Proposed Minnesota Public Health Association Resolution:

Endorsing Doula Care for All Birthing Women, Especially Those Receiving Medical Assistance and Minnesota Care

WHEREAS, doulas provide continuous physical and emotional support to women during labor and birth, including support for self-advocacy and informed consent₁₃; and

WHEREAS, doulas often meet with mothers prenatally and postpartum in their homes, where they offer support and resources for all aspects of a woman’s individual perinatal needs and experience_{13, 24}; and

WHEREAS, women who have a doula have up to 50% fewer cesarean sections _{6,7,8,9,23 ;} and

WHEREAS, cesarean sections have been shown to contribute to maternal mortality and morbidity ₃₀ and also to preterm birth₂₂ ; and

WHEREAS, the cesarean rate has increased every year in Minnesota and the United States for the last 13 years, to rates of 25.5 % and 31.4% respectively ₂₈ ; and

WHEREAS, cesarean rates are increasing for all groups of birthing women, regardless of age, the number of babies they are having (multiples), the extent of health problems, their race/ethnicity, or other breakdowns_{24 ;} and

WHEREAS, babies of high risk women supported by a doula prenatally have better birth weights _21,  and fewer NICU admissions _8,9 ; and

WHEREAS, women who have doula care are less likely to give birth with vacuum or forceps, have regional analgesia (e.g. and epidural), have any analgesia (e.g., narcotic pain medication), _{23, 29} or be induced₁₁  thereby reducing the risks, side effects and expense of those interventions;  and

WHEREAS, postpartum depression (PPD) is the number one complication of childbirth affecting an estimated 12-15% of all postpartum women₂₄ (8000-11000 Minnesota women annually); and

WHEREAS, PPD impacts maternal adjustment, attachment and bonding _1,2,,4,5, and breastfeeding ₃, while infants whose mothers are suffering from PPD are more likely to have behavioral, language, and developmental deficits as well as display an increase in depressive symptomology such as irritability, prolonged crying and poor weight gain, ₂₅ ;and

WHEREAS, doula support during pregnancy and labor has been proven to decrease rates of PPD _26,27 ; and  

WHEREAS, women who receive doula care have an enhanced birth experience and self-image _2,3,17 ; and

WHEREAS, in nearly every culture throughout history women have been surrounded and cared for by other women familiar to them during childbirth ₁₂ ; and

WHEREAS, doctors, midwives and nurses have demonstrated appreciation for the extra attention given to their patients and the greater satisfaction expressed by women who were assisted by a doula ₁₄ ; and

WHEREAS, in the State of Minnesota women have a statutory right to doula care if they choose ₃₁ ; and

WHEREAS, low-income women and those without family support benefit most from doula support and benefit most from support persons who are not hospital employees ₂₃.

Therefore, be it resolved that the Minnesota Public Health Association supports legislation and policies that increase access to and funding for doula care.

References

1. Hofmeyr J, Nikodem VC, Wolman WL,Chalmers BE, Kramer T. "Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding," Br J Obstet Gynaecol, 98:756-764, 1991.
2. Wolman WL, Chalmers B, Hofmeyr  J. Nikodem VC. “Postpartum depression and companionship in the clinical birth environment: a randomized, controlled study,” Am J Obstet Gynecol, J 68: 1388-1393, 1993.
3.Langer A, Campero L, Garcia C, Reynoso S. "Effects of Psychosocial support during labour and childbirth on breast feeding, medical interventions and mothers' well-being in a Mexican public hospital: a randomized clinical trial," Br J Obstet Gynaecol, 105:1056-1063, 1998.
4. Martin S, Landry S, Steelman L, Kennell JH, McGrath S. "The effect of doula support during labor on mother-infant interaction at 2 months," Infant Behav Devel, 21:556, 1998.

