Are there any benefits to hiring a doula?

Research on Improved birth outcomes for mother and baby with a doula present.

There has been some research into the improved outcomes in birth satisfaction and the level and rate of interventions when families have a doula with them for birth. A notable one was carried out in Botswana and reported in the following peer reviewed journal entry:

Madi BC, Sandall J, Bennett R, MacLeod C . 1999  Effects of female relative support in labor: a randomized controlled trial. .Birth, 26(1):4-8.

Their results were as follows:

“Significantly more mothers in the experimental group had a spontaneous vaginal delivery (91% vs 71%), less intrapartum analgesia (53% vs 73%), less oxytocin (13% vs 30%), fewer amniotomies to augment labor (30% vs 54%), fewer vacuum extractions (4% vs 16%), and fewer cesarean sections (6% vs 13%) than in the control group. These differences were all significant at p < 0.05. Epidural analgesia was not used in the hospital at the time of the study. The only analgesics used were intramuscular pethidine or hyoscine N-butylbromide (Buscopan).”

Their conclusions  were as follows

“The presence in labor of a female relative was shown to be associated with fewer interventions and a higher frequency of normal delivery compared with the outcomes of those without family member support. The presence of a female relative as a labor companion is a low-cost, preventative intervention that is consistent with the traditional cultural practices in Botswana. In the light of this and previous studies, all women giving birth in a hospital should be offered the choice of a female relative as a companion to give support during labor”

Statistics for benefits of having a doula present

Klaus et al wrote their ground breaking book Mothering the Mother in the mid 1990s, now in its third edition,

Klaus, M. H., Kennell, J. H., Klaus, P. H. (2012). Mothering the mother : how a doula can help you have a shorter, easier and healthier birth. Reading MA Addison, Wesley.

They  discuss how labour support reduces the rate of caesarean sections, length of labour, need for pain medicine, and number of episiotomies and they demonstrate the positive effects of having a doula on mother-infant bonding. Also they found that 6 weeks after the birth mothers who used a doula were:

  • Less anxious and depressed
  • Had more confidence with baby
  • More satisfied with partner (71% v 30%)
  • More likely to be breastfeeding (52% v 29%)

In general all the studies on the influence of doulas at a birth conclude that having a doula present will improve the birth experience for all those present. Klaus et. al. conclude that in their work that having a doula present can result in:

  • 50% reduction in the caesarean rate
  • 25% shorter labour
  • 60% reduction in epidural requests
  • 40% reduction in oxytocin use
  • 30% reduction in analgesia use
  • 40% reduction in forceps delivery

Published research on the benefits of having a doula

Other writings on the efficacy of doulas in reducing birth interventions are listed below.

Kennell, J. MD; PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1488-1491 (doi:10.1542/peds.2004-1721R)

Klaus MH, Kennell JH, Klaus PH. The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth. 2nd ed. Cambridge, MA: Perseus Publishing; 2012

Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J. The effects of a supportive companion on perinatal problems, length of labor, and mother-infant interaction. N Engl J Med.1980;303 :597– 600

Klaus MH, Kennell JH, Robertson SS, Sosa R. Effects of social support during parturition on maternal and infant morbidity. Br Med J.1986;293 :585– 587

Hodnett ED, Osborn R. Effects of continuous intrapartum professional support on childbirth outcomes. Res Nurs Health.1989;12 :289– 297

Hemminnki E, Virta AL, Kopinen P, Malin M, Kojo-Austin H, Tuijmala R. A trial on continuous human support during labor: feasibility, interventions and mother’s satisfaction. J Psychosom Obstet Gynaecol.1990:239– 250

Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA.1991;265 :2197– 2201

Hofmeyr GJ, Nikodem VC, Wolman WL, Chalmers BE, Kramer T. Companionship to modify the clinical birth environment: effects on progress and perceptions of labour and breastfeeding. Br J Obstet Gynaecol.1991;98 :756– 764

Hodnett ED. Support from caregivers during childbirth. In: Neilson JP, Crowther CA, Hodnett ED, Hofmeyr GJ, Keirse MJNC, eds. Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews [database on disk and CD-ROM]. Issue 2. Oxford, United Kingdom: Cochrane Collaboration; 1997

Kennell JH, McGrath SK. Labor support by a doula for middle income couples: the effect on cesarean rates [abstract]. Pediatr Res.1993;33 :12A

Wolman W-L. Social Support During Childbirth: Psychological and Physiological Outcomes [DPhil thesis]. Johannesburg, South Africa: University of Witwaterstrand; 1991

Landry SH, McGrath S, Kennell JH, Martin S, Steelman L. The effect of doula support during labor on mother-infant interaction at 2 months [abstract]. Pediatr Res.1998;43 :13A

McGrath SK, Kennell JH, Suresh M, Moise K, Hinkley C. Doula support vs epidural analgesia: impact on cesarean rates [abstract]. Pediatr Res.1999;45 :16A

Ross, S. (2011) Doula: Why every pregnant women deserves one. Rockpool NSW Australia

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