Doulas Make a Difference

If you are hoping for a natural (the definition of which varies widely, but in my definition it means at least unmedicated–including induction–and unassisted–i.e., no vacuum extraction, forceps, etc.) birth, then the best way to prepare for that is to arm yourself with a support team. A partner, mother, and friend on board is wonderful, but a professional labor assistant can be an important key to reaching your birth goals.

This study shows that a doula’s presence almost normalized Cesarean-section rates, and did reduce (though not as markedly as I would have expected) epidural rates:

BACKGROUND: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery. METHODS: Nulliparous women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner. RESULTS: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively. CONCLUSIONS: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula.

Delayed Cord Clamping and Iron Stores

One of my favorite games to play is justifying why doing something “natural” makes good sense scientifically. We’ve spent years “proving” that breastfeeding is the best choice (duh), and so we also need to “prove” that not interfering unduly with birth also makes sense.

Here’s a study showing a significant increase in iron stores for babies (who, naturally, are breastfed and not receiving supplemental iron) that is sufficient to maintain their iron levels until they begin taking in complementary foods at around 6 months of age.

Apparently the contention that delayed cord clamping leads to an increased incidence of jaundice is neither able to be backed up by good research,  nor conclusively a problem. Again, if something happens when there’s no interference, does that make it a problem or normal?

Please comment with other good research to share.