Shaped by personal experience, each person’s perspective on the validity of the doula profession may differ substantially. A growing number of expecting mothers need little evidence proving the case for doulas: They’ve been thoroughly convinced after hearing a friend loudly singing the praises of your fellow industry professionals. On the other hand, some expecting mothers and their families may be entirely unfamiliar with the term and require a bit of education before formulating their opinion.
Yet, others might be wary- or even seriously doubtful- of your industry’s value and demand more detailed statistics as evidence to justify your presence in the birthing process. Regardless of the scenario, the numbers don’t lie. If you require evidence to support your cause, we’ve compiled research-based data to quell any doubts regarding the proven benefits of doula support.
An Objective Study
In a report published in The Cochrane Library, twenty-one trials involving 15,061 women were conducted with one objective: “To assess the effects of continuous, one-to-one intrapartum support compared with usual care.”
The study, entitled Continuous Support for Women During Childbirth, explains that “modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour.” Furthermore, the resulting dehumanization of the childbirth experience can be positively modified through engaging a doula for continuous support.
Although historically, women have leaned on other women during labor and delivery, today, continuous support during labor “has become the exception rather than the routine.” Should continuous support- as provided by a doula- be the exception? Or should doulas in the delivery room become the new standard of care?
Defining Continuous Support
Before hashing out the numbers, let’s first define the term “continuous support.”
“Supportive care during labour may involve emotional support, comfort measures, information, and advocacy. These may enhance physiologic labour processes as well as women’s feelings of control and competence, and thus reduce the need for obstetric intervention.” (Cochrane, 2011, p.6)
Does an expecting mother require continuous support from a doula?
If a mother’s partner/mother/sister will be in the delivery room, their loved one may, indeed, be able to provide some much-appreciated support. However, the study suggests that continuous support was most effective “when provided by a woman who was neither part of the hospital staff nor the woman’s social network….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.”
According to the results of the Cochrane study:
Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% CI 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.97) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition their labours were shorter (mean difference -0.58 hours, 95% CI -0.86 to -0.30), they were less likely to have a caesarean (RR 0.79, 95% CI 0.67 to 0.92) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.84 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low 5-minute Apgar score (fixed-effect, RR 0.70, 95% CI 0.50 to 0.96). (Cochrane, 2011, p. 5-6)
The (Simplified) Results
While doulas will support you regardless of your chosen birth plan, those who hire doulas are more likely to have a spontaneous vaginal birth.
According to the American Academy of Family Physicians, spontaneous vaginal delivery at term “has long been considered the preferred outcome for pregnancy” due to the “perceived health, economic, and societal benefits derived from vaginal deliveries.”
Sources credit vaginal birth with the avoidance of epidurals side effects such as “increased risk of tearing, longer labor, increased risk of pelvic floor problems, increased use of synthetic oxytocin (pitocin) to induce labor, and increased risk of forceps being used for delivery.”
Women who receive continuous labor support are also less likely:
- to be administered pain-relieving drugs during the act of labor
- to report dissatisfaction with their labor experience
- to have a c-section
- to require the use of forceps or a vacuum device to extract the fetus from the vagina
Their babies are less likely to have a low five-minute APGAR score.
Developed by Dr. Virginia Apgar in 1952, a baby’s APGAR score is based on his or her appearance, pulse, grimace response, activity, and respiration. The immediate (one-minute) APGAR score indicates how the baby tolerated the birthing process. At five minutes, the examination is conducted again; this second score measures how well the baby is doing outside its mother’s womb. According to Medical Daily, very low five- minute APGAR scores have been linked to a slight increase in the risk of cerebral palsy though lower than normal scores are not evidence of permanent health problems.
In the author’s own words…
Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. (Cochrane, 2011, p.6)
While the study very plainly states that “all women should have support throughout labour and birth,” we believe the decision is personal. All we can do now is to help expecting mothers make an informed decision to ensure the best possible outcome for their babies and for themselves.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub3.