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

Obstet Gynecol. 1999 Mar;93(3):422-6. doi: 10.1016/s0029-7844(98)00430-x.


Objective: To evaluate whether providing doulas during hospital-based labor affects mode of delivery, epidural use, breast-feeding, and postpartum perceptions of the birth, self-esteem, and depression.

Methods: This was a randomized study of nullipara enrollees in a group-model health maintenance organization who delivered in one of three health maintenance organization-managed hospitals; 149 had doulas, and 165 had usual care. Study data were obtained from the mothers' medical charts, study intake forms, and phone interviews conducted 4-6 weeks postpartum.

Results: Women who had doulas had significantly less epidural use (54.4% versus 66.1%, P < .05) than women in the usual-care group. They also were significantly (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 performance (58.0% versus 41.0%). The two groups did not differ significantly in rates of cesarean, vaginal, forceps, or vacuum delivery, oxytocin administration; or breast-feeding, nor did they differ on the postpartum depression or self-esteem measures.

Conclusion: For this population and setting, labor support from doulas had a desirable effect on epidural use and women's perceptions of birth, but did not alter need for operative deliveries.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anesthesia, Epidural / statistics & numerical data
  • Breast Feeding / statistics & numerical data
  • Delivery, Obstetric / statistics & numerical data
  • Female
  • Health Maintenance Organizations
  • Humans
  • Infant, Newborn
  • Labor, Obstetric / psychology*
  • Patient Care / methods*
  • Personnel, Hospital*
  • Postpartum Period / psychology
  • Pregnancy