Effects of providing hospital-based doulas in health maintenance organization hospitals

Objective: To evaluate whether providing doulas during hospital-based labor affects mode of delivery, epidural use, breast-feeding, and postpartum per ceptions of the birth, self-esteem, and depression. Methods: This was a randomized study of nullipara enrollees in a group-mode l health maintenance organization who delivered in one of three health main tenance organization-managed hospitals; 149 had doulas, and 165 had usual c are. Study data were obtained from the mothers' medical charts, study intak e forms, and phone interviews conducted 4-6 weeks postpartum. Results: Women who had doulas had significantly less epidural use (54.4% ve rsus 66.1%, P <.05) than women in the usual-care group. They also were sign ificantly (P <.05) more likely to rate the birth experience as good (82.5% versus 67.4%), to feel they coped very well with labor (46.8% versus 28.3%) , and to feel labor had a very positive effect on their feelings as women ( 58.0% versus 43.7%) and perception of their bodies' strength and performanc e (58.0% versus 41.0%). The two groups did not differ significantly in rate s of cesarean, vaginal, forceps, or vacuum delivery, oxytocin administratio n; or breast-feeding, nor did they differ on the postpartum depression or s elf-esteem measures. Conclusions: For this population and setting, labor support from doulas had a desirable effect on epidural use and women's perceptions of birth, but d id not alter need for operative deliveries. (C) 1999 by The American Colleg e of Obstetricians and Gynecologists.)