It looks as if the old wives knew what they were talking about. A new study shows that women in labor who are assisted by a doula-a trained woman who has given birth herself-have significantly lower incidence of Caesarean section and less need for pain-blocking medication. Doulas (the name comes from the Greek word referring to a woman who guides a new mother) offer no medical advice. Their function is to provide emotional support, from hugging and hand-holding, to words of encouragement, to explanations of what is likely to occur.
The study, published last week in The Journal of the American Medical Association, looked at 616 unaccompanied laboring women at a public hospital in Texas. They were divided into three groups: those assisted by a doula, those monitored by an observer who did not offer support and a control group. Only 8 percent of the women assisted by doulas had Caesarean sections. For the observed group the figure was 13 percent, and the control group 18 percent. The difference in the need for a painblocking epidural anesthesia was even more dramatic. Only 8 percent of the assisted women received the drug, compared to 23 percent for the observed group and 55 percent for the controls.
No one is certain exactly what accounts for these differences, but the study’s authors believe that the doula’s presence has a calming effect on both the laboring woman and the hospital staff. “Our hypothesis is that the doula lessens a woman’s anxiety, which helps her body do what it is supposed to do,” says coauthor Susan McGrath, a psychologist at Case Western Reserve University School of Medicine. “A more indirect effect is that when someone is there watching labor from start to finish, the medical staff doesn’t feel the necessity to move things along quite so much.”
Certainly, a safe way to reduce medical intervention is welcome. The United States is a world leader in incidence of Caesarean section; it occurs in nearly a quarter of all births, and there is concern that many Caesareans are done unnecessarily.
Esther Zorn, founder of the Caesarean Prevention Movement, a self-help group based in Syracuse, N.Y., welcomes the findings. “This contributes to returning birth to where it came from-women helping women,” she says.
