Doula Support via Research
In the late 1970’s when Drs. John Kennel and Marshall Klaus investigated ways to enhance maternal-infant bonding they found, almost accidentally, that introducing a doula into the labor room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications3,4. Since their original studies, published in 1980 and 1986, numerous scientific trials have been conducted in many countries, comparing usual care with usual care plus a doula. Two recently published abstracts reported that when women had Doulas during labor, their ‘mother-infant affectionate interaction scores’ at a home visit two months later were significantly higher than for women who did not have a doula1,2. Another recent randomized controlled trial reported that the cesarean rates in induced labors were reduced from 64% to 20% if a doula was present5.
References:
1. Hofmeyer J, Nikodem VC, Wolman WL, Chalmers BE, Kramer L. “Companionship to modify the clinical birth environment: effects on progress and perceptions of labor, and breastfeeding.” Br J Obstet Gynaecol. 98:756-764, 1991
2. Landry SH, McGrath SK, Kennell JH, Marting S, Steelman L. “The effects of doula support during labor on a mother-infant interaction at 2 months.” Pediatric Res, 43(4): Part II 13A 1998.
3. Sosa R, Kennel JH, Klaus MH, Roberston S, Urrutia J. “The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction.” N Engl J Med, 303:597-600, 1980
4. Klaus MH, Kennell JH, Robertson SS, Sosa R. “Effects of social support during parturition on maternal and infant morbidity.” Br Med J, 293:585-587
5. McGrath SK, Kennell JH. “Induction of labor and doula support.” Pediatric Res. 43(4): Part II. 14A 1998.
6. Gilliland AL. “Commentary: nurses, doulas and childbirth educators.” J Perinatal Ed. 7:18-24, 1998
Doula Services and Costs
There are two basic types of Doula services: independent doula practices and hospital/agency doula programs. Independent Doulas are employed directly by the parents. They usually have telephone contact and at least one prenatal meeting with their clients to establish a relationship. When labor begins, the Doula arrives and stays with the woman until after the birth. A postpartum meeting to process the birth is usually included in the Doula’s service. Most Doulas charge a flat fee for their services, and many base their fees on a sliding scale.
Some Doula programs are administered or associated with a hospital or community service agency. The Doulas may be volunteers or paid employees of the hospital or agency. These programs vary widely in their design. Other hostpial/agency Doula programs make doula services available to the expectant mother or parents, who may meet and choose their Doula, or have one assigned to them, along with a backup doula. They may work with their Doula in much the same way that private Doulas and clients work together.
There is a growing third part reimbursement for labor support. Grant funding is often available, and some health agencies have contracts with doula organizations to support women in poverty and women with special needs. At present, however, most Doula care is paid for directly by the client.