Doulas Help Families Have Both Safe and Healthy Births and Postpartum Periods

world doula week 2017.pngMarch 22nd through March 28th, 2017 is World Doula Week and Lamaze International along with Science & Sensibility recognize the benefits and contributions that birth and postpartum doulas provide in support of families around the world every day.

The research has been solid and consistent since 1991 when Drs. John Kennell and Marshall Klaus first published "Continuous emotional support during labor in a US hospital. A randomized controlled trial."  Labors are shorter, interventions are reduced, parents are more satisfied and babies are more stable when there is a doula present at the birth. Since then, many more papers have been published that support these original findings.

I have been delighted to see that the American College of Obstetricians and Gynecologists has stated in two recent groundbreaking committee opinions that doulas are recommended as they improve outcomes and reduce interventions. "The Safe Prevention of the Primary Cesarean Delivery" in 2014, and the just released "Approaches to Limit Interventions During Labor and Birth" both clearly and without hesitation recommend the presence of doulas at births.

Science & Sensibility has covered the topic of doulas many times and now is a great time to consider skimming over some of the articles. Consider some of the suggestions for how you might cover the topic of doulas and professional labor and postpartum support in your classes so families can understand the significant benefits they could receive.

Brilliant Activities for Birth Educators: Celebrate the Doula and International Doula Month with Your Classes

Informational Support vs Education: The Difference Between Doulas and Childbirth Educators

Op-Ed: Regulation of Doulas - A Simple Solution or a Complex Conundrum

Free Injoy Webinar: Secrets of a Postpartum Doula: Newborn Care and Soothing Techniques

From Childbirth Educator to Doula and Back Again: Trends in the History of Birth Advocacy and Education 

Evidence Supports Celebrating the Doula!

Black Infant Mortality and the Role of the Childbirth Educator and the Doula

Lamaze Healthy Birth Practice #3 - Bring a Loved One, Friend or Doula for Continuous Support

Book Review: Birth Ambassadors; Doulas and the Re-Emergence of Woman-Supported Birth in America

Doula referral sources for your students

DONA International Find A Doula Database - International database of certified doulas

DoulaMatch - doula database for USA and Canada with doula availabilityacog doula 2014.jpg

What do you do in your childbirth classes and with your patients to help families to understand the how a birth or postpartum doula can help make the childbearing year better?  Do you share the ACOG recommendations of a doula to reduce the primary cesarean and limit labor interventions?  Please share in the comments section.


Caughey AB, Cahill AG, Guise JM, Rouse DJ. (2014). Safe Prevention of the primary cesarean delivery. American College of Obstetricians and Gynecologists & Society of Maternal-Fetal Medicine. Am J Obstet Gynecol 210(3):179-193.

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5.

Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991;265:2197–201. 

Wharton KR, Ecker JL, Wax JR. (2017). Approaches to limit intervention during labor and birth. Committee Opinion No. 687. American College of Obstetricians and Gynecologists. Obstet Gynecol 129:e20-28.

1 Comment

World Doula Week

March 24, 2017 01:14 PM by Jacqueline Levine

During this week of celebration of doulas the world over, your article brings two points to mind: first, the right of every birthing woman to get only best-evidence, optimal maternity care all the time, and second, the obligation of every OB or clinician to dispense only BE care, as promulgated by respected best-evidence sources.

ACOG is now on record recognizing doula care as best-evidence care. But as far back as 2001, the “industry’s” own journal, Clinical Obstetrics and Gynecology, gave doula care an official imprimatur, via the publication of an in-depth study. (Clinical Obstetrics and Gynecology, Volume 44 Number 4- pp 692-703© 2001, Lippincott Williams & Wilkins, Inc.) Yes, the studies have been around for a long time, but so has the recognition of the scientifically-proven value of doula care. Docs know that doulas are a valuable adjunct to a safe and healthy birth.

So now, with this official reiteration of doula care as a “best-evidence” intervention, it stands to reason that OBs and other caregivers should hardly need urging to be among the loudest voices advocating for the presence of the doula as a necessary part of optimal maternity care. What’s holding docs and other clinicians back from jumping in as strong supporters for legitimizing the use of this best-evidence tool with its proven beneficial effects? Do docs really need prodding to be willing and even eager to advocate for evidence-based care for their patients?

Sadly, I have rarely seen or even heard of a doc who explained the benefits of doula care to patients or urged them to find a way to make doula care part of their plans for birth. After many years as educator and doula, I see what we all see; optimal maternity care is hard to come by. Of course I’ve seen docs who valued the doula’s role in childbirth, and they proved to be more hands-off than most and willing to let a birth unfold in its own time, and midwives and doulas are allied in their support of normal and healthy birth.

I’ve posted the following info more than once. It still obtains, and it still astounds. I am among the many who wonder why docs won't adopt new methods or protocols that are proven to be better for their patients. Researchers have asked about the reluctance of OBs to change a practice or protocol when good studies prove that practice to be useless or even harmful. Is it the simple unwillingness of caregivers to change the way do what they have always done?

Abstract: A questionnaire mailed to family physicians and obstetricians found that only 40% felt that evidence-based medicine was "very applicable to obstetric practice". Concerning comments from this survey included "obstetrics requires manual dexterity more than science", "evidence-based medicine ignores clinical experience", and that following guidelines could result in "erosion of physician autonomy". These views were described as obstacles to the adoption of evidence-based practices, and the authors recommended emphasis of critical analysis of the literature as part of medical education. (Olatunbosun OA, Eduoard L Pierson RA. Physicians' attitudes toward evidence based obstetric practice: a questionnaire survey. Br. Med J 1 316, 365-366 (1998).

And this little tidbit from an AMA journal: the title of the article says it best:

"The Difference between Science and Technology in Birth: Obstetrics seems to be particularly resistant to making evidence-based changes to common practice, perhaps because of the emotional climate surrounding pregnant women and babies. Aron C. Sousa, MD, and Alice           Dreger, PhD    ., Volume 15, Number 9: 786-790."

So it's the "emotional climate" that makes it difficult for docs to advocate for and adhere to best-evidence care? The truth is that it’s a patient's right to be fully informed about her care and to accept or refuse that care in an informed way: it's a patient's right to be offered and treated with only best-evidence care and nothing less. If you asked a birthing momma if she's paying for less than optimal care or whether she's paying for best-evidence care for herself and her baby, we all know what the answer would be.

And just to take a peek into one OB’s thinking, this article, in “Contemporary OB/GYN” (billing itself as “Expert Advice for Today’s OB/GYN), has some charm. It delves into some of the thinking behind some behaviors of the profession:

“Don’t Fear the Patient with a Birth Plan September 19, 2016 By Yalda Afshar, MD, PhD

On L&D units throughout the country, more and more women are being admitted with birth plans. Birth plans have become an increasingly common part of women’s prenatal preparation. Women cite these documents as an opportunity for educating, empowering, and developing confidence about childbirth. My residency at a busy urban hospital piqued my interest in patient birth preferences and birth plans. However, despite the high proportion of women with birth plans, there was an unspoken negative perception of them by many L&D staff. The clear disconnect between obstetricians and patients was baffling. What happened to shared-decision making and patient-centered care? What was lost in creating this “informed consent,” this personal manifesto, and “(living) labor will”? Where are the power struggles? Birth plans are often created in childbirth education classes to share preferences for birth and perhaps exert control over events during labor…. They can cause women to be perceived as inflexible and feel disappointed with their birth experience when their plans cannot be implemented.”  

It goes on to give advice and comfort to colleagues, thusly: Birth cannot be planned, but preferences can be shared, and a provider must ensure that all parties are willing to adapt and be flexible, given the unpredictable nature of childbirth. I stand with the birthing community and believe the name “birth plan” is perhaps too restrictive. I propose renaming or marketing a “birth preference” document to emphasize the iterative nature of this process. Perhaps most importantly, providers need to be educated and encouraged to recognize that direct communication and shared decision-making is essential to facilitate and enhance women’s birth experiences.”

I wonder whether this doc advises clients to try to make doula care one of the “essential” elements of birth. Perhaps I’ll get in touch with him and find out.


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