DOULAS CONTRIBUTIONS TO THE MODERN OBSTETRICS
L.1 Verónica Valdés, Ximena Morley H.1
1Department of Family Medicine, School of Medicine, Catholic University of Chile .
[...]
L.1 Verónica Valdés, Ximena Morley H.1
1Department of Family Medicine, School of Medicine, Catholic University of Chile .
[...]
is
INTRODUCTION defined as doula accompanies the woman to pregnant women during labor and delivery, providing ongoing emotional support. Having this company is an ancient practice that still persists in many primitive cultures. There are 128 cultural anthropological studies of hunter-gatherer or agricultural areas, where 127 have the emotional support of other women during childbirth (1). Upon moving to hospital births, this important component was removed and for many years, women have had to have their deliveries with occasional support from various members of the health team. Only in recent decades, has been allowing the father's presence at birth, but it still does not is a universal practice. Even now, few women are constantly accompanied by a woman who is dedicated to make you feel good during labor and delivery.
25 years, Klaus et al. (1) were observed and investigated the case with the presence of a woman who offers "continuous emotional support" during labor and delivery. To date there have been more than 5000 women in 16 randomized controlled trials (ERC) showing reduced duration of labor, the need for anesthesia or analgesia, and incidence of caesarean section, featuring more natural childbirth.
DOULA THE PRESENCE OF REDUCING THE DURATION OF LABOR
In 3 studies made under different scenarios, as in Guatemala (2, 3) and Houston (4), we observed that the presence of a doula reduces the duration of labor significantly. On the other hand Zhang et al (5) in a meta-analysis of 7 randomized controlled trials involving low-income primigravidae in public hospitals, which did not allow the presence of family, a reduction of labor time of 2.8 hours (95% [CI] 2.2 to 3.4).
DOULA THE PRESENCE OF REDUCING THE NEED FOR ANESTHESIA OR ANALGESIA
A Kennell JRT et al. (4) with doulas trained women were divided into 3 groups, one receiving the support of the doula, another who had the constant presence of another woman in the room, but which was not allowed to talk to the mother and a control group without the permanent presence of another woman. Women were asked about their pain and anesthesia if they needed periodically. 7.8% of those accompanied by a doula, 22.6% of which were observed and only 55% of women with standard management (health professionals attending to several women and allowing occasional visits from relatives), chose epidural anesthesia. Hodnett et al (6), in a Cochrane systematic review, reviewed 6 trials comparing the presence of a doula with the current management and use of regional analgesia / anesthesia (n = 10,048, relative risk (RR) = 0.90, 95% confidence interval (CI) 0.81 to 0.9) and 11 trials using any type of analgesia or anesthesia (n = 11,051, RR = 0.87, 95% CI = 0 ,79-0, 96). It was observed that the presence of a doula reduces the use of anesthesia or analgesia.
The continued presence of a doula reduces the incidence of CESARES
In the study by Zhang et al (5) above, we found a lower incidence of cesarean sections among women accompanied by doulas (RR = 0.54, 95% CI = 0.4 to 0.7). In the meta-analysis of Scott et al (7) found a 51% reduction in caesarean sections, significant only when the presence of the doula is continuous, not when it is intermittent. Hodnett et al (6), including both continuous and intermittent support, showed a lower incidence of caesarean sections in women with doulas in 15 ERC (n = 12,791, RR = 0.90, 95% CI 0.82 to 0.99) .
NATURAL BIRTHS ARE FREQUENTLY IN WOMEN WHO HAVE THE PRESENCE OF A
DOULA natural childbirth is considered to occur vaginally, without oxytocin, anesthesia, analgesia or forceps. In the ERC developed in Houston (3) found that 12% of women with the current management had a natural birth compared to 55% of those who had the support of a doula. Hodnett et al (6), found a greater likelihood of spontaneous vaginal delivery in 14 ERC (n = 12,757, RR = 1.08, 95% CI = 1.04 to 1.13).
