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Why do researchers love doulas so much?

posted Nov 3, 2016, 6:04 AM by Ariel Purkeypile   [ updated Nov 3, 2016, 6:22 AM ]
Evidence on the benefits of doula care from Enhancing Doulas of Lubbock, Texas

The Evidence for Doula Care

Being a doula is my favorite thing. But I didn’t begin my career in birth work as a doula. I started as a labor & delivery nurse, and I’m also a lactation consultant and board-certified holistic nurse with a certification in MotherMassageTM. The reason I became a doula and have spent the majority of the last five years being a doula and training doulas is that research shows doula care is one of the most effective and evidence-based ways to improve outcomes for women, babies, and families with no evidence of side effects or other risk. So today we’re going to discuss the evidence for the benefits of doula care.

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We may be “touchy-feely,” but our touchy-feely is evidence-based.

Part of why it can be surprising that doulas can have such a positive effect is that doula care isn’t clinical. That means that we don’t do clinical tasks such as giving medications or doing vaginal exams and that we don’t share in clinical care planning, such as deciding whether or not to induce labor or break water. Doulas provide informational, emotional, and physical support. Enhanced Doulas are also trained in helping our clients access and make the most of their social support networks. A lot of what we do might be described as “touchy-feely.” And we’re ok with that. If helping our clients understand and feel empowered and involved in their birth experience through hands-on care is touchy-feely, then we’re touchy-feely. But our particular brand of touchy-feely stuff is backed by decades of evidence and support from all major medical and professional organizations related to childbearing in the United States.

Modern doulas were “discovered” by researchers.

The modern doula movement was “discovered” by pediatric medical researchers and has been nurtured by decades of evidence since. To hear the story of how birth doula care was discovered (really, there isn’t a better word for it!) from the people who were there, watch a bit of this brief documentary Doula: The Missing Ingredient from DONA-International. The story starts about 44 seconds in, but really, the whole thing is less than 15 minutes, you should just watch it.

To summarize if you’re not watching the video, in the 1960s, some pediatricians wanted to investigate the effects of keeping mom and baby together in the hospital postpartum, also called rooming-in. Hospitals in the US kept newborns away from their mothers almost all the time after birth because they mistakenly believed that this would reduce infection in the newborns. US hospitals wanted proof that rooming-in wasn’t a crazy idea before they would allow it, so the researchers went to Guatemala to do some research and find that proof. They had a bilingual research assistant doing intake (explaining the study, getting consent forms signed, etc.) for the study as women came to the hospital in labor. When women in the study had significantly better outcomes than women not in the study, they discovered that the research assistant had stayed with the women during their labor. Even though she didn’t “do” anything and her presence wasn’t a part of their study, the difference in outcomes was so strong that the researchers stopped what they were doing and trained a few local women as doulas to see if the results could be replicated. Spoiler alert! The results were replicated, the women and their babies benefited from doula care, and some of the researchers went on to form what would eventually be known as DONA-International, the oldest organization that certifies doulas. Fascinating!

We use the best evidence available.

So research on doula care goes way, way back. Most of the doulas working today weren’t even born at the time research into doula care began, but we all benefit from a tradition that is based not only on millennia of women supporting women during childbirth but also on decades of research on our work. But we don’t rely only on data from 50 years ago, because the research on doula care is robust, ongoing, and continues to support our “touchy-feely” work. In developing the service offering, doula care and documentation standards, and client education and doula training materials for Enhancing Doulas, I primarily cite studies from the 21st century and the most recent positions and recommendations of professional organizations like the American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP). And I primarily cite medical groups because most obstetric care in the US occurs in hospitals where women are attended by doctors, but also rely on the wisdom of related fields like nursing and lactation consultation, because those are my home, where I grew up, you might say. A reference list is available on the Evidence page.

Doula care is widely recommended.

Doula care is recommended by organizations and institutions across the spectrum of birthwork professionals. We’ll discuss evidence for the specific benefits of doula care in a moment, but first will list some of my favorite direct quotes in favor of doula care.

Wise pediatricians will recommend a doula to their patients' parents.

From a 2004 article in Pediatrics, the official journal of the AAP.

One of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. . . . Given that there are no associated measurable harms, this resource is probably underutilized.

From “Safe prevention of the primary cesarean delivery,” a 2014 joint position paper from ACOG and the Society for Maternal-Fetal Medicine (SMFM)

Continuous support in labour increased the chance of a spontaneous vaginal birth, had no harm, and women were more satisfied.” [Birth doula care] "has clinically meaningful benefits for women and infants and no known harm. . . . All women should have support throughout labour and birth.

From a 2013 review by the Cochrane Database of Systematic Reviews, which is “internationally recognized as the highest standard in evidence-based health care resources”

Amazing, right? It’s uncommon for so many thought-leaders and investigators to make such enthusiastic statements. Doula research is so fun!

Second half of discussion to follow Open House event this weekend.

We’ll continue our discussion of the evidence supporting doula care on Monday, when we’ll discuss the specific benefits of doula care. We’ll be spending the time until then celebrating our new location with our Open House event, Saturday and Sunday November 5th and 6th from 1 to 5 p.m. both days. See you then!