June 4, 1997 For almost 20 years, researchers have been examining a centuries-old phenomenon -- women helping women through childbirth. Continuous support from an experienced female companion, called a "doula" from the Greek word for servant, has been demonstrated to have impressive benefits, including shorter labors, less need for analgesia, and reduced likelihood of cesarean delivery. These findings about a time-proven, risk-free method come at a time when the focus in childbirth is on increased use of technology and medical intervention.
In a recent study, researchers John Kennell, M.D., and Susan K. McGrath, Ph.D., from the Department of Pediatrics at the Case Western Reserve University (CWRU) School of Medicine, looked at the childbirth experience of women at a Houston maternity hospital. Thirty-nine women were randomly chosen to be supported by a doula. Another 45 first-time mothers were randomly chosen to receive epidural analgesia to help control the pain of labor and delivery but were not supported by a doula. The day after delivery, both groups of women were asked to evaluate their pain levels and ability to cope with pain at three different times during childbirth. They rated their pain as ranging from "no pain" to "maximum pain" at the following times: 1) before receiving pain intervention (epidural analgesia or doula support), 2) after pain relief intervention, and 3) 24 hours after delivery. (Women who delivered by cesarean section were not included in the pain evaluation analysis.)
For women in both groups, pain was rated highest before the pain relief intervention, significantly less after the intervention, and much less again 24 hours after delivery. More importantly, when the pain evaluations from women in the doula group were compared to those from women in the epidural group, the two groups experienced equivalent levels of pain at all three measurement points.
Laboring women supported by a doula (with no pain relief medication) experienced the same levels of pain as women who received epidural analgesia, both during and after labor. Additionally, there were no differences in a laboring woman's ability to cope with pain whether she had an epidural or the continuous emotional support of an experienced doula.
According to the researchers, doula support is an effective, risk-free, non-pharmacologic, and inexpensive pain relief method that may be a viable alternative to epidural analgesia for many women in labor. Without the negative side effects and expense of an epidural, doula support offers the laboring woman a significant reduction in the pain of childbirth while also decreasing the chance for a cesarean delivery. Physicians, midwives, and consumers should consider these results when choosing obstetric pain relief.
The research team also included Vijay S. Varadarajulu, a premedical student at CWRU.
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