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The Human Touch: Nurse, Midwife and Doula

Continuous support during labor has clinically meaningful benefits for women and infants and no known harm

 

The Cochrane Collaboration conducted the study “Continuous Support for Women During Childbirth” in 2011 and concluded that:

“Continuous support during labor has clinically meaningful benefits for women and infants and no known harm.  All women should have support throughout labor and birth.”

This study clearly shows the emotional and mental benefits of having a close, intimate relationship with a professional before and during childbirth. The above study demonstrated that women receiving continuing support were most likely to give birth spontaneously and had a shorter labor. The role of mid-wife and doula in providing that extra human touch is therefore seen in easier pregnancies and births. Results for both mid-wife and doula successful labors are well-documented.

Additionally, according to the above study, women with continuous support used less pain medication and experienced slightly shorter labor. Their babies were also less likely to have low five-minute Apgar scores.

Nurse as Mid-wife

The midwife is a pregnant woman’s primary health care provider. As such her primary responsibility is focused on the health of the mother and her baby. A midwife’s relationship with the mother starts early in the pregnancy, where the goal is to become a partner in comfort and care rather than a mere provider of medical intervention.

The relationship that develops over the course of the pregnancy for many months contributes greatly to the emotional well-being and confidence of the expectant mother. Often the midwife can spend more time with the expecting mother than a doctor.

Once the birthing process begins, and perhaps most important, a mid-wife is more willing to allow the process of childbirth to proceed at the mother’s natural pace than an OB-Gyn.  This equates to less medical intervention and less dissatisfaction on the part of the mother.

A 2009 study in the Canadian Medical Association Journal compared midwife assisted home births, midwife assisted hospital births, and physician attended hospital births.  The study found the following mortality rate per 1,000 births:

  • 0.35 in the home birth group
  • 0.57 in the midwife assisted hospital births, and
  • 0.64 in the doctor assisted hospital births.

Doula

In a hospital setting, a mid-wife’s other responsibilities may keep her from devoting exclusive attention to a single expecting mother.  She may have a number of expectant mothers to attend to or her shift may end before one of her mother’s gives birth.  But more importantly, her attention must stay focused on the health of the mother and the baby.

This is where the emotional support of a doula comes into play.  Her role is a very intimate one.  With no clinical role to play in childbirth, her focus is solely on the welfare of the mother. 

The authors of another Cochrane Collaboration study, published by the Maternity Center Association in New York in 2003 reported that women using doulas were:

  • 26% less likely to give birth by cesarean
  • 28% less likely to use any anesthesia
  • 41% less likely to give birth utilizing vacuum extraction or forceps
  • 33% less likely to be dissatisfied with their birthing experience

The evidence clearly shows that women receiving continuous labor support fare better than their counterparts without such available assistance.  Historically, women have always been attended to and closely supported by other women during labor and birth.  Only in recent history has this trend become the exception rather than the norm.

About the Author:

Kathryn Norcutt has been an active member of the health care community for over 20 years.  During her time as a nurse, she has helped people from all walks of life and ages.  Now, Kathryn leads a much less hectic life and devotes most of her free time to writing for RNnetwork, a site specializing in pediatric travel nursing.

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