Doula Support

 One of the key aspects of the involvement of doula support is that they provide emotional and other support by maintaining a “constant presence” throughout labor, providing specific labor support techniques and strategies, encouraging laboring women and their families, and facilitating communication between mothers and medical caregivers. Studies examining the impact of continuous support by doulas report significant reductions in cesarean births, instrumental vaginal births, need for oxytocin augmentation, and shortened durations of labor (Campbell, Lake, Falk, & Backstrand, 2006; Klaus & Klaus, 2010; Newton, Chaudhuri, Grossman, & Merewood, 2009; Papagni & Buckner, 2006; Sauls, 2002). Continuous support also has been associated with higher newborn Apgar scores (greater than 7) and overall higher satisfaction by mothers with the birthing process (Sauls, 2002). Others report that many of these effects occurred when support was provided by someone other than an attending nurse (Rosen, 2004; Sakala, Declercq, & Corry, 2002; Sauls, 2002). 

The evidence suggests that it is likely more than the emotional, physical, and informational support doulas give to women during the birthing process that accounts for the reduced need for clinical procedures during labor and birth, fewer birth complications, and more satisfying experiences during labor, birth, and postpartum (Meyer, Arnold, & Pascali-Bonaro, 2001; Wen, Korfmacher, Hans, & Henson, 2010). Klaus and Klaus (2010) argue that the modern hospital birthing process tends to be highly interventionist, taking away decision making from mothers. This results in many unwanted and, in many cases, unwarranted procedures. Medical providers sometimes prefer women to be compliant and recommend procedures to ward off pain and discomfort. However, these actions may actually interfere with birth outcomes, with mothers counseled to focus on their comfort and not necessarily on the possible implications of those interventions on the birth of their baby, the baby’s immediate health, or on later complications from these procedures. A doula serves as a mother’s advocate, providing a woman a sympathetic but informed ear for the choices that the birthing staff may ask her to make during the birthing process (Hazard, Callister, Birkhead, & Nichols, 2009; Papagani & Buckner, 2006). The doula empowers decisions that are made in the best interest of both the mother and her child (Breedlove, 2005; Deitrick & Draves, 2008). 

 Studies that examine the relationship between birthing mothers and their doulas report consistently positive experiences (Deitrick & Draves, 2008; Hazard et al., 2009; Koumouitzes-Douvia & Carr, 2006). Other studies have noted positive effects into the postpartum period. Newton et al. (2009), for example, found among a sample of Latina women giving birth at a Boston hospital that mothers supported by doulas were more likely to breastfeed their newborns and to delay first infant formula feed. Similarly, Nommsen-Rivers, Mastergeorge, Hansen, Cullum, and Dewey (2009) reported that in comparison to a group of women receiving standard care (n = 97), a doula-paired group of women (n = 44) experienced significantly shorter periods of labor, less instances of instrument-assisted birth, and better Apgar scores (greater than 7) at 1 minute postpartum. The doula mothers also experienced earlier onset of lactogenesis (within 72 hours postpartum) and were more likely to breastfeed their babies at 6 weeks. In a study of 2,174 expectant mothers receiving doula services compared with a sample of 9,297 receiving standard care, Mottl-Santiago and associates (2007) also found higher rates of breastfeeding and early initiation rates among the doula-supported mothers. 

Few studies have investigated the birth outcomes associated with and without the support of a doula. Campbell et al. (2006), in a study of 300 doula-supported and 300 nondoula-supported low income women giving birth between 1998 and 2002 at a perinatal care hospital in New Jersey, found that doula mothers had significantly shorter lengths of labor, more cervical dilation, and higher Apgar scores at 1 and 5 minutes. No differences were reported in birth weight or in rates of cesarean births or epidural anesthesia.

The purpose of this study is to present a comparative analysis of birth outcome results of two groups of mothers served by the same childbirth education program. The groups are defined by one receiving pre-birth assistance from a certified doula and the other representing a sample of birthing mothers who elected not to work with a doula birthing coach.