal, healthy birth. This fall’s edition of The Journal of Perinatal Education features the article “Doula Care For Middle-Class Women With Male Partners Substantially Lowers Cesarean Rates”. The article describes a recent study that demonstrates some of the benefits of having a doula present.

Of course, being a labor support doula, I am a little biased towards the rewards of having continuous labor support from someone in addition to one’s partner. But more importantly, this study is relevant because of the negative press doulas are getting lately in mainstream America. Last year in the New York Times, Pamela Paul wrote a not-so-supportive piece, And Doula Makes Four, about problems with doulas in the labor and delivery room. Just a few weeks ago, The Today Show aired a segment about doulas in which a doctor discussed how bothersome doulas were at her hospital and in fact, that particular hospital has banned doulas from coming into the labor and delivery room. I would be curious to see that hospital’s cesarean rate! The segment, especially the written transcript, did try to create some balance by highlighting some of the positive aspects of having a doula present. However, the piece did not provide hard facts about the upside of adding a doula to the support team. That is why I am thrilled to share some of this new study:

A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates

Authors: McGrath, Susan K.; Kennell, John H.1
Source: Birth, Volume 35, Number 2, June 2008 , pp. 92-97(6)
Publisher: Blackwell Publishing

: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery. Methods: Nulliparous (First time mothers) women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula 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 doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively.

For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula. (BIRTH 35:2 June 2008)

I like facts and studies. I know it makes me slightly geeky and maybe it is the result of having a lawyer for a father, or being part of the Lamaze Association (I am also a certified Lamaze teacher), which is always impressing on me the importance of substantiating the work with evidence-based research. Whatever the reason, it feels very empowering to have current research supporting a topic that is near and dear to my heart and that lately has garnered some negative attention in our society.




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