EMBARGOED FOR RELEASE: May 4, 1999
Contact:
George Stamatis
[email protected]
(216) 368-3635
Please call 410-905-1001 to speak with researchers during the meeting (May 1-4).
Doula support decreases epidurals, shortens labor, and reduces complications
Researchers at Case Western Reserve University (CWRU) School of Medicine found that continuous support from a doula during childbirth decreased the need for epidural analgesia, shortened labor, and reduced labor complications. As a result, delivering mothers had an extremely low rate of cesarean delivery. The findings were presented today at the Pediatric Academic Societies meeting in San Francisco.
A doula is a woman experienced in childbirth who provides continuous support to a woman during labor and delivery. For more than 20 years, John Kennell, M.D., and his research team at the CWRU School of Medicine have been investigating the effects of doula support on laboring women and their infants. Previous studies have shown that laboring women provided with continuous support from doulas had reduced rates of cesarean deliveries and the use of forceps, as well as decreased need for analgesia and shortened length of labor.
Few women in the U.S. choose to have a doula support them through labor and delivery. In contrast, epidural analgesia is administered almost routinely to laboring women in many U.S. hospitals in spite of limited information about possible adverse effects.
The current study was designed to compare epidural analgesia, narcotic analgesia and doula support as alternate methods of managing the pain of labor. In the study, 427 first-time mothers with low-risk pregnancies were randomly assigned to receive one of the three methods of pain relief at the beginning of their labor. All women were permitted to receive additional or different forms of pain relief at their request.
The group of women who had the continuous support of a doula during their labor had a cesarean rate of about 3 percent (4 of 127 women), in contrast to the rate of 15.5 percent for women in the epidural group and 11.6 percent for women in the narcotic analgesia group. (It should also be noted that all three groups had a lower cesarean rate than the almost 25 percent common in many U.S. hospitals.)
Statistical analysis revealed that the likelihood of a woman in this study delivering by cesarean was strongly linked to the use of epidural analgesia, the length of labor and the development of labor complications.
Providing continuous doula support did not directly reduce the likelihood that a woman would have a cesarean delivery, but did decrease the need for epidurals, shorten labor and reduce complications. Consequently, women who were supported by a doula through labor had an extremely low rate of cesarean delivery. In questionnaires completed after delivery, women reported a significant decrease in pain following pain relief. Doula support provided less pain relief than epidural analgesia, but more than narcotic analgesia. Women who were supported by a doula reported a more positive labor and delivery experience than did women who received an epidural or narcotic analgesia.
This study demonstrates that doula support, in contrast to epidural analgesia, is a risk-free alternative to manage the pain of labor.
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Doula Support vs Epidural Analgesia: Impact on Cesarean Rates. Susan McGrath, John Kennell (Pediatrics, Case Western Reserve Univ., Cleveland, OH), Maya Suresh (Obstetric Anesthesia, Baylor University, Houston, TX), Kenneth Moise, Clark Hinkley (Ob/Gyn, Baylor University, Houston, TX).
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