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Emotional aid delivers labor-saving results.

An expectant mother entering a modern hospital collides head-on with hightech medicine. During labor and delivery, she stands a good chance of getting intravenous infusions, injections of medications that facilitate labor and reduce pain, continuous electrode monitoring of her unborn child and, perhaps, a forceps delivery or a cesarean section.

But a new study demonstrates for the first time in a fully equipped hospital that old-fashioned, one-to-one emotional support throughout labor substantially decreases cesarean-section rates, forceps deliveries, the duration of labor and the use of anesthetics and labor-inducing drugs. Moreover, this low-tech emotional support -- provided by women who have already experienced a normal labor -- reduces maternal and infant hospital stays following delivery, according to a report in the May 1 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

If U.S. hospitals routinely offered consistent emotional support during labor, using technological interventions as back-ups, annual savings could reach $2 billion, asserts study director John Kennell of Case Western Reserve University in Cleveland.

Kennell's team studied 616 women, age 13 to 34, undergoing labor and delivery at a public hospital in Houston. The women had full-term, normal pregnancies and no previous children. Most came from poor households and had no husband. Prenatal care ranged from good to nonexistent. Hispanic women made up two-third of the sample.

Each of 212 randomly chosen participants receive emotional support during labor from one of 11 specially trained women. A female observer recorded medical care offered to another 200 women, but never spoke to the laboring mothers. The remaining "controls" underwent regular hospital procedures.

The researchers refer to the women who provide support as "douglas," a Greek word for an experienced mother who guides a new mother in infant care. Emotional support during labor from female relatives has long characterized many cultures. The doulas, recruited from the local community, spoke English and Spanish. In three weeks of training they learned about normal and abnormal labors, obstetric procedures, hospital policies and support techniques.

From admission through delivery, a doula stayed at her assigned patient's side to provide encouragement, to soothe and touch the woman when necessary and to explain the process of labor and what to expect next. Doulas received an average of $20 per patient.

Eight percent of the emotional-support group required a cesarean section, compared with 13 percent of the observed group and 18 percent of controls. Among women with spontaneous vaginal deliveries, only 8 percent receiving doula support needed anesthesia, compared with 23 percent of the observed group and 55 percent of the controls. Women supported by doulas also needed fewer induced labors and delivered their babies faster. Moreover, fewer of their infants required prolonged hospital stays.

The Houston study highlights the benefits of "hands-on" support during labor, writes Mortimer G. Rosen of Columbia Presbyterian Medical Center in New York City in an accompanying editorial. But he suspects doulas may produce less striking effects in hospitals if patients have had prelabor education, if fathers coash the mothers through delivery, and if hospitals maintain a ratio of one nurse per laboring patient.

Kennell disagrees. Even men who dutifully take Lamaze-type courses often find themselves ill-prepared for the "smells, cries, tears and vomit" encountered at the hospital, he asserts. In an ongoing study of doula care with couples, men express the most enthusiasm for additional emotional support, Kennel says. And sadly, the great demands on nurses usually prevent them from providing continuous support to a woman during labor, he adds.
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Title Annotation:emotional support reduces rates of pregnancy complications
Author:Bower, Bruce
Publication:Science News
Date:May 4, 1991
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