Do you doula? An exclusive interview with Dr. John Kennell.

Recently, New Life Journal had the opportunity to speak with the renowned Dr. John Kennell, a pioneer in the field of perinatal healthcare. It was Dr. Kennell (along with his colleague Dr. Marshall Klaus) who introduced the United States to the benefits of having a doula (birth attendant) present during a birth. His near 200 publications reflect a prominent career as a pediatrician, scholar, and most importantly, as an advocate for children and their families. As a Founding Member of the Doulas of North America (DONA) and as Ohio Pediatrician of the Year, many credit Dr. Kennell with revolutionizing maternal and newborn care practices.

NLJ: Dr. Kennell, you are an adamant supporter of doulas, and much of your research has focused on the benefits of having a doula present during the birth process. You are often quoted, having stated: "If a doula were a drug, it would be malpractice not to use it." That's a pretty, strong statement.

Dr. Kennell: Yes it is.

NLJ: Why do you feel doulas are so important?

Dr. Kennell: Up until 100 years ago, mothers almost entirely delivered at home. They were usually in a familiar environment, usually with people they knew very well. There was no separation of mother and baby. The baby was delivered, started breastfeeding, and they just stayed together. In the Twentieth Century, there were big changes, motivated to a great extent by the great problems of infections. Fortunately, antibiotics came along and helped to improve that situation. Then, along came "Twilight Sleep" which was originally thought to be so good. Mothers who had the medication were just wild; they didn't know what they were doing. Their families weren't allowed to see them. So that separated the mother from her family, and separated the baby from its mother. A lot of things happened that took the woman supporting the mother out of the picture. In the 1950s and 1960s, there was a big movement to get away from medication and to get back to more natural childbirth. Mothers were awake and conscious, and many were doing it by natural childbirth. The support for the mother, which had been the nurse up until that point, needed to be replaced. The first thought was that the replacement would be the father, but there was initially a struggle to get the fathers admitted into the labor and delivery areas. But in the 1960s and 1970s, we saw a great increase in the amount of father participation.

NLJ: Why do you think that was?

Dr. Kennell: Oh, I think that was due to mother's wanting to have someone with them. Why I feel so strongly about a doula ... I haven't gotten there yet, have I? [Laughter] When providing the mother with a doula, which is really bringing back an old, old practice, we found that it just made a remarkable difference in the obstetric outcomes. So that's one reason. There are strong suggestions that mothers who have a doula feel much better about themselves and how they did during labor. Mothers think they've got a great baby They think they've got a very clever baby. That they have the most beautiful baby. Essentially, there is a greater enthusiasm. Remarkably, the mothers who have a doula think their relationship with their partner after the birth improved. So, something that makes mothers enthusiastic about their baby and about what they did themselves, that's great.

In the late 1960s, [Dr. Klaus and I] did the bonding study. Back at that time, the practice in almost every medical center was that mothers would have medication. Mothers would deliver their baby. The obstetrician might show the baby to the mother. Then the nurse would bring the baby to the mother six, ten, twelve hours later and would show her that the baby had ten fingers and toes. Often, the mother didn't get to hold the baby at that point. Then the baby would come in every four hours for a twenty-minute feeding. This was terrible thing for breastfeeding.

NIJ: Why did that happen?

Dr. Kennell: Some of the early pediatricians did studies on babies that had died, on how much fluid the stomach could hold. [These pediatricians] figured out that if you gave a certain amount every four hours, it would meet the needs of the baby. There was no paying attention to what the baby wanted. The babies would be ready to eat right away, but they wouldn't get to their mother for twelve hours. Then, the poor baby would cry for hours and would fall asleep, exhausted. Then the baby comes in for twenty minutes, and the mother is trying to get the baby up and get the breastfeeding going. So, in our bonding studies, we wanted to get mothers and babies together within the first hour. The babies had early contact an hour or so after birth mother and baby together. When the babies were a month of age, we had them come back. There was a significant difference in the behavior of the mothers who had that early contact.

There were behaviors of the mother, in that study, that are similar to what I'm talking about with the mothers who have doulas. That keeps me wondering if we haven't done away with a lot of the natural, wonderful behaviors mothers have towards their babies. Modern obstetrics is so high pressure, so rush-rush. So many things for a mother to worry, about.

NLJ: Are doulas able to help encourage mothers to have a natural birth?

Dr. Kennell: Absolutely. Not all doulas appreciate how important they might be [to empowering a birthing mother]. Mothers can have plenty of questions. "What's going to happen next? What did the doctor mean just then?" If it's a fairly long labor, it is very confusing to mothers where they stand. Are they making reasonable progress? Things like that. A doula is not just present to lessen pain. Actually, a doula has a similar effect as an epidural. Just to qualify, that a bit: by mothers being more relaxed, they don't see the same pain or pressure. By that relaxation, comfort and assurance mothers get from a doula, it has almost the same effect as an epidural.

NIJ: So doulas are able to help not only through their use of pain management techniques but also by giving emotional support. They're useful for all different types of births then?

Dr. Kennell: So why doesn't everyone have one? Doulas don't seem to fit in with obstetrician's ideas about birthing. While they go 'along with it, they're not strongly talking to the mothers about how valuable it can be. There are exceptions. Doulas that have been effective have been ones that were hired by the mother. They are independent contractors. [Although] there are doulas who work for no charge at all, the fact that there is a charge is important to families these days, so that's a factor. And if your obstetrician isn't saying this is a very desirable thing, that pushes the mother a certain way.

NLJ: Are doulas a replacement for family?

Dr. Kennell: The labor and delivery area really isn't like an intensive care area. It really isn't like an open heart surgery area. But there are a lot of machines around. There are a lot of things that are baffling to parents. The great majority of fathers want to do everything they can to support their wife. I do want to support fathers, but they really are not well prepared. We've compared fathers to doulas, and their patterns are very different. A doula has a number of things that the average father doesn't have (because of her training).

NLJ: Can doulas help to encourage fathers to participate?

Dr. Kennell: It's important to emphasize that a great many fathers have an image that this [birth] is going to be a wonderful, little, private affair for himself and his partner. So they bring their music, their pictures, all sorts of things. With that expectation, many fathers say, "No, we don't want a doula." In our studies, we would have fathers who would say, "I'm going to be there with my wife. We'll be fine." A month later when they got to the hospital in labor, I got many frantic calls. "Can we get a doula? Can we get a doula?" Of course at that point, it's too late. The response upon its is much better than I ever thought it would be. The mothers and fathers are very, very, positive about their experiences with a doula.

Emily Ray is a freelance writer in Atlanta, GA and a frequent contributor to New Life Journal. Dr. Kennell will be a featured speaker at the upcoming Asheville Birth Conference, "Nurturing the Birth of a New Family," on April 2-4, 2004. For more information on the Asheville Birth Conference, call 828-250-5290 or visit www.buncombe.org/abc/