AND LONG-TERM PSYCHOLOGICAL EFFECTS ON WOMEN IN THE PRESENCE OF A
DOULA Childbirth is one of the few experiences in the life of a woman who can make so deeply, positively or negatively, because it is a very sensitive period in the that it is open to change. The care you receive it and your child has long-term impact on their self-esteem, your relationship, how you will care for your child and their welfare (1). A growing body of information that supports what has been called "sensitive periods." During this period the mother is particularly open to improving their future relationship with the child care and depending on the surrounding environment during delivery. Studies have shown that caring for the mother and child, affectionate, custom and practices in the Baby Friendly Hospital Initiative on Maternal, such as the remaining skin to skin, breastfeeding within the first hour, room together, breastfeeding on demand and possibly the father's presence during childbirth, have resulted in lower abandonment of newborns in the hospital (8), decreased rates of child abuse (9), breastfeeding more successful during the first year and greater involvement of fathers in child care. Simkin and Ancheta (10) showed that the memory of labor is still alive in women at least 20 years and that these memories are determined by the care provided by those around her rather than by delivery. For example, a vaginal delivery, quick and simple could be remembered negatively if the woman was left alone and did not know what was going on, on the contrary, prolonged labor, complicated, and could even have ended in cesarean section could be remembered as a very positive experience if he was accompanied, informed and respected. The continued presence of the doula can make the difference in experience and memory of women (10).
One of the few publications on the long-term effects of the presence of a doula is a Hofmeyer JRT et al (11) in Johannesburg with 198 mothers. Half of them were accompanied by doulas in the community that they are trained to give emotional support to mothers. The doula group, compared with the standard management group showed significant positive differences when interviewed 24 hours after birth in the following areas: lower score on the test anxiety level, fewer women felt a high level of pain during childbirth , the index much lower total pain. The same study interviewed the mothers 6 weeks after and significant differences were as follows: consider that it is easy to become mothers, are handled well with newborns are breastfed, have flexible hours to breastfeed. Wolman et al (12) analyzed in the same study, rates of depression at 6 weeks postpartum, found that women with doula indices were highly significant positive self-esteem compared with usual care, and practice tests for depression ( Pitt Depression Inventory and the Edinburgh Scale) the results were also highly significant, noting that those who had a doula had a lower total score, none had a high score and had significantly lower risk of depression score.
In Chile there are two experiences with doulas (13, 14). The first, held at the JJ Aguirre Hospital that underwent a randomized controlled In order to evaluate the impact of the doula in the cesarean rate, the degree of satisfaction with the experience of childbirth, breastfeeding and postpartum depression at 6 weeks postpartum in primiparous. The results of this study showed no significant difference in the percentage of caesarean sections, but a higher proportion of mothers in the intervention group had less fear during childbirth (RR: 0.79, CI 0.63 to 0.99) and higher percentage of exclusive breastfeeding at six months (13). The second experience in Chile, is the project in the commune of La Florida called "Mama Embark, an initiative that aims to provide support to pregnant teens in psycho-social risk. This program is from 2001 and is accompanying psycho, training and education to teenage pregnancy and until the child turns one year old, given by trained volunteers and the support during delivery of most of them by a community doula chosen by the teenager. So far preliminary results show an incidence of cesarean sections 12% of teenagers in a period when the hospital's cesarean rate is over 20%. The percentage of exclusive breastfeeding at six months among these adolescents is 68% (14). FEATURES
DOULA will review and discuss some of the characteristics required of a "doula" and its function:
1. Being a woman: Anthropological studies show that women who came during the birth process is always a woman. Taylor et al (15) suggest that the female response to stress, unlike the male is "fight or flight" is the tendency to group or association and care. This contact, especially if another woman, reduce your stress level.
For a woman, birth, in a place with strangers, is a situation that creates fear and stress. This results in release of catecholamines, which can slow labor, reduce blood flow to the uterus, placenta and fetus, and changes fetal heart rate. All this can lead to the need for increased medical interventions (10). The presence of a woman who says she will stay by his side, who cares about their welfare and acts as an intermediary with the health team, reduces the level of fear and stress. What woman
best served as a doula? Rosen (16) A review of RCTs in the literature to observe the effect of different types of doulas described by the authors: women of the community, untrained, trained doula, mother's female relatives, nurses and midwives. Found that in a hospital environment that do not permit the presence of family, women who were accompanied by volunteers community, untrained, had the most impressive benefits: a significant reduction in the duration of labor, use of oxytocin, and operative deliveries, compared with a control group without the support (2, 3).
