Doulas ease patient labor
For family physician Chip Taylor, M.D., doulas during labor and delivery are a necessity. "I've done labor and delivery with doulas and without," he said, "and labor really seems to work better for the patient if there is a doula there."
Doulas are women who support the laboring patient. They don't work as midwives; they aren't nurse practitioners. Doulas serve as labor coaches and advocates for the woman giving birth.
Research shows that the presence of a doula can shorten the duration of labor, says Chip Taylor, M.D., who works with volunteer doulas at the Naval Hospital in Jacksonville, Fla.
(Photo by Leigh Ann Bathke/AAFP)"Their concern is for the woman -- meeting her needs that aren't clinical," said Taylor, a family physician at the Naval Hospital in Jacksonville, Fla. "Sometimes a husband can get caught up in the moment and not be able to help the patient. Doulas know their job is to help the woman get through labor and delivery."
In fact, 1996 research at Mount Sinai School of Medicine in New York showed that labor can be shortened by 2.8 hours if a doula is present. A 1997 study from the University of California-San Francisco showed not only a reduction in the duration of labor, but also less use of medications for pain relief and fewer operative vaginal deliveries and Caesarean sections. A 1991 study published in the Journal of the American Medical Association said of 412 women studied, the rate of Caesarean sections, epidurals and forceps deliveries among the 212 women with doulas was less than half that of the 200 women in the control group.
Taylor, who first started using doulas about two years ago, asks all his pregnant patients if they want one present during delivery.
"There's a volunteer doula service here," he said. "I explain to my patients what a doula does and how research shows their presence can help cut short labor. Most of my patients request one, even if their husbands are going to be there."
But since Taylor works at a military hospital, having husbands present isn't always possible.
"I had one patient whose husband had been shipped out to Italy," Taylor said. "The doula walked the patient up and down the hall until about 15 minutes before delivery. We were in the room in the final stages of delivery when the patient decided she wanted her husband on the phone. The doula quickly called the base in Italy, and the husband got on the phone line just in time to hear his baby crying half a world away."
Doulas should be one of the main supports for a program of family-centered maternity care, Taylor said. Their purpose is to make the mother feel safe, comforted and supported during labor.
"Family-centered care means there's a difference between delivering babies and birthing babies," Taylor said. "It means a change in philosophy beyond guiding babies down the birth canal."
Doulas offer a continuous presence in active labor. Although nurses may come and go, a patient knows her doula will be there throughout the labor. Doulas offer a comforting touch with encouraging words throughout the birth process.
Sometimes the patient's viewpoint means asking for more medication, not less, and it's the doula's job to see that the patient's wishes are followed.
"I had one patient who came to me because she didn't want an epidural or an episiotomy," said Taylor. "I talked to her about doulas, and she was enthusiastic about having one present."
But once this patient had been in labor awhile, she decided she wanted an intrathecal narcotic at the last minute. It was the doula who went out to find Taylor and tell him about the patient's wishes.
"The doula served as the patient's advocate in this case," Taylor said. "And the patient was grateful. But this kind of collaboration can be threatening if not done appropriately."
Some critics of doulas are concerned that doulas may force their wishes on the patient. Taylor said he's never had that problem with the doulas he's worked with. But the doula-patient relationship works best if the doula gets to know the woman before delivery and supports the patient afterwards.
"A professional doula understands her role," Taylor said. "I've worked with several of them, and they do make the labor and delivery go a lot smoother. Doulas can reduce the need for intervention. A majority of my patients who gave birth with a doula would do it again."
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.
