The word “doula” first used in an article published in 1969 by Dr. Dana Raphael, a medical anthropologist who believed in the need for female companions to guide mothers through pregnancy, birth, and postpartum. In the midst of their research on maternal-infant bonding, Drs. Marshall Klaus and John Kennell verified the benefit of labor support.  They first published an article documenting these benefits in the New England Journal of Medicine in 1980. Several years later they followed up with more research published in the Journal of the American Medical Association. The Cochrane Library published its first review of literature in 2003 affirming the benefits of labor support.  That publication has been updated several times (the last time being in 2013) and the results remain the same: doula support results in many benefits and with no adverse effects. To quote the executive summary:  “The review of studies included 23 trials (22 providing data), from 16 countries, involving more than 15,000 women in a wide range of settings and circumstances…. Women who received continuous labour support were more likely to give birth ‘spontaneously’, i.e. give birth with neither caesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours. Their babies were less likely to have low five-minute Apgar scores. No adverse effects were identified. We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial.” An article published in 2013 in the American Journal of Public Health Katy Kozhimannil, PhD and others demonstrated the financial benefits that doula care can have on the health care system.  Because of the lower intervention rate, paying doulas is actually cost effective.  Several states now either have or are considering Medicaid reimbursement for doula care. The American College of Obstetricians and Gynecologists (ACOG) have now released two Committee Opinions in support of doula support during labor.  Safe Prevention of the Primary Cesarean Delivery published in 2014 suggested doula care as one of many ways to help lower the primary cesarean birth rate.  Citing data from the Cochrane meta-analysis mentioned above they stated, “the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery. Given that there are no associated measurable harms, this resource is probably underutilized.” The most recent ACOG support for doula care was published in February 2017. Approaches to Limit Intervention During Labor and Birth stated that “women benefit from continuous emotional support and the use of non-pharmacologic methods to manage pain. Support offered by trained labor coaches such as doulas has been associated with improved birth outcomes, including shortened labor and fewer operative deliveries.” For decades the benefits of doula care during labor and birth have been researched and documented.  The results have never varied: women and their families benefit in many ways from the emotional and physical support that doulas offer. This is World Doula Week.  Help spread the word! #worlddoulaweek #doulasbenefiteveryone

References

American College of Obstetricians and Gynecologists. (2017). Approaches to limit intervention during labor and birth. Committee Opinion No. 687. Obstet Gynecol;129:e20–8. American College of Obstetricians and Gynecologists. (2014). Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123: 693–711. Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien, M. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health. 103(4), e113-e121. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Roberts, Sam. (2016). “Dana Raphael, proponent of breastfeeding and use of doulas, dies at 90”. Retrieved March 15, 2017 from https://www.nytimes.com/2016/02/21/nyregion/dana-raphael-proponent-of-breast-feeding-and-the-use-of-doulas-dies-at-90.html?_r=0