Skip to main content
SpringerLink
Log in

A Hospital-Based Doula Program and Childbirth Outcomes in an Urban, Multicultural Setting

Maternal and Child Health Journal Aims and scope Submit manuscript

Cite this article

Abstract

Objectives

The objective of this study is to determine whether there are differences in birth and breastfeeding outcomes for women who received labor support through a hospital-based doula program, compared with those who did not receive doula support in labor.

Methods

We conducted a retrospective program evaluation to compare differences in birth outcomes between births at 37 weeks or greater with doula support and births at 37 weeks or greater without doula support through the first seven years of a hospital-based doula support program. Log-binomial regression models were used to compare differences in cesarean delivery rates, epidural use, operative vaginal delivery, Apgar scores, breastfeeding intent and early breastfeeding initiation after controlling for demographic and medical risk factors. The propensity score was included as an additional covariate in our regression model to minimize issues of selection bias. Analyses were conducted for the whole cohort of 11,471 women and by parity and provider service in subgroup analyses. Cochran-Mantel-Haenszel test was performed to detect differences in effects over time.

Results

For the whole cohort, women with doula support had significantly higher rates of breastfeeding intent and early initiation. Subgroup analysis showed that having doula support was significantly related to: (a) higher rates of breastfeeding intent and early initiation rates for all women regardless of parity or provider with the exception of multiparous women with physician providers; (b) lower rates of cesarean deliveries for primiparous women with midwife providers.

Conclusion

A hospital-based doula support program is strongly related to improved breastfeeding outcomes in an urban, multicultural setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Sosa, R., Kennell, J., Klaus, M., Robertson, S., & Urrutia, J. (1980). The effect of a supportive companion on perinatal problems, length of labor and mother-infant interaction. The New England Journal of Medicine, 303, 597–600.

    Article  PubMed  CAS  Google Scholar 

  2. Klaus, M. H., Kennell, J. H., Robertson, S. S., & Sosa, R. (1986). Effects of social support during parturition on maternal and infant morbidity. BMJ, 293, 585–587.

    PubMed  CAS  Google Scholar 

  3. Kennell, J., Klaus, M., McGrath, S., Robertson, S., & Hinkley, C. (1991). Continuous emotional support during labor in a US hospital: A randomized controlled trial. JAMA, 265, 2197–2201.

    Article  PubMed  CAS  Google Scholar 

  4. Hodnett, E. D., & Osborn, R. W. (1989). Effects of continuous intrapartum professional support on childbirth outcomes. Research in Nursing & Health, 12, 289–297.

    Article  CAS  Google Scholar 

  5. Hofmeyr, G. J., Nikodem, V. C., Wolman, W. L., Chalmers, B. E., & Kramer, T. (1991). Companionship to modify the clinical birth environment: Effects on progress and perceptions of labour, and breastfeeding. British Journal of Obstetrics and Gynaecology, 98, 756–764.

    PubMed  CAS  Google Scholar 

  6. Madi, B. C., Sandall, J., Bennett, R., & MacLeod, C. (1999). Effects of female relative support in labor: A randomized controlled trial. Birth, 26, 4–8.

    Article  PubMed  CAS  Google Scholar 

  7. Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2004). Continuous support for women during childbirth (Cochrane Review). Oxford, England: Cochrane Library, Update Software; 2004:issue 4.

  8. Langer, A., Campero, L., Garcia, C., & Reynoso, S. (1998). Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers’ well-being in a Mexican public hospital: A randomised clinical trial. British Journal of Obstetrics and Gynaecology, 105, 1056–1063.

    PubMed  CAS  Google Scholar 

  9. Wolman, W. L., Chalmers, B., Hofmeyr, J., & Nikodem, V. C. (1993). Postpartum depression and companionship in the clinical birth environment: A randomized, controlled study. American Journal of Obstetrics and Gynecology, 168, 1388–1393.

    PubMed  CAS  Google Scholar 

  10. Zhang, J., Bernasko, J. W., Lebovich, E., Fahs, M., & Hatch, M. C. (1996). Continuous labor support from labor attendant for primiparous women: A meta-analysis. Obstetrics and Gynecology, 88, 739–744.

    Article  PubMed  CAS  Google Scholar 

  11. Scott, K. D., Berkowitz, G., & Klaus, M. (1999). A comparison of intermittent and continuous support during labor: A meta-analysis. American Journal of Obstetrics and Gynecology, 180, 1054–1059.

    Article  PubMed  CAS  Google Scholar 

  12. Rosen, P. (2004). Supporting women in labor: Analysis of different types of caregivers. Journal of Midwifery and Womens Health, 49, 24–31.

    Article  Google Scholar 

  13. Scott, K. D., Klaus, P. H., & Klaus, M. H. (1999). The obstetrical and postpartum benefits of continuous support during childbirth. Journal of Womens Health and Gender-based Medicine, 8, 1257–1264.