5. Landry SH, McGrath SK, Kennell JH, Martin S, Steelman L. "The effects of doula support during labor on mother-infant interaction at 2 months," Pediatric Res, 43(4):Part II, 13A, 1998. .
6. Sosa R, Kennell JH, Klaus MH, Robertson S, Urrutia J. "The effect of a supportive companion on perinatal problems, length of labor and mother-infant interaction," N Engl J Med, 303:597-600, 1980.
7. Klaus MH, Kennell JH, Robertson SS; Sosa R. "Effects of social support during parturition on maternal and infant morbidity.” Br Med J, 293:585-587, 1986.
8. Kennell JH, Klaus MH, McGrath SK, Robertson S, Hinkley C. "Continuous emotional support during labor in a US hospital: a randomized controlled trial." JAMA, 265:2197-2201, 1991.
9. Kennell JH, McGrath SK. "Labor support by a doula for middle-income couples: the effect on cesarean rates."  Pediatric Res, 32:12A, 1993.
10.Kennell J H. "The effects of continuous emotional support for couples during labor," Presentation at the first international conference of Doulas of North America; Seattle, WA, July 22,1994..
11.McGrath SK, Kennell JH. "Induction of labor and doula support," Pediatric Res, 43(4): PartII, 14A, 1998.
12. Ashford JI. George Engelmann and Primitive Birth. Janet Isaacs Ashford, Solana Beach, CA, 1988.
13. Doulas of North America; Code of Ethics and Standards of  Practice. DONA, Seattle, WA, 1992.
14. Gilliland AL. “Commentary: nurses, doulas, and childbirth, educators,”  J Perinatal Ed, 7:18-24, 1998.
15. Hodnett ED. "Support from caregivers during childbirth." (Cochrane Review) In the Cochrane Library, Issue 2. Oxford Update Software,1998. Updated quarterly. .
16. Hommel F. "Natural childbirth: Nurses in private practice as monitrices," Amer J of Nursing, 69: 1446-50, 1969.
17. Gordon NP, Walton D, McAdam E, Derman J, Gallitero G, Garrett L. "Effects of providing hospital-based doulas in health maintenance organization hospitals," J Obster Gynecol, 93(3):422-426, 1999.
18., Hodnett ED, Osborn RW."A randomized trial of the effects of monatrice support during labor: mothers' views two to four weeks postpartum," Birth, 16:177-183, 1989.
19. Hodnett ED, Osborn RW. “Effects of continuous intrapartum professional support on childbirth outcomes," Res Nurs Hlth, 12:289-297, 1989.
20. Cogan R, Spinnato JA. "Social support during premature labor: effects on labor and the newborn," J Psychosom Obstet Gynaecol, 8:209-216,1988.

21. Draves, P, Deitrick, LM, Carnot, N. (2002) Examination of the Value of Providing Prenatal Doula Services to Women Receiving Prenatal Health Department Home Visitation Service.  Proceedings of the 130^th Annual Meeting of the APHA (abstract #47842), Philadelphia, PA.
22. Bettegowda VR. “The relationship between cesarean delivery and gestational age among US singleton births,” Clinics in Perinatology, Vol. 35 Issue 2:293-468, June 2008

23. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003766. DOI: 10.1002/14651858. CD003766.pub2

24. Declercq ER, Sakala C, Corry MP, Appleebaum . (2007) Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences.  Journal of Perinatal Education, 16(4), 9-14.

25. Newport DJ, et at. (2002) The treatment of postpartum depression: Minimizing infant exposure. Journal of Clinical Psychiatry, 63(Suppl7), 31-44

26. Keenan P. (2000). Benefits of massage therapy and use of a doula during labor and childbirth. Alternative Therapies Health Medicine, 6, 66-74

27. Klaus MH, Kennell JH (1997). The doula: an essential ingredient of childbirth rediscovered.

Acta Paediatric, 86, 1034-6.

28. Minnesota Department of Health, Minnesota Vital Signs, Vol 3 No 1, January 2007

29.Simkin P, O’Hara M.(2002) Nonpharmacologic relief of pain during labor: Systematic review of five methods.  American Journal of Obstet and Gyn, 186 (Suppl.5),  131-159

30. Childbirth Connection, (2006) online at www.childbirthconnection.org, Vaginal and Cesarean Births: How do the Risks Compare? Booklet summary PDF

31. Minnesota Statutes 2006, section 144.651, subdivision 10,  337.6-337.14 in “Patients Bill of Rights.