Can Doula Birthing Support Reduce the Risk of Stillbirth? Setting a research agenda

Can Doula Birthing Support Reduce the Risk of Stillbirth? Setting a research agenda

James A. McGregor (1,2), Janice I. French (2), Charmaine Carvalho (3), Marti Perhach (1)

(1) Group B Strep International; (2) LA Best Babies Network; (3) Quebec Association of Doulas

Background
Information suggests that doula care during pregnancy may reduce risks of stillbirth (SB). Our objectives were to:
A. Conduct a logic model review and analysis to examine the possibility of doula participation reducing the risk of intrapartum SB
B. Suggest research approaches for measuring the possible benefit of doula support for birthing vs. prenatal or preconception care
C. Review the established benefits of doula care for pregnancy adverse outcomes

Methods
We conducted a logic model analysis. An electronic literature search was conducted using the search terms “doula” and “stillbirth.”

Results
Reviews prior to 2008 suggested multiple benefits of supportive birth attendants providing physical and emotional support for women in labor provided multiple benefits in observational and quasi-experimental studies. Further research reaffirmed these and other benefits employing trained professional doulas. These benefit include reduced necessity of primary cesarean section, shorter labors, reduced use of oxytocin and lower rates of low birth weight and NICU admission along with improved maternal satisfaction and breastfeeding rates.

Conclusions
Current reviews report improvements with doula participation in improved outcomes including more spontaneous births, shorter labors, fewer primary cesarean births and higher APGAR scores. ACOG and SMFA concluded that doula care reduced the risk of primary cesarean section. They concluded, “This resource is probably underutilized.” No studies were found describing adverse effects. Modern hospital care cannot provide the “constant supportive care” that professional doulas intend to provide. Doula birth support is documented to be associated with multiple maternal and neonatal benefits. No information was found regarding SB or fetal death outcomes. A research agenda including large epidemiology-informed studies should be designed and performed to evaluate the effects of doula participation in varied populations.

Ethics statement
No patients were involved. No institutional consent required/obtained.

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