Doula Support Lowers Cesarean Rates

Doula support lowers cesarean rates

For centuries, women have supported women during labor and birth. The twentieth century brought labor from the home to the hospital, and the supportive component of childbirth was de-emphasized.

At the Pediatric Academic Societies' annual meeting in New Orleans, John H. Kennell, MD, and Susan McGrath, PhD, of Case Western Reserve University, report results of the latest in a series of studies conducted to examine the effects of labor support by a female companion experienced in labor and delivery. Women who offer this type of labor support are known as doulas, from the Greek word for servant. In six clinical trials, providing the support of a doula to laboring women decreased cesarean delivery rates, shortened labor, and reduced the need for analgesia. These studies included only women who were likely to have an uncomplicated labor and delivery.

The study being reported at the pediatric research meeting included 555 first-time mothers who were accompanied through labor by their spouse or some other family member. Half of these women were randomly chosen to also receive the support of a doula during their labor.

Within this group of 555 women, 42 had labor induced by receiving pitocin and/or having their amniotic membranes ruptured by their obstetrician. In 21 cases pregnancy had extended more than a week beyond the due date; 10 developed potentially dangerous high blood pressure; 3 had spontaneous rupture of membranes with no labor; and no reason was given in the hospital charts for 8 inductions. Of these 42 women, 20 had been randomly assigned to receive the support of a doula during their labor, and 22 were in the control group receiving routine obstetric care.

Having a doula to provide support during an induced labor made a significant change in the rate of cesarean delivery. In the group without doula support, over 63% of mothers (14 of 22 women) had a cesarean delivery. The cesarean delivery rate for mothers with induced labor who had the continuous support of a doula was 20% (4 of 20 women). Up to this time, clinical trials of doula support have enrolled healthy women who were having a normal pregnancy and were anticipating uncomplicated deliveries. The powerful effects of doula support for women with low-risk pregnancies have been demonstrated repeatedly with reduced cesarean rates, less need for analgesia, and shortened labors. The present results from women who required labor induction highlight the importance of continuous doula support as an effective method for lowering cesarean rates in both low- and high-risk labor and deliveries.

The support of a doula offers a risk-free, human element to labor and delivery that can have a positive medical impact as well.