In the study by Klaus et al. (3) above, even though the size of the study, some results were not statistically significant, positive effects were found in both accompanied and observed, with the largest gains among that accompanied observed. This reinforces the concept of calming effect produced by the permanent presence of another woman during labor.
2. Continuous presence until after Childbirth: The continued presence is the most important aspect of care that offers the doula. In a meta-analysis of 11 ERC, Scott et al (7) found that the continued presence of a doula has an impact significantly different from the intermittent presence. When analyzing the intermittent presence of emotional support found no significant results. Noting the continued presence of a doula, found a 36% reduction of the need for analgesia, 71% of the need for oxytocin, 57% reduction in forceps delivery and 51% lower incidence of cesarean section with reduced the duration of labor of 98 minutes when compared to standard management.
3. Support: The doula offers unconditional support, one by one, without judging, congratulating the women for their achievements, dares to touch, massage, as it is comfortable and acceptable to the mother and uses words with great delicacy and care. The doula's role is only to provide emotional support, be present in every woman needs to allow you to star in that crucial moment of his life so this is a positive experience. While the publications show a range in the variety of doulas, the capacity of these centers on unconditional acceptance of women, care with language, always using positive words and can use relaxation techniques. Also learn techniques for pain management such as massage, pressure point movements that help to mobilize the fetus through the birth canal and environmental management (light level, aromas, music). In situations with presence of many relatives, which is privately doula refers to the mother if you need regular visits, which shows the parent or other guests to how to help and respect Mother (1). The doula is committed to staying with the mother throughout the birth process, regardless of the duration of this. This certainly gives women an incalculable security, reducing the stress level.
4. Supports both the woman and your partner: A common question that arises when you mention the emotional and the doula is if the parent can provide the same emotional support. The answer is no. And you can not do that is emotionally involved. Stein et al (17) presented a case where the couple classic question in a prenatal consultation on doulas. Both have doubts about whether the presence of this stranger is going to interfere with an experience as personal as is delivery. When they return after the birth of the child, the father expresses the positive experience with the doula and how it helped him that he could accompany and help his wife. ERC
In comparing the father's presence with and without doula shows that the cesarean rate was 14.2% among those counted doula compared with those who were alone with your partner which was 22.5% (18).
5. Establishes a link between the health team and women: Explaining what's going on and communicating the needs of women health personnel. Of things that scare a woman during the birth process is not knowing what is going on, not understanding what the experts speak. The doula is who plays in the language of women, what is happening and asks questions she does not dare to do. When a doula or doula program appears in a hospital, this is often viewed with suspicion by health personnel, fearing encroachment on their roles, but to begin to experience the help that they offer pampering doulas, valued and requested the (17). In a hospital with a lot of workload, this facilitates the task of health workers who can not remain alone with a mother. CONCLUSION
Few obstetric interventions supported by evidence, they have many benefits as the continued presence of a doula and are increasingly institutions, which knew the benefits include a program of doulas in your services. BIBLIOGRAPHY
1. Klaus MH, Kennel JH, Klaus PH. The Doula Book. Perseus Publishing, 2002, ISBN 0-7389-0609-1.
2. Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J. The effect of a Supportive Companion on Perinatal Problems, length of labor, and mother-infant interaction. N Engl J Med 1980, 303 (11): 597-600.
3. Klaus MH, Kennell JH, Robertson SS, Sosa R. Effects of social support during parturition on maternal and infant morbidity. Br Med J (Clin Res Ed). 1986; 293(6547): 585-7.
4. Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991; 265(17): 2197-201.
5. Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labor support from labor attendant for primiparous women: a meta-analysis. Obstet Gynecol 1996; 88(4 Pt 2): 739-44.
6. Hodnett ED, Lowe NK, Hannah ME, Willan AR, Stevens B, Weston JA, et al. Nursing Supportive Care in Labor Trial Group. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.JAMA 2002; 288(11): 1373-81.
7. Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol 1999; 180(5): 1054-9.
8. Lvoff NM, Lvoff V, Klaus MH. Effect of the baby-friendly initiative on infant abandonment in a Russian hospital. Arch Pediatr Adolesc Med 2000; 154(5): 474-7.
9. O'Conner S, Vietze PM, Sherrod KB et al. Reduced incidence of parenting inadequacy following rooming-inn. Pediatrics 1980; 66: 176-92.
10. Simkin P, Ancheta RS. Labor Progress Handbook. Blackwell, Malden MA 2000.
11. Hofmeyer GJ, Nykodem VC, Wolman W et al. Companionship to modify the clinical birth environment: Effect on progress and Perceptions of work and breastfeeding. Br Obstet Gynecol 1991; 98: 756-64.
12. Wolman WL, Chalmers B, Hofmeyr GJ et al. Postpartum depression and companionship in the clinical environment: A randomized, controlled study. Am J Obstet Gynecol 1993; 168: 1380-93.
13. Torres J, Kopplin E, Peña V, Klaus M, Salinas R, Herrera M. Impact of emotional support during labor in reducing cesarean and gratification of the process. Rev Chil Obstet Ginecol 1999, 64 (5): 405-12.
14. Cabezas A, Kopplin E, Pugin E, Larrain C, Palma P, Gonzalez M. Accompanying program psycho pregnant adolescents at risk. Rev Pediatrics Día 2003; 19(5): 41-45.
15. Taylor E, Klein LC, Lewis BP, Grunewald TL et al. Biobehaviorial responses to stress in females: Tend and Befriend, Not Flight-or-Fight. Psychological Rev 2000; 107(3): 411-29.
16. Rosen P. Supporting women in labor: analysis of different types of caregivers. J Midwifery Womens Health 2004; 49(1): 24-31.
17. Stein MT, Kennell JH, Fulcher A. Benefits of a doula present at the birth of a child. J Dev Behav Pediatr 2003; 24(3): 195-8. 18. Kennell JH, Mc Grath SK. Labor support by a doula for middle-income couples. The effect on cesarean rates. Pediatric Res, 1993; 33: 12A.
INTRODUCTION defined as doula accompanies the woman to pregnant women during labor and delivery, providing ongoing emotional support. Having this company is an ancient practice that still persists in many primitive cultures. There are 128 cultural anthropological studies of hunter-gatherer or agricultural areas, where 127 have the emotional support of other women during childbirth (1). Upon moving to hospital births, this important component was removed and for many years, women have had to have their deliveries with occasional support from various members of the health team. Only in recent decades, has been allowing the father's presence at birth, but it still does not is a universal practice. Even now, few women are constantly accompanied by a woman who is dedicated to make you feel good during labor and delivery.
25 years, Klaus et al. (1) were observed and investigated the case with the presence of a woman who offers "continuous emotional support" during labor and delivery. To date there have been more than 5000 women in 16 randomized controlled trials (ERC) showing reduced duration of labor, the need for anesthesia or analgesia, and incidence of caesarean section, featuring more natural childbirth.
DOULA THE PRESENCE OF REDUCING THE DURATION OF LABOR
In 3 studies made under different scenarios, as in Guatemala (2, 3) and Houston (4), we observed that the presence of a doula reduces the duration of labor significantly. On the other hand Zhang et al (5) in a meta-analysis of 7 randomized controlled trials involving low-income primigravidae in public hospitals, which did not allow the presence of family, a reduction of labor time of 2.8 hours (95% [CI] 2.2 to 3.4).
