The Effect of Doula Support During Labor on Mother-Infant Interaction at 2 Months • 62

The support of an experienced female labor companion (doula) has significant obstetric and perinatal benefits. The continuous presence of a doula during labor results in fewer cesarean and forceps deliveries, less need for analgesia and shorter labors. This study is part of a larger randomized controlled trial of doula support and examines mother-infant (M-I) interaction, infant development and breast feeding 6-9 weeks after delivery.

Primigravida mothers with uncomplicated vaginal deliveries were randomly assigned to a doula (n=33) or one of two no-doula (n=71) groups. A home visit was made when the infant was 2 months of age in order to administer the Bayley Scales of Infant Development-Second Edition (BSID-II) and to observe the mother's interaction with her infant. M-I interaction was scored on a scale of 1-7 that included operational definitions of mother's physical contact, visual attention, and affectionate behaviors toward the child. M-I interaction was assessed at five pre-defined points during the visit: 1) when the examiner entered the mother's house, 2) while a Bayley exam was being set up, 3) while the exam was being scored, 4) during a feeding and 5) while the mother changed the baby. Inter-rater reliability was.91 across two examiners who were blind to group assignment.

Breast feeding practices and scores on the Bayley exam were not related to the social support received by the infant's mother during labor as the means did not differ significantly across the 3 groups. The M-I interaction scores revealed significant differences between the doula-supported and no-doula group of mothers. The doula supported mothers' mean interaction score was significantly higher than the no-doula group of mothers for 4 of 5 observation points (p<.05). Overall, the mean M-I interaction scores of all 5 observation points for the doula and no-doula groups respectively were 5.61 and 4.75 (t=3.66, p<.001).

Overall, results demonstrate that providing a laboring woman with the continuous support of a doula results in a significantly more positive level of interaction with her infant at 2 months after delivery. Questions remain regarding the physiological and/or psychological mechanism that could explain this powerful and long-lasting effect of doula support.

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