Wednesday, October 6, 2010

doula research

DONA (Doulas of North America), an international organization, has a fantastic in-depth description of what doulas are.  Read it here.

This is an excerpt describing the research behind doula care.

"In the late 1970s, when Drs. John Kennell and Marshall Klaus investigated ways to enhance maternal-infant bonding they found, almost accidentally, that introducing a doula into the labor room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications.(6,7) Since their original studies, published in 1980 and 1986, numerous scientific trials have been conducted in many countries comparing usual care with usual care plus a doula.

Table 1 summarizes the findings of North American trials and a meta-analysis of all trials of continuous labor support.(12) Obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas in settings where the women had no loved ones present, the intervention rates were routinely high (as indicated by the data for the control groups) and the doulas were not health care professionals.

Results of 7 North American Trials of Labor Support including 2259 women
(comparing continuous labor support by doulas with usual care)
(# subjects)
5 min.
Apgar <7
Cogan (13)
1988 (25)
N.A. No diff N.A. decrease N.A. N.A. decrease
Hodnett (14)
1989 (103)
No diff increase N.A. decrease No diff N.A. N.A.
Kennell (7)
decrease decrease decrease No diff decrease N.A. decrease
Kennell (8)
1993 (570)
decrease N.A. No diff N.A. N.A. N.A. N.A.
Gordon (15)
1999 (314)
No diff No diff decrease No diff No diff decrease N.A.
McGrath (9)
1999 (531)
decrease decrease decrease decrease No diff N.A. N.A.
Trueba (16)
2000 (100)
decrease decrease decrease N.A. N.A. N.A. N.A.
KEY: No diff- no statistically significant difference between groups;N.A. – not assessed; increase – statistically significant increase in the supported group; decrease – statistically significant decrease in the supported group.

The results of 3 North American Trials 3, 17, 18 including 8052 women (comparing continuous labor support by NURSES – not doulas – with usual care) showed no differences in any outcomes listed in Table 1.
Findings of Hodnett’s et al meta-analysis of 15 trials from N. America, Europe, and Africa(10)
Women cared for during labor by a birth doula, compared to those receiving usual care were
  • 26% less likely to give birth by cesarean section
  • 41% less likely to give birth with a vacuum extractor or forceps
  • 28% less likely to use any analgesia or anesthesia
  • 33% less likely to be dissatisfied or negatively rate their birth experience"

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