~ Benefits of having a birth doula ~
In March of 2014, ACOG published an obstetric consensus on the safe prevention of the primary cesarean in which it says this about doulas: "Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula." Read the compelling 2013 study here.
In the past, we have seen the same evidence that doulas make a difference. See more below.
An analysis of the Cochrane review (see below) revealed that women who had continuous labor support from a non-hospital
staff doula:
- had 26% fewer cesarean births
- had 41% fewer instrumental vaginal deliveries
- were 28% less likely to use any analgesia or anaesthesia
- were 33% less likely to be dissatisfied or to rate their birth experience negatively
- had increased likelihood of satisfaction with the birth experience as measured by:
-an overall satisfaction and feeling that one coped well
-finding labour to be as expected or better than one expected
-a feeling of personal control.
Postpartum benefits found in a review of 12 trials show that women are:
- more likely to be fully breastfeeding at four to six weeks post birth
- more likely to display more positive mother-baby interaction at eight weeks post birth
- more likely to have good self-esteem
- more likely to find mothering easy and to feel they were managing well
- less likely to experience anxiety and postnatal depression.
staff doula:
- had 26% fewer cesarean births
- had 41% fewer instrumental vaginal deliveries
- were 28% less likely to use any analgesia or anaesthesia
- were 33% less likely to be dissatisfied or to rate their birth experience negatively
- had increased likelihood of satisfaction with the birth experience as measured by:
-an overall satisfaction and feeling that one coped well
-finding labour to be as expected or better than one expected
-a feeling of personal control.
Postpartum benefits found in a review of 12 trials show that women are:
- more likely to be fully breastfeeding at four to six weeks post birth
- more likely to display more positive mother-baby interaction at eight weeks post birth
- more likely to have good self-esteem
- more likely to find mothering easy and to feel they were managing well
- less likely to experience anxiety and postnatal depression.
(From the Hodnett ED, Gates S, Hofmeyr GJ et al. Continuous support for women during childbirth.
The Cochrane Database of Systematic Reviews 2003, issue 3)
*** Various systematic reviews have looked at the impact of continuous labor support under different conditions. Several reviews have found that the type of person providing the care appears to make a difference. Labor support provided by caregivers who come to the labor setting expressly to provide this care appears to offer women more benefits than labor support provided by nurses or other clinical caregivers from that setting (Hodnett and colleagues 2004, Simkin and O'Hara 2002, Scott and colleagues 1999).
The Cochrane Database of Systematic Reviews 2003, issue 3)
*** Various systematic reviews have looked at the impact of continuous labor support under different conditions. Several reviews have found that the type of person providing the care appears to make a difference. Labor support provided by caregivers who come to the labor setting expressly to provide this care appears to offer women more benefits than labor support provided by nurses or other clinical caregivers from that setting (Hodnett and colleagues 2004, Simkin and O'Hara 2002, Scott and colleagues 1999).
How Effective is a Doula in Helping a Mom Cope with Pain in Labor?
A Cochrane systematic review of 15 RCTs comprising 12,791 women revealed that continuous labour support by an experienced female labour companion (doula) significantly reduced the likelihood of using any anesthesia/analgesia. One RCT comparing the effectiveness of assigning a doula versus administering epidural analgesia reported that women in the two groups rated an equal decrease in pain levels. Another RCT comparing women assigned a female labour companion to women labouring alone surveyed participants the day after the birth. Researchers found that women with a companion were 60% less likely to report that labour pain had been severe. Evidence from North America suggests that labour support providers who are nurses or midwives are not as effective as trained, non-medical women (doulas) who are not affiliated with the hospital. An RCT of nurse providers and another RCT using retired nurses as doulas reported no reduction in pain medication or medical interventions.The authors speculated
that the high rates of routine medical intervention in the participating institutions could have overpowered any effects of continuous labour support. It is also possible that caregivers acculturated into the medical model of care, where their attentions are divided between applying technology, interventions, charting and helping the woman cope, do not achieve the same benefits as non-medical providers whose sole responsibility is to support the woman. Benefits appear to be more pronounced when: the labour
support is continuous (without interruption except for going to the toilet) rather than intermittent; support was initiated before active labour; and the labouring woman is otherwise unaccompanied by a loved one35. Having a doula may help the parturient (woman about to give birth) delay/reduce/avoid the use of pain medication, thus reducing the likelihood of experiencing their adverse effects.
A Cochrane systematic review of 15 RCTs comprising 12,791 women revealed that continuous labour support by an experienced female labour companion (doula) significantly reduced the likelihood of using any anesthesia/analgesia. One RCT comparing the effectiveness of assigning a doula versus administering epidural analgesia reported that women in the two groups rated an equal decrease in pain levels. Another RCT comparing women assigned a female labour companion to women labouring alone surveyed participants the day after the birth. Researchers found that women with a companion were 60% less likely to report that labour pain had been severe. Evidence from North America suggests that labour support providers who are nurses or midwives are not as effective as trained, non-medical women (doulas) who are not affiliated with the hospital. An RCT of nurse providers and another RCT using retired nurses as doulas reported no reduction in pain medication or medical interventions.The authors speculated
that the high rates of routine medical intervention in the participating institutions could have overpowered any effects of continuous labour support. It is also possible that caregivers acculturated into the medical model of care, where their attentions are divided between applying technology, interventions, charting and helping the woman cope, do not achieve the same benefits as non-medical providers whose sole responsibility is to support the woman. Benefits appear to be more pronounced when: the labour
support is continuous (without interruption except for going to the toilet) rather than intermittent; support was initiated before active labour; and the labouring woman is otherwise unaccompanied by a loved one35. Having a doula may help the parturient (woman about to give birth) delay/reduce/avoid the use of pain medication, thus reducing the likelihood of experiencing their adverse effects.
Click here for an IVillage article written for women who may be considering a doula and wanting to know more...