Since the late-80s, the US cesarean rate stayed around 30%, and there are real risks for mothers and babies when cesarean surgeries are not needed for emergency situations. Unnecessary cesareans contribute to adverse outcomes, while cascading maternity interventions increase the chance of unnecessary cesareans.
Documented proof discusses varied approaches to improve health outcomes around birth and decrease the need for interventions. One successful evidence-based approach is that women receive continuous support from certified doulas during labor and birth. Both qualitative research and quantitative research show significant benefits of doula support.
When doulas are independent (not hospital employees) then support is more effective, leading to the most positive outcomes, helping reduce interventions including cesarean. (It is best if women know their doulas before labor, and if doulas are present throughout labor and birth, which may not be the case for staff doulas working on shifts.)
Given doulas’ significant contribution to maternity care, stakeholders should co-create a standard practice model policy for US hospitals, which focuses on how to successfully integrate and involve independent certified doulas at clients’ births. Significant stakeholders in this conversation must include hospitals, obstetricians and gynecologists, mothers and families, as well as doulas and childbirth advocates (such as DONA International, Lamaze International, BirthWorks International) and other stakeholders.
Non-profit organizations should collaborate on how to initiate this conversation with the medical community. The discussion could explore how to assure high standards for doulas (i.e., the idea of an independent certifying organization) and consideration of the US medicalized birth context (issues of technology, liability and insurance).