Continuous emotional support during labor in a US hospital: a randomized controlled trial

Article Abstract:

Studies from Guatemala show that, in addition to providing comfort and reassurance to the mother during labor, the presence of a supportive female companion (doula) reduces the rate of cesarean section and other complications of labor and delivery. To evaluate this issue in a United States hospital, a study was carried out in a public hospital in Texas that did not normally allow laboring women to bring companions. Four hundred twelve women were randomly assigned to the supported group (212 women) or observed group (200 women). In the supported group, a specially trained doula was at the patient's bedside throughout labor and delivery, where she soothed and encouraged her. Women in the observed group were watched unobtrusively by a researcher. An additional group of 204 women whose records were studied after delivery (control group) was added, to control for any possible effects of the unobtrusive observer. Data concerning labor and delivery were obtained from hospital charts or other records. Results showed positive effects of doula support, similar to those in the Guatemalan studies: fewer women in the supported group than the observed or control groups underwent cesarean delivery (8 percent, 13 percent, and 18 percent, respectively), and the duration of labor was shortest in the supported group. Statistics are presented regarding the use of oxytocin (to augment uterine contractions), anesthesia, and forceps; all outcomes favored the supported group. This group also experienced a better neonatal outcome: fewer infants born to supported mothers than to mothers in the other groups remained in the hospital longer than 48 hours after delivery; fewer evaluations for sepsis (blood-borne infection) were required for these babies; and fewer supported women developed fever. A discussion is presented of the role of the husband or male companion, the person most often present during labor in the US. Whether his presence affects the course and outcome of labor in a manner similar to that of the doula has not been studied. The positive effect of the doula on the labor complication rate and on the health of mother and infant make a strong case for reviewing current obstetric practice. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Doula at the bedside of the patient in labor

Article Abstract:

An article in the May 1, 1991 issue of The Journal of the American Medical Association reports on research that shows an improvement in the outcome of labor and delivery among women who received support during labor from trained support persons (doulas). Women with doulas, compared with controls, had shorter labor and fewer required epidural anesthesia; in addition, they required fewer cesarean sections. In most labor and delivery rooms, the nurse is the primary staff person to provide support for laboring mothers. However, nurses' tasks are many, and they are often diverted from a patient by other demands. While the study shows the benefits that can be attributed to emotional support, it is possible that knowledge by staff that this process was taking place led them to alter their caregiving behavior. Modern obstetrical practice relies to a great extent on instrumentation, and has moved away from ''hands-on'' care. While older obstetrical textbooks cited the importance of using the resources of nature to deliver infants, one current text devotes 12 pages to anesthesia and analgesia, and 1 page to physiologic, non-drug methods of pain control. A brief review is presented of methods utilizing natural ways of combatting the discomfort and anxiety associated with childbirth. Whether the study findings can be generalized to other types of patients in other settings - the women who used doulas were poor and the majority had not attended childbirth classes - remains to be seen, but its results are most interesting. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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New parents and mental disorders: A population-based register study

Article Abstract:

A population-based register study is used to estimate the risk of postpartum mental disorders among new parents and also investigate whether parents in general differ from nonparents in the risk of admission with a mental disorder and how this difference varies with age. The results have shown that in Denmark, the risk of postpartum mental disorders among primiparous mothers increased for many months after childbirth, but among fathers there is no excess of severe mental disorders necessitating admission or outpatient contacts.

United States, Risk factors, Parents, Postpartum psychiatric disorders

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