In a randomized controlled trial (RCT) of childbirth pain relief methods, 45 women who received epidural analgesia and 39 women received continuous labor support by a woman companion (doula) were asked to evaluate their pain levels at three different times. Healthy primigravidas used a 100 mm visual analog scale to rate their labor pain from no pain to maximum pain at the following times: 1) before receiving pain relief intervention (epidural analgesia or doula support), 2) after pain relief intervention and 3) 24 hours after vaginal delivery. A similar scale was used to indicate how well they were able to cope with their pain.

With all subjects combined, pain was rated highest (mean = 62.0 mm) before the pain relief intervention, significantly less after the intervention (mean= 36.5 mm), and significantly less again 24 hours after delivery (mean = 18.0 mm) (p<.001). More importantly, when the pain evaluations from women in the doula group were compared to those from women in the epidural group, the two groups experienced equivalent levels of pain at all three measurement points(p = N.S.). Thus, laboring women supported by a doula (with no analgesic medication) experienced the same levels of pain as women who received epidural analgesia, both during and after labor. Additionally there were no significant differences (p = N.S.) in a laboring woman's ability to cope with pain whether she had an epidural or the continuous emotional support of an experienced doula.

Physicians, midwives and consumers should consider these results when choosing obstetric pain relief. Doula support is an effective, risk-free, non-pharmacologic, and less expensive pain management technique when compared to the epidural. In addition to benefits for the newborn and for early mother-infant interaction, doula support has shortened labor and decreased the need for cesarean delivery in seven RCTs.