McGrath, S. K., & Kennell, J. H. (2008). Birth, 35, 92-97.

Previous research has demonstrated the positive effects of continuous labor support by a doula for low-income women laboring without the support of family members. The purpose of this randomized controlled trial was to examine the effects of support from a doula for middle- and upper-income nulliparous women who were accompanied by a male partner during labor and delivery. Nulliparous women in the third trimester of an uncomplicated pregnancy were recruited from childbirth education classes in Cleveland, Ohio; 420 women who met the study criteria were randomly assigned to the experimental group (n=224) or the control group (n=196). Couples in the experimental group received a doula's continuous bedside presence and support during labor and delivery. Doula support included touch, teaching, reassurance, and encouragement of the woman and her male partner. Ten women served as doulas for the study, all of whom completed training requirements equivalent to Doulas of North America International certification.

The doula and control groups were similar in race, marital status, maternal education, and maternal age; 78% of women were white and 88% were married. The doula group had a significantly lower cesarean birth rate than those in the control group (13.4% vs 25.0%), and significantly fewer women in the doula group required epidural analgesia than women in the control group (64.7% vs 76.0%). Among women with induced labor, those in the doula group had a significantly lower rate of cesarean birth than those in the control group (12.5% vs 58.8%). In response to a questionnaire administered at 24 hours postpartum, 93% of the women and their male partners rated the presence of the doula as "very positive." The results of this study suggested that doula support has positive effects for middle- and upper-income women who also have support from a male partner, particularly in terms of a reduced rate of cesarean birth.

Commentary by

Maureen Heaman