The Impact of a Hospital Based Doula Program on Cesarean Section Rate [28O]

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INTRODUCTION:Previous studies have shown a positive association between continuous labor support and positive perinatal outcomes including a shortened duration of labor, increased rate of spontaneous vaginal delivery and a decreased use of interventions including oxytocin, analgesia, operative vaginal deliveries and cesarean sections. The purpose of this study was to compare labor and delivery outcomes between a cohort of patients who received hospital-sponsored doula continuous labor support and a matched cohort of patients who did not elect to receive doula services.METHODS:We analyzed the charts of all patients who delivered a single infant either by cesarean section or vaginal delivery between 1/1/2012 and 12/31/2013 at Danbury Hospital. Planned cesarean sections, multifetal gestations, fetal demises, urgent or emergent deliveries, and precipitous deliveries were excluded. The primary outcome was cesarean section rate. Secondary outcomes also calculated included labor augmentation rate, labor induction rate, VBAC rate, neonatal outcomes (Apgar score, weight). The results were adjusted for patient age and parity.RESULTS:After exclusions, the cohort of patients who received doula care included 275 women and the matched cohort included 2688 patients. The rate of cesarean section in the Doula group was 19.6% whereas the rate was 16.2% in the control group (P=.315). VBAC rate, augmentation and induction rate were not statistically different between the two groups.CONCLUSION:This study did not show a statistically significant decreased cesarean section rate among women who had continuous labor support. Limitations of this study include small sample size, limited data on socioeconomic factors between groups and possible confounding factors.

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