DOULA THE PRESENCE OF REDUCING THE NEED FOR ANESTHESIA OR ANALGESIA
A Kennell JRT et al. (4) with doulas trained women were divided into 3 groups, one receiving the support of the doula, another who had the constant presence of another woman in the room, but which was not allowed to talk to the mother and a control group without the permanent presence of another woman. Women were asked about their pain and anesthesia if they needed periodically. 7.8% of those accompanied by a doula, 22.6% of which were observed and only 55% of women with standard management (health professionals attending to several women and allowing occasional visits from relatives), chose epidural anesthesia. Hodnett et al (6), in a Cochrane systematic review, reviewed 6 trials comparing the presence of a doula with the current management and use of regional analgesia / anesthesia (n = 10,048, relative risk (RR) = 0.90, 95% confidence interval (CI) 0.81 to 0.9) and 11 trials using any type of analgesia or anesthesia (n = 11,051, RR = 0.87, 95% CI = 0 ,79-0, 96). It was observed that the presence of a doula reduces the use of anesthesia or analgesia.
The continued presence of a doula reduces the incidence of CESARES
In the study by Zhang et al (5) above, we found a lower incidence of cesarean sections among women accompanied by doulas (RR = 0.54, 95% CI = 0.4 to 0.7). In the meta-analysis of Scott et al (7) found a 51% reduction in caesarean sections, significant only when the presence of the doula is continuous, not when it is intermittent. Hodnett et al (6), including both continuous and intermittent support, showed a lower incidence of caesarean sections in women with doulas in 15 ERC (n = 12,791, RR = 0.90, 95% CI 0.82 to 0.99) .
NATURAL BIRTHS ARE FREQUENTLY IN WOMEN WHO HAVE THE PRESENCE OF A
DOULA natural childbirth is considered to occur vaginally, without oxytocin, anesthesia, analgesia or forceps. In the ERC developed in Houston (3) found that 12% of women with the current management had a natural birth compared to 55% of those who had the support of a doula. Hodnett et al (6), found a greater likelihood of spontaneous vaginal delivery in 14 ERC (n = 12,757, RR = 1.08, 95% CI = 1.04 to 1.13).
AND LONG-TERM PSYCHOLOGICAL EFFECTS ON WOMEN IN THE PRESENCE OF A
DOULA Childbirth is one of the few experiences in the life of a woman who can make so deeply, positively or negatively, because it is a very sensitive period in the that it is open to change. The care you receive it and your child has long-term impact on their self-esteem, your relationship, how you will care for your child and their welfare (1). A growing body of information that supports what has been called "sensitive periods." During this period the mother is particularly open to improving their future relationship with the child care and depending on the surrounding environment during delivery. Studies have shown that caring for the mother and child, affectionate, custom and practices in the Baby Friendly Hospital Initiative on Maternal, such as the remaining skin to skin, breastfeeding within the first hour, room together, breastfeeding on demand and possibly the father's presence during childbirth, have resulted in lower abandonment of newborns in the hospital (8), decreased rates of child abuse (9), breastfeeding more successful during the first year and greater involvement of fathers in child care. Simkin and Ancheta (10) showed that the memory of labor is still alive in women at least 20 years and that these memories are determined by the care provided by those around her rather than by delivery. For example, a vaginal delivery, quick and simple could be remembered negatively if the woman was left alone and did not know what was going on, on the contrary, prolonged labor, complicated, and could even have ended in cesarean section could be remembered as a very positive experience if he was accompanied, informed and respected. The continued presence of the doula can make the difference in experience and memory of women (10).
One of the few publications on the long-term effects of the presence of a doula is a Hofmeyer JRT et al (11) in Johannesburg with 198 mothers. Half of them were accompanied by doulas in the community that they are trained to give emotional support to mothers. The doula group, compared with the standard management group showed significant positive differences when interviewed 24 hours after birth in the following areas: lower score on the test anxiety level, fewer women felt a high level of pain during childbirth , the index much lower total pain. The same study interviewed the mothers 6 weeks after and significant differences were as follows: consider that it is easy to become mothers, are handled well with newborns are breastfed, have flexible hours to breastfeed. Wolman et al (12) analyzed in the same study, rates of depression at 6 weeks postpartum, found that women with doula indices were highly significant positive self-esteem compared with usual care, and practice tests for depression ( Pitt Depression Inventory and the Edinburgh Scale) the results were also highly significant, noting that those who had a doula had a lower total score, none had a high score and had significantly lower risk of depression score.
