Six trials that investigated postpartum outcomes found that women who had doulas had these more positive outcomes 4 to 8 weeks later than those without doulas.
- enhanced breastfeeding
- better maternal-infant interaction
- less postpartum depression, anxiety, and greater self-esteem
- higher maternal assessments of their baby when compared to the "standard baby"
- greater satisfaction with the birth experience
** complied by Penny Simkin, PT, CD(DONA)
**DONA International **
Page 1.6 of the DONA Birth Doula workshop Manuel/introduction to labor support/labor support by doulas.doc/2006
A Meta-Analysis of 15 high-quality randomized controlled trials of continuous support from around the world.
(From a press release from Maternity Center Association, NY September 2003)
New York, September 8, 2003 -A new comprehensive study describing the experiences of nearly 13,000 women has found that women who receive supportive care from a companion throughout labor are more likely than women without such care to avoid cesarean birth and other major medical interventions and to be satisfied with their birth experience. The study, "Continuous Support for Women During Childbirth," was carried out through the prestigious Cochrane Collaboration.
Overall, women who received continuous labor support were less likely to experience:
- Epidural or other regional analgesia
- Any analgesialanesthesia, including epidurals and opioids
- Birth with vacuum extraction or forceps
- Birth by cesarean
- Dissatisfaction or a negative rating of their experience
The authors concluded that all women should have support throughout their labor and birth.
The positive impact is greater with "non-hospital employees" (i.e., doulas) as labor support providers than with staff nurses, even when they have had extra training in labor support.
In addition to examining overall effects of continuous labor support, the new research examined effects of this care under different circumstances. A major finding is that the type of person providing care appears to make a difference in the impact of this care. Effects were stronger when the person was not a member of the hospital staff and was an outsider present expressly to provide one-to-one supportive care. Compared to women without continuous support, those who had continuous support from non-hospital caregivers experienced impressive reductions in risk for major abdominal surgery, other interventions, and dissatisfaction.
These women were:
- 26% less likely to give birth by cesarean section
- 41% less likely to give birth with vacuum extraction or forceps
- 28% less likely to use any analgesia or anesthesia and
- 33% less likely to be dissatisfied with or negatively rate their birth experience
- 25% decrease in length of labor
"The organization of care in modern maternity units -including shift changes, diverse staff responsibilities, and staff shortages - appears to limit the effectiveness of labor support provided by members of the hospital staff," said Ellen D. Hodnett, RN, PhD, and Professor, Faculty of Nursing, at the University of Toronto. Dr. Hodnett, the lead author of the Review, added, "Non-hospital caregivers may be able to give greater attention to the mothers' needs."
[These findings are summarized from Hodnett ED. Gates S. Hofmevr GJ. Sakala C. Continuous support for women during childbirth.
The Cochrane Database of Systematic Reviews 2003. Issue 3. Art. No. CD003766 DOI: 10.100211465 1858.CD003766. ]
**DONA International **
FINANCIAL IMPLICATIONS OF DOULA CARE:
Note: Information is taken from estimates in 2009. Actual amounts will vary by facility and geographical location.
If every woman had a doula (costing the national average of $500.00 per client -- $50,000 total per 100 women) and we were able to decrease epidurals and cesarean sections by 40% (the current average rate), the cost savings INCLUDING PAYMENTS TO THE DOULA, would be MORE THAN a quarter of a million dollars in health care costs.