International Doula Month 2017

May is International Doula Month and both birth and postpartum doulas are being celebrated for the important contributions they make to maternal-infant health and the family's birth and postpartum experience. Childbirth educators play a key role in introducing expectant families to the role of the doula.

Many families are not familiar with what a birth or postpartum doula does, and even fewer are familiar with the research that shows the many benefits of birth doulas. Recent research from the Listening to Mothers III survey determined that only 6% of families had a doula support them at their birth. I am not able to assess how many families have benefited from working with a postpartum doula. When one in seven postpartum birthing parents and one in ten postpartum partners experience a postpartum mood or anxiety disorder, I imagine that not nearly enough families are supported by a postpartum doula easing the transition into parenthood for them. Childbirth educators are in the unique position of explaining the research behind doulas and how the families in their classes might benefit. Lamaze International's Third Healthy Birth Practice encourages the use of doulas as an evidence-based option to improve outcomes. Lamaze even has an infographic that can be used in class to help families learn about doulas.

ACOG endorses and encourages doulas to be a member of the birth team

Readers of this blog should be aware that the two most recent groundbreaking committee opinions put out by the American College of Obstetricians and Gynecologists stated that having trained doulas at a birth improved outcomes and should be explored as an option for all birthing families. In the 2014 Safe Prevention of the Primary Cesarean - ACOG and the Society for Maternal-Fetal Medicine stated:

"Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery. Given that there are no associated measurable harms, this resource is probably underutilized. According to a 2013 Cochrane Database Systematic Review, "continuous support during labor has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labor and birth."

In early 2017, in the Approaches to Limit Intervention During Labor and Birth, ACOG went even further in their statement about labor support:

"Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor."

"Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Benefits found in randomized trials include shortened labor, decreased need for analgesia, fewer operative deliveries, and fewer reports of dissatisfaction with the experience of labor. As summarized in a Cochrane evidence review, a woman who received continuous support was less likely to have a cesarean delivery (RR, 0.78; 95% CI, 0.67-0.91) or a newborn with a low 5-minute Apgar score (fixed-effect, RR, 0.69; 95% CI, 0.50-0.95). Continuous support for a laboring woman that is provided by a nonmedical person also has a modest positive effect on shortening the duration of labor (mean difference -0.58 hours; 95% CI, -0.85 to -0.31) and improving the rate of spontaneous vaginal birth (RR, 1.08; 95% CI, 1.04-1.12).

It also may be effective to teach labor-support techniques to a friend or family member. This approach was tested in a randomized trial of 600 nulliparous, low-income, low-risk women, and the treatment resulted in significantly shorter length of labor, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at 1 minute and 5 minutes. Continuous labor support also may be cost-effective given the associated lower cesarean rate. One analysis suggested that paying for such personnel might result in substantial cost savings annually. Given these benefits and the absence of demonstrable risk, patients, obstetrician-gynecologists and other obstetric care providers, and health care organizations may want to develop programs and policies to integrate trained support personnel into the intrapartum care environment to provide continuous one-to-one emotional support to women undergoing labor."

Your childbirth class families need to know about doulas

Last year, I provided childbirth educators with a "Brilliant Activities for Birth Educators" idea: Celebrate the Doula and International Doula Month with your Class and shared activities that educators can easily implement in their childbirth classes to highlight the role and importance of the doula.

Doulas are important

I consider it nothing less than remarkable that ACOG is suggesting that doula support is paid for by institutions and health insurance providers as these organizations will realize cost savings from the reduction in cesarean deliveries. Could the tide be turning and one day soon, doula support will be recognized as a critical component of maternal infant health outcomes and made available to all who need or want one?

For more information about the benefits of a doula, check out DONA International's web page and read their position papers: The Birth Doula's Role in Maternity Care and The Postpartum Doula's Role in Maternity Care.

Do you know any doulas professionally or personally? Have you thanked them for providing their services to families during both the birth and postpartum period? If you have not recognized the doulas you know, take a moment to share this blog with them and give them a thoughtful and heartfelt thank you for their contributions to improving maternal-infant health. You can download our graphic and share it on social media with your favorite doulas!

Resources

Caughey, A. B., Cahill, A. G., Guise, J. M., Rouse, D. J., & American College of Obstetricians and Gynecologists. (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology, 210(3), 179-193.

Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2013). Listening to mothers III: Pregnancy and birth. New York: Childbirth Connection, 53.

Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2013). Continuous support for women during childbirth. The Cochrane Library.

Wharton, K. R., Ecker, J. L., & Wax, J. R. (2017). Approaches to Limit Intervention During Labor and Birth Committee on Obstetric Practice.

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