In Chile there are two experiences with doulas (13, 14). The first, held at the JJ Aguirre Hospital that underwent a randomized controlled In order to evaluate the impact of the doula in the cesarean rate, the degree of satisfaction with the experience of childbirth, breastfeeding and postpartum depression at 6 weeks postpartum in primiparous. The results of this study showed no significant difference in the percentage of caesarean sections, but a higher proportion of mothers in the intervention group had less fear during childbirth (RR: 0.79, CI 0.63 to 0.99) and higher percentage of exclusive breastfeeding at six months (13). The second experience in Chile, is the project in the commune of La Florida called "Mama Embark, an initiative that aims to provide support to pregnant teens in psycho-social risk. This program is from 2001 and is accompanying psycho, training and education to teenage pregnancy and until the child turns one year old, given by trained volunteers and the support during delivery of most of them by a community doula chosen by the teenager. So far preliminary results show an incidence of cesarean sections 12% of teenagers in a period when the hospital's cesarean rate is over 20%. The percentage of exclusive breastfeeding at six months among these adolescents is 68% (14). FEATURES
DOULA will review and discuss some of the characteristics required of a "doula" and its function:
1. Being a woman: Anthropological studies show that women who came during the birth process is always a woman. Taylor et al (15) suggest that the female response to stress, unlike the male is "fight or flight" is the tendency to group or association and care. This contact, especially if another woman, reduce your stress level.
For a woman, birth, in a place with strangers, is a situation that creates fear and stress. This results in release of catecholamines, which can slow labor, reduce blood flow to the uterus, placenta and fetus, and changes fetal heart rate. All this can lead to the need for increased medical interventions (10). The presence of a woman who says she will stay by his side, who cares about their welfare and acts as an intermediary with the health team, reduces the level of fear and stress. What woman
best served as a doula? Rosen (16) A review of RCTs in the literature to observe the effect of different types of doulas described by the authors: women of the community, untrained, trained doula, mother's female relatives, nurses and midwives. Found that in a hospital environment that do not permit the presence of family, women who were accompanied by volunteers community, untrained, had the most impressive benefits: a significant reduction in the duration of labor, use of oxytocin, and operative deliveries, compared with a control group without the support (2, 3).
In the study by Klaus et al. (3) above, even though the size of the study, some results were not statistically significant, positive effects were found in both accompanied and observed, with the largest gains among that accompanied observed. This reinforces the concept of calming effect produced by the permanent presence of another woman during labor.
2. Continuous presence until after Childbirth: The continued presence is the most important aspect of care that offers the doula. In a meta-analysis of 11 ERC, Scott et al (7) found that the continued presence of a doula has an impact significantly different from the intermittent presence. When analyzing the intermittent presence of emotional support found no significant results. Noting the continued presence of a doula, found a 36% reduction of the need for analgesia, 71% of the need for oxytocin, 57% reduction in forceps delivery and 51% lower incidence of cesarean section with reduced the duration of labor of 98 minutes when compared to standard management.
3. Support: The doula offers unconditional support, one by one, without judging, congratulating the women for their achievements, dares to touch, massage, as it is comfortable and acceptable to the mother and uses words with great delicacy and care. The doula's role is only to provide emotional support, be present in every woman needs to allow you to star in that crucial moment of his life so this is a positive experience. While the publications show a range in the variety of doulas, the capacity of these centers on unconditional acceptance of women, care with language, always using positive words and can use relaxation techniques. Also learn techniques for pain management such as massage, pressure point movements that help to mobilize the fetus through the birth canal and environmental management (light level, aromas, music). In situations with presence of many relatives, which is privately doula refers to the mother if you need regular visits, which shows the parent or other guests to how to help and respect Mother (1). The doula is committed to staying with the mother throughout the birth process, regardless of the duration of this. This certainly gives women an incalculable security, reducing the stress level.
4. Supports both the woman and your partner: A common question that arises when you mention the emotional and the doula is if the parent can provide the same emotional support. The answer is no. And you can not do that is emotionally involved. Stein et al (17) presented a case where the couple classic question in a prenatal consultation on doulas. Both have doubts about whether the presence of this stranger is going to interfere with an experience as personal as is delivery. When they return after the birth of the child, the father expresses the positive experience with the doula and how it helped him that he could accompany and help his wife. ERC
In comparing the father's presence with and without doula shows that the cesarean rate was 14.2% among those counted doula compared with those who were alone with your partner which was 22.5% (18).
