Doula Support During Labor and Birth to Decrease Risks of Interventions and Cesarean Surgeries

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Easeful Birth

Easeful Birth

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.)

Priority is Suport for Mother

Doula’s Priority – Mother

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 InternationalLamaze InternationalBirthWorks 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).

Clear Eyes (No Intervention)

Healthy clear-eyed babies

Doulas help reduce maternal mortality and infant mortality, so initiating this discussion is key in the human rights context.

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5 Responses to “Doula Support During Labor and Birth to Decrease Risks of Interventions and Cesarean Surgeries”

  1. msenbet1 Says:

    This is a very important topic especially at the time where the increasing healthcare cost in the US is unsustainable. In addition to reducing maternal and infant mortality, reducing unnecessary cesarean would help reduce healthcare cost, and ideally, reallocate those resources to areas where healthcare is truly needed.
    Thank you for raising awareness of this issue.

    • dancinginwater Says:

      Yes, added-value of doula care – as a way to reduce healthcare costs. Ideally those resources would be reallocated into research or programs to support positive birth outcomes!

  2. jlauer Says:

    I agree this is an important issue that needs to be addressed by multiple stakeholders. You linked to some good sources of data that indicates doula’s have a positive impact on labor and delivery. This data should be interpreted with caution, though. Due to the nature of the the topic, high quality studies (prospective, blinded, randomized) are near impossible to do. The last statement regarding the impact of doula’s on maternal mortality and infant mortality does not seem clearly supported by the WHO documents the statement is linked to.

    You make a vital point that the role of doula’s needs to be standardized regulated. I think this would go a long way to help integrate the role of a doula into the modern labor experience. Having non-certified and non-standardized personnel working alongside physicians and nurses in an otherwise highly regulated environment can create a sense of mistrust and unease regarding liability. Using certified doula’s as part of the healthcare team would promote a sense of teamwork and collegiality that would benefit the patient.

    It will be important to identify more specifically some of the stakeholders from the medical side of things. There is so much variation between hospitals in how they are run and how decisions are made that incorporating doula’s into hospital based birth will likely have to be advocated for on a very local level to see widespread adoption of the doula’s role.

    Thanks for bringing up a topic that is obviously important to patients and has the potential to positively impact obstetrical care in the U.S.

  3. dancinginwater Says:

    You’re welcome!

    How we use data to influence decisions about birth is an intriguing topic worth much more discussion. How much data is needed and who says how it influences policy is interesting, or how certain things became more typical practice without high quality studies proving their benefit first (e.g., forceps (historically), continuous monitoring, pitocin to induce labor, episiotomy).

    Regarding the WHO documents. The second one states: “For women, human rights include access to services that will ensure safe pregnancy and childbirth.” I argue that doula support falls under those services.

    Your point about how the team perceive a doula is significant to discuss further. Well-trained doulas are clear on their role of supporting mother (in varied aspects, not medical), and also on when to step back and let the medical experts do their job.

  4. gatorkatie Says:

    Accessibility to quality trained doulas as care advocates in the delivery room is certainly something I hope will gain traction in next several years. Many women establish their relationship with their OB/GYN long before they consider having children and given the trust that is built once a woman is pregnant there are so many other things going on than to feel empowered to “shop around” for a new OB. Also, given that most OB/GYN practices have several doctors any of whom may be in the delivery room at the time of the birth having a doula along the way as a constant beacon makes logical sense in improving quality of experience and outcomes regarding the birth process for the mother.

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