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THE EFFECT OF DOULA SUPPORT DURING LABOR ON MOTHER-INFANT INTERACTION AT 2 MONTHS

Scott Martin, Susan Landry, Laura Steelman, John H. Kennell, Susan McGrath

Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44 IO6

The support of an experienced female labor companion (doula) has been shown to have significant obstetric and perinatal benefits. The continuous presence of a doula during labor results in fewer cesarean and forceps deliveries, less need for analgesia and shorter labors. This study is part

of a larger randomized controlled trial of doula support and examines mother-infdnt (M-l) interaction, infant development and breast feeding 6-9 weeks after delivery. Data on these variables were collected during a visit to the mother’s home approximately 2 months postpartum.

Primigravida mothers with uncomplicated vaginal deliveries were randomly assigned to a doula (n=33) or one of two no-doula (n=7 I) groups. The Boyley Scales ofInfant Development- Second Edition (BSID-II) were used to assess infant development at 2 months. The home visit made by the examiner in order to administer the Barley exam provided the opportunity to observe the mother’s interaction with her infant. M-l interaction was scored on a scale of l-7 which included operational definitions of mother’s physical contact and visual attention to the child as well as mother’s

affectionate behaviors toward the child. A higher score signified a more positive level of M-l interaction. The examiner assessed M-l interaction at five pre-defined points during the visit: I) when

the examiner entered the mother’s house, 2) while the Bayley exam was being set up, 3) while the exam was being scored, 4) during a feeding and 5) while the mother changed the baby. Inter-rater reliability was .9 I , and the two ewminen were blind as to whether or not the mothers were supported by a doula during labor.

Scores on the Bayley exam were not related to the social support received by the infant’s mother during labor as the means did not differ significantly across the 3 groups (R motor= I 06, S.D.=2. I I ;R mental= 104, S.D.=4.57). The M-l interaction scores revealed significant differences

between the doula-supported and no-doula group of mothers. Upon the arrival of the examiner at the mother’s house, the doula group’s mean interaction score was 5.5, while the no-doula group received a score of 4.2 (t=2.94, pc .O I). Likewise, 3 of the other 4 observations revealed a significantly higher score (p-z -05) in the doula group than the no_doula group. There was no significant difference between the 2 groups on the assessment of M-l interaction while the Bayley exam was being scored. Overall, the mean M-l interaction scores of all 5 observation points for the

doula and no-doula groups respectively were 5.6 I and 4.75 (t=3 -66, p< .OO I).

During the home visit, the levels at which each mother was breast feeding was assessed. A high level of breast feeding was related to higher interaction scores (t=2. I 8, p< .05), but no relation existed between the presence or absence of a doula and the levels of breast feeding. Providing a laboring woman with the continuous support of a doula r-es& in a significantly more positive level of interaction with her infant at 2 months after delivery. Questions remain regarding the physiological and/or psychological mechanism that could explain this powerful and long-lasting effect of doula support.