Considering a Labor Doula? What You Need to Know

What are the advantages of having a doula?
The evidence for the benefits of doula care is especially compelling. It is established by numerous random assignment trials, which produce the best research evidence because random assignment ensures that the comparison groups are truly similar. It has also been conducted with different socioeconomic groups in several countries and under various circumstances, which further strengthens its validity. An analysis of the random assignment trials on this topic concludes: "Given the clear benefits and no known risks. . . every effort should be made to ensure that all laboring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort and encouragement (5)."

Compared with women receiving standard care, women accompanied throughout labor by a caring, experienced woman are more likely to:
-- feel less pain and anxiety in labor (6,16)
-- feel that they were in control and that they coped well (2,5,12)
-- express greater satisfaction with the labor (2,5)
-- have higher self-esteem, including pride in their bodies' strength and performance and in themselves as women (2,5,6,16)
-- have an easier time with mothering and have better mothering skills (6,16)
-- express more positive feelings toward the baby (10)
-- report a better relationship with the father (9)
-- breastfeed longer (6,12,16)
-- experience less postpartum depression (6,16)

Women having continuous woman-to-woman support are less likely to have epidurals or narcotic pain medication, which reduces the incidence of adverse effects that may arise from their use (1,2,5,13). This may at least partially explain why a doula's presence can reduce the:
-- length of labor (12,17)
-- need for intravenous Pitocin or "Pit" to stimulate stronger contractions (13,17)
-- number of episiotomies (an incision to enlarge the vaginal opening for birth) (3,4)
-- number of vacuum extractions or forceps deliveries (5,13,17)
-- cesarean rate (5,7,12,15)

In addition, because fewer medical interventions are needed, fewer babies:
-- are born in poor condition (1,5)
-- are admitted to special-care nurseries (11)
-- require evaluation for infection (8). This usually includes drawing blood and a spinal tap and may include keeping the baby in the nursery for observation
-- have longer than usual hospital stays (8)

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