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Doula Support Vs Epidural Analgesia: Impact on Cesarean Rates

Abstract 84 Clinical Trials in Perinatal Neonatal Medicine Platform, Tuesday, 5/4

Continuous labor support by an experienced woman (doula) has been demonstrated in randomized controlled trials (RCTs) to have a positive effect on perinatal outcome, including reductions in cesarean deliveries and the need for analgesia. Few women in the U.S. choose to have a doula support them through labor and delivery. In contrast, epidural analgesia is administered almost routinely to laboring women in many U.S. hospitals in spite of limited information from RCTs about possible adverse effects. A RCt of 531 low-risk primigravidas was conducted in a large teaching hospital in Houston to compare the perinatal effects of epidural analgesia and continuous doula support. 88% of the patients were Hispanic; 7% were African-American; mean maternal age was 21 yrs; mean maternal education was 9 yrs.; and 79% reported an annual family income <$18,000. At the first indication of pain, patients in the Epidural Group received epidural analgesia; patients in the Control Group first received narcotic medication followed by epidural analgesia if necessary (the hospital's standard protocol for pain relief); and patients in the Doula Group received continuous doula support with narcotic and/or epidural analgesia given when necessary. Patients in the Chart Review Group were enrolled post-delivery and received routine hospital care and pain relief. Patients in the Doula Group had significantly different perinatal outcomes in several important respects, as shown on the table, with lower use of epidural analgesia, less pitocin, fewer mothers developing fever, fewer forceps or vacuum deliveries, and an extremely low number of cesarean deliveries. During post-delivery interviews about the amount of pain experienced before and after intervention (epidural or doula), patients rated the decrease in their pain level as equivalent, whether they received epidural analgesia or were supported by a doula. Epidural analgesia resulted in increased interventions, complications and cesarean deliveries. Continuous doula support was a risk-free intervention that offered adequate pain relief and reduced the need for cesarean delivery.

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McGrath, S., Kennell, J., Suresh, M. et al. Doula Support Vs Epidural Analgesia: Impact on Cesarean Rates. Pediatr Res 45, 16 (1999).

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