5. Establishes a link between the health team and women: Explaining what's going on and communicating the needs of women health personnel. Of things that scare a woman during the birth process is not knowing what is going on, not understanding what the experts speak. The doula is who plays in the language of women, what is happening and asks questions she does not dare to do. When a doula or doula program appears in a hospital, this is often viewed with suspicion by health personnel, fearing encroachment on their roles, but to begin to experience the help that they offer pampering doulas, valued and requested the (17). In a hospital with a lot of workload, this facilitates the task of health workers who can not remain alone with a mother. CONCLUSION
Few obstetric interventions supported by evidence, they have many benefits as the continued presence of a doula and are increasingly institutions, which knew the benefits include a program of doulas in your services. BIBLIOGRAPHY
1. Klaus MH, Kennel JH, Klaus PH. The Doula Book. Perseus Publishing, 2002, ISBN 0-7389-0609-1.
2. Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J. The effect of a Supportive Companion on Perinatal Problems, length of labor, and mother-infant interaction. N Engl J Med 1980, 303 (11): 597-600.
3. Klaus MH, Kennell JH, Robertson SS, Sosa R. Effects of social support during parturition on maternal and infant morbidity. Br Med J (Clin Res Ed). 1986; 293(6547): 585-7.
4. Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991; 265(17): 2197-201.
5. Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labor support from labor attendant for primiparous women: a meta-analysis. Obstet Gynecol 1996; 88(4 Pt 2): 739-44.
6. Hodnett ED, Lowe NK, Hannah ME, Willan AR, Stevens B, Weston JA, et al. Nursing Supportive Care in Labor Trial Group. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.JAMA 2002; 288(11): 1373-81.
7. Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol 1999; 180(5): 1054-9.
8. Lvoff NM, Lvoff V, Klaus MH. Effect of the baby-friendly initiative on infant abandonment in a Russian hospital. Arch Pediatr Adolesc Med 2000; 154(5): 474-7.
9. O'Conner S, Vietze PM, Sherrod KB et al. Reduced incidence of parenting inadequacy following rooming-inn. Pediatrics 1980; 66: 176-92.
10. Simkin P, Ancheta RS. Labor Progress Handbook. Blackwell, Malden MA 2000.
11. Hofmeyer GJ, Nykodem VC, Wolman W et al. Companionship to modify the clinical birth environment: Effect on progress and Perceptions of work and breastfeeding. Br Obstet Gynecol 1991; 98: 756-64.
12. Wolman WL, Chalmers B, Hofmeyr GJ et al. Postpartum depression and companionship in the clinical environment: A randomized, controlled study. Am J Obstet Gynecol 1993; 168: 1380-93.
13. Torres J, Kopplin E, Peña V, Klaus M, Salinas R, Herrera M. Impact of emotional support during labor in reducing cesarean and gratification of the process. Rev Chil Obstet Ginecol 1999, 64 (5): 405-12.
14. Cabezas A, Kopplin E, Pugin E, Larrain C, Palma P, Gonzalez M. Accompanying program psycho pregnant adolescents at risk. Rev Pediatrics Día 2003; 19(5): 41-45.
15. Taylor E, Klein LC, Lewis BP, Grunewald TL et al. Biobehaviorial responses to stress in females: Tend and Befriend, Not Flight-or-Fight. Psychological Rev 2000; 107(3): 411-29.
16. Rosen P. Supporting women in labor: analysis of different types of caregivers. J Midwifery Womens Health 2004; 49(1): 24-31.
17. Stein MT, Kennell JH, Fulcher A. Benefits of a doula present at the birth of a child. J Dev Behav Pediatr 2003; 24(3): 195-8. 18. Kennell JH, Mc Grath SK. Labor support by a doula for middle-income couples. The effect on cesarean rates. Pediatric Res, 1993; 33: 12A.
