December 30, 2005

New Study On Birth Coaching: Eh

According to a new study of 320 first-time mothers published in the Jan. issue of the American Journal of Obstetrics and Gynecology, there are only minimal measurable benefits to coaching during labor: final stage pushing only lasted an average of 13 minutes less for the coached deliveries (59 min. vs 46 min.).

The women in the study all had simple pregnancies and no epidurals. Half received midwife-nurse coaching and half were told to "do what comes naturally." I would've thought "do what comes naturally" means "demand to know where the freakin' anesthesiologist is," but that's just me. They did it for science.

In the absence of any definitive benefits or conclusive harm, the decision to get a birth coach seems based on the woman's own sense of comfort--and her attachment to that $1,000 or whatever a doula costs these days.

Coaching women during childbirth has little impact
[reuters, also in the Houston Chronicle, via dt reader paul]


I think this is a bizarre study to have conducted in the first place. Why would you only study the effects of birth coaching in the second stage (pushing)? For a lot of women (especially women who do it drug-free) the pushing part is the least of our problems. And, frankly, if anyone had dared to yell "Push!" at me during that stage I would have gone ballistic. I can't imagine that anyone else in the room wanted to get that watermelon out as much as I did, so to have them yelling at me as if I needed to be told what to do? Well, let's just say I might have grabbed a scalpel and sliced someone.

Also, I'd rather get my baby out 13 minutes more slowly and have no tears than faster and get all ripped up. Yowza.

But to get back to my point, I think it's odd to look at whether having someone tell you to push or not helped women give birth faster. The benefit of a labor coach (whether it's a paid or unpaid doula, your partner, your mom, or a friend) is helping you get through the labor. Not the pushing. By the time you get to the pushing the battle's mostly over. Why not look at interventions and health outcomes, or feelings of satistfaction, or success with nursing, or rate of PPD, or any of the other things that can actually be considered valuable?

I soooo wished we'd gotten a doula. We took all the classes. I made it clear to everyone in ear shot from month 3 that I wanted an epidural the moment I felt a twinge of discomfort.

So what happens when the big moment comes? My husband is on the opposite side of the room uselessly pacing with a panicked look on his face while Nurse Clueless doesn't bother to re-page the anesthesiologist who fell back asleep. Didn't get my epidural until I got to 10 cm with back labor when the midwife bothered to show up.
Yeah - we'll be spending that $1000 plus some on marriage counseling - or a divorce lawyer.
Bitter much?

Oh - do I wish I'd gotten a doula like my gut told me to.

[yeah, I'm waiting for the study of the health effects to first-time dads who tell their wives who want coaches/doulas, "But honey, a study showed they were of limited effectiveness, so I canceled." -ed.]

#1. 13 minutes of pushing is a loooooooooong time.

#2. the longer the baby is in the birth canal the greater the possibility that baby's vitals will decline and interventions will be neccesary

#3. in a hospital setting the hospital staff is FAR from telling women to "do what comes naturally". they are the ones screaming "push!" so they can get your baby out and the next paying customer in the room as quickly as possible

#4. a doula is a support person and advocate. they are there to make sure you have the type of birth you want and that you come through the birthing experience safe and happy. i agree with moxie- support cannot be measure quantitatively in number of minutes. every womans birth is different and a labor coach is there to make sure it goes the best, not the fastest.

I wrote a long tirade about how my wife and I didn't need a doula, and what a pain in the ass the whole doula selection process was. I'll save you the details, you can read it if you want.

Granted, in San Francisco doula culture is far more annoying than it is further out from its epicenter in Berkeley, but we basically came to the conclusion we did because it would be WEIRD to have a person in the room who we weren't both totally cool with.

Man, did I get some hate e-mails though. Don't mess with the doulas, I tell ya.

But Dutch, the whole point of hiring a doula is that it be someone you both feel comfortable with. Why hire someone you didn't like? You can get a bad nurse by luck of the draw at the hospital at no extra cost. You can also get a good nurse, but there's no way to guarantee having someone you want in the room with you unless you arrange on your own for that person to be there. If you didn't want a doula it's good that you didn't have one, but the idea that you'd hire someone you weren't both totally cool with doesn't make sense to me.

It is common for new dads to eschew doulas because #1 they don't know much about doulas, #2 they perceive doulas as competition or an indication that the dad is incapable of completely supporting his wife, or #3 doulas cost money. New moms often don't want doulas unless they know other moms who have used one.

[good points, AJ, I haven't posted about doulas much/at all because I still know nearly nothing about them; the first I heard of them was at the end of the birth class. I still figure it's a west coast thing. (hi, Dutch!) -ed.]

I just want to reiterate Jess's #4 - a large part of what doulas do is advocate for the mother. If the mother has decided on a natural birth, no drugs, no episiotomies it will be the doula who keeps that from happening when the mother is too in the zone to fend for herself.

I pushed for two hours without drugs. It would probably have taken me 3 hours if my nurse and nurse-midwife hadn't stepped in a directed the pushing because I was a first time mother and had no idea what I was doing. Next time it will likely be different but without their instruction I would've been lost!

i agree angela! i was getting nowhere pushing until my doula suggested pulling on a bedsheet (?!) it totally directed my pushing, got my body in the right position and facilitated a sucessful natural childbirth for a complete wimp

another thing- where does the article get off saying "childbirth coaching of little impact" based on this one aspect??? it is a logical fallacy not to include "with regards to length of time pushing

[ultimately, Jess, I think it's a fault of the study and what they were studying. I'm sure reading the actual study (instead of news reports based on press releases) would reveal more info about what they mean by "coaching" and what other types of measurable/identifiable medical impacts they looked at. Obviously, the major benefit of coaching is going to be subjective and more qualitative, the type of well-being and control and comfort and engagement that probably helps prevent many complications, but that'd be identified through an interview/survey-type study instead. -ed.]

Here's a summary of the article from the NYT

Turns out it's not about doulas at all, actually a little more interesting than that!

January 3, 2006
Childbirth: Rethinking the Big Push During Contractions

A new study is raising questions about one of the most accepted practices in the delivery room: urging women to push during contractions to help the baby come out.

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