I became a doula with DONA in 2003, a year after I started my PhD program. During my graduate student years, I attended both hospital and home births. I stopped attending births when Zari was born, except for a friend's birth when Zari was 5 weeks old. I brought Zari along in a sling, and the hospital staff were more than gracious to both of us.
I have my reservations about doulas--not about doulas themselves, but about how they may unintentionally support the status quo in our maternity care system. Jennifer Block's Pushed touched on this. There is a much longer discussion of the impact of doula work in Barbara Katz Rothman's Laboring On. Do read Rothman's book; it's well worth the time.
But despite these reservations, I think doulas are a fantastic resource, especially for women planning to birth in a hospital. Early studies of doulas found that their presence decreased the need for pain medication and medical intervention, increased rates of breastfeeding, less postpartum depression, and more positive birth experiences. These studies, though, mostly involved lower-class single women without a husband or partner present during labor. This left questions about a doula's effectiveness for middle-class married/partnered women. A recent RCT (randomized controlled trial) of 420 couples answered this question. The results are phenomenal, although not particularly surprising for those of us involved in doula work.
The findings: having a doula significantly lowered cesarean rates, from 25.0% to 13.4% overall. This decrease was especially marked in induced labors: 12.5% in the doula group vs 58.8% in the control group. (Yikes! 58.8%!?) Epidural rates were also lower (64.7% vs 76.0%), although the difference was not as striking as the reduction in the cesarean rate.
Below is the abstract:
A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates.
SK McGrath and JH Kennell. Birth, June 1, 2008; 35(2): 92-7.
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio 44106, USA.
BACKGROUND: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery.
METHODS: Nulliparous women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner.
RESULTS: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively.
CONCLUSIONS: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula.