Three randomized controlled studies by the principal investigator have shown a significant effect of continuous human support provided by a lay women (doula) during labor and delivery on the incidence of cesarean deliveries and obstetric interventions in low SES Guatemala and U.S. populations. Little is known about the effect of support provided by the father (the sole support person in 80% of U.S. deliveries) of the effect of doula support for middle-class couples. Preliminary studies have shown that the supportive behavior of a father is significantly different than a doula. In addition, both mothers and fathers strongly agree about the desirability of the father's presence during labor and delivery, but whether the father can have an influence on the outcome of labor and delivery similar to that shown by the doula remains unanswered. This proposed randomized controlled study will investigate the effects of a female labor companion (doula) in a population of lower- and middle-class women accompanied through labor by their male partners.
The specific aims of the study are to analyze the effects of the presence of a doula with a couple on: (1) the incidence of cesarean delivery, (2) obstetric interventions during labor and delivery, (3) perinatal problems in the fetus and neonate; (4) the length of labor, (5) the mother's and father's subjective experience of labor and delivery; and (6) post- delivery self-concept. The reduced cesarean delivery rate among supported women in studies in Guatemala and Houston is in direct contrast to the national trend of increased use of cesarean delivery with major financial, physical, social and emotional costs. The effects on medical care costs, when projected onto a national birth rate of 3.8 million per year are striking, even before adding the hidden costs of medical complications and the accompanying fiscal or personal costs to the family. The provision of a doula to women laboring alone offers the exciting possibility of curbing the meteoric rise in costs of maternity care in the U.S. by greatly reducing the cesarean delivery rate and decreasing obstetrical interventions and perinatal complications. Can similar perinatal effects be achieved by doulas supporting both women and their male partners? In both lower- and middle- class populations? The answers to these questions may lead to changes in obstetric practice which can greatly reduce the incidence of cesarean delivery and perinatal complications and their accompanying fiscal, physical and social costs.
| McGrath, Susan K; Kennell, John H (2008) A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates. Birth 35:92-7 |
| Kennell, J H; Klaus, M H (1998) Bonding: recent observations that alter perinatal care. Pediatr Rev 19:4-12 |
| Kennell, J; Klaus, M; McGrath, S et al. (1991) Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 265:2197-201 |
| Kennell, J H; Klaus, M H (1988) The perinatal paradigm: is it time for a change? Clin Perinatol 15:801-13 |
