Continuous emotional support during labor in a US hospital. A randomized controlled trial

Abstract

The continuous presence of a supportive companion (doula) during labor and delivery in two studies in Guatemala shortened labor and reduced the need for cesarean section and other interventions. In a US hospital with modern obstetric practices, 412 healthy nulliparous women in labor were randomly assigned to a supported group (n = 212) that received the continuous support of a doula or an observed group (n = 200) that was monitored by an inconspicuous observer. Two hundred four women were assigned to a control group after delivery. Continuous labor support significantly reduced the rate of cesarean section deliveries (supported group, 8%; observed group, 13%; and control group, 18%) and forceps deliveries. Epidural anesthesia for spontaneous vaginal deliveries varied across the three groups (supported group, 7.8%; observed group, 22.6%; and control group, 55.3%). Oxytocin use, duration of labor, prolonged infant hospitalization, and maternal fever followed a similar pattern. The beneficial effects of labor support underscore the need for a review of current obstetric practices.

Multisite implementation of trained volunteer doula support for disadvantaged childbearing women: a mixed-methods evaluation

“…Despite the modest improvement, cost savings due to the doula service were evidenced even in the sensitivity analysis scenario in which all caesareans were assumed to be performed as emergency procedures. Contrasting the marginal difference observed here are two US studies, by Kennell et al 15 and Kozhimannil et al, 62 in which the differences between the two caesarean rates were of the order of 10%, in favour of doula support. If this level of improvement were translated into the UK context, then the contribution to cost savings due to the doula service would be substantial.…”

“…Information available from the original site prior to the start of this research suggested positive impacts on C-section and epidural rates. Reduced C-section rates were reported in studies of doula support in non-UK settings, for example by Kennell et al 15 and Madi et al 78 We have not found significant differences but, it must also be noted, we have not observed any worrying trends in any of the outcomes examined that would seriously call into question the safety of doula support. In the context of concerns about C-section rates in the UK, where significant reductions in rate are unlikely to be achieved, it is worth considering practices that may help to avoid increases.…”

“…Support during labour from trained doulas is associated with reduced length of labour, 14 less pharmacological pain relief and oxytocin augmentation, and fewer instrumental or operative births. 15 In particular, instrumental and operative births are associated with increases in the risk of morbidity for women and their babies. This morbidity includes postpartum haemorrhage, 16 genital tract trauma for the mother 17 and increased risk of intracranial haemorrhage for babies.…”

The midwife factor in obstetric procedures and neonatal outcome

“…Emotional support decreases forceps frequencies [10,23] and involves trust, which has been shown to be an essential component of nursing practice [17] and hence we believe for midwifery practice too.…”

Desempeño de las doulas en la atención de la mujer y su familia durante el periodo gestacional, parto y post parto en Costa Rica

“…Otros investigadores como Kennel, Klaus, McGrath, Robertson & Hinkley (1991) realizaron una serie de estudios aleatorios controlados (p.2) y extendieron el empleo de este término a mujeres ayudantes tanto en el postparto como durante el parto.…”