    CAS  Google Scholar 

  14. Massachusetts Department of Public Health. (2005) Massachusetts births. Available at: http://www.mass.gov/dph/bhsre/resep/resep.htm#birth. Retrieved May 14, 2005.

  15. McNutt, L. A., Wu, C., Xue, X., & Hafner, J. P. (2003). Estimating the relative risk in cohort studies and clinical trials of common outcomes. American Journal of Epidemiology, 157, 940–943.

    Article  PubMed  Google Scholar 

  16. Zhang, J., & Yu, K. (1998). What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA, 280, 1690–1691.

    Article  PubMed  CAS  Google Scholar 

  17. Saadeh, R., & Akré, J. (1996). Ten steps to successful breastfeeding: A summary of the rationale and scientific evidence. Birth, 23, 154–160.

    Article  PubMed  CAS  Google Scholar 

  18. Merewood, A., & Philipp, B. L. (2001). Implementing change: Becoming baby-friendly in an inner city hospital. Birth, 28, 36–40.

    Article  PubMed  CAS  Google Scholar 

  19. Philipp, B. L., Merewood, A., Miller, L. W., Chawla, N., Murphy-Smith, M. M., Gomes, J. S., et al. (2001). Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics, 108, 677–681.

    Article  PubMed  CAS  Google Scholar 

  20. Philipp, B. L., Malone, K. L., Cimo, S., & Merewood, A. (2003). Sustained breastfeeding rates at a US baby-friendly hospital. Pediatrics, 112, 234–236.

    Article  Google Scholar 

  21. Hodnett, E. D., Lowe, N. K., Hannah, M. E., Willan, A. R., Stevens, B., Weston, J. A., et al. (2002). Effectiveness of nurses as providers of birth labor support in North American hospitals: A randomized controlled trial. JAMA, 288, 1373–1381.

    Article  PubMed  Google Scholar 

  22. Lederman, R. P., Lederman, E., Work, B. A., & McCann, D. S. (1978). The relationship of maternal anxiety, plasma catecholemines, and plasma cortisol to progress in labor. American Journal of Obstetrics and Gynecology, 132, 495–500.

    PubMed  CAS  Google Scholar 

  23. Lederman, R. P., Lederman, E., Work, B. A., & McCann, D. S. (1985). Anxiety and epinephrine in multiparous women in labor: Relationship to duration of labor and fetal heart rate pattern. American Journal of Obstetrics and Gynecology, 153, 870–877.

    PubMed  CAS  Google Scholar 

  24. Zuspan, F. P., Cibils, L. A., & Pose, S. V. (1962). Myometrial and cardiovascular responses to alterations in plasma epinephrine and norepinephrine. American Journal of Obstetrics and Gynecology, 84, 841.

    PubMed  CAS  Google Scholar 

  25. Kelly, J. (1962). Effect of fear upon uterine motility. American Journal of Obstetrics and Gynecology, 83, 576.

    PubMed  CAS  Google Scholar 

  26. Rosenblatt, R. A., Dobie, S. A., Hart, G. L., Schneeweiss, R., Gould, D., Raine, T. R., et al. (1997). Interspecialty differences in the obstetric care of low-risk women. American Journal of Public Health, 87, 344–351.

    PubMed  CAS  Google Scholar 

  27. MacDorman, M. F., & Singh, G. K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. Journal of Epidemiology and Community Health, 52, 310–317.

    PubMed  CAS  Google Scholar 

  28. Pallotto, E. K., Collins, J. W., & David, R. J. (2000). Enigma of maternal race and infant birth weight: A population-based study of US-born Black and Caribbean-born Black women. American Journal of Epidemiology, 151, 1080–1085.

    PubMed  CAS  Google Scholar 

  29. Singh, G. K., & Yu, S. M. (1996). Adverse pregnancy outcomes: Differences between US- and foreign-born women in major US racial and ethnic groups. American Journal of Public Health, 86, 837–843.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We acknowledge the support of Dr. Howard Cabral, PhD, MPH, Boston University School of Public Health, as consultant for the statistical analysis. Birth SistersSM is a registered service mark of Urban Midwife Associates and is used with permission. This study was unfunded.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, 91 East Concord Street, Rm 4113, Boston, MA, 02118, USA

    Julie Mottl-Santiago, Catherine Walker, Jean Ewan, Olivera Vragovic & Phillip Stubblefield

  2. Boston Medical Center, Boston, MA, 02118, USA

    Suzanne Winder

Authors
  1. Julie Mottl-Santiago
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean Ewan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivera Vragovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Suzanne Winder
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Phillip Stubblefield
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie Mottl-Santiago.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mottl-Santiago, J., Walker, C., Ewan, J. et al. A Hospital-Based Doula Program and Childbirth Outcomes in an Urban, Multicultural Setting. Matern Child Health J 12, 372–377 (2008). https://doi.org/10.1007/s10995-007-0245-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-007-0245-9

Keywords

search

Navigation