176000 Doula care improves birth and breastfeeding outcomes for low-income, primiparous mothers

Tuesday, October 28, 2008

Laurie A. Nommsen-Rivers, PhD, RD, IBCLC , Nutrition, University of California, Davis, Davis, CA
Arlene Cullum, MPH , Northeastern California Perinatal Outreach Program, Sutter Medical Center - Sacramento, Sacramento, CA
Robin L. Hansen, MD , Human and Community Development, University of California, Davis, Davis, CA
Ann M. Mastergeorge, PhD , Human and Community Development, University of California, Davis, Davis, CA
Kathryn G. Dewey, PhD , Nutrition, University of California, Davis, Davis, CA
We examined whether doula care (lay childbirth support), coupled with 2 postpartum home visits, decreases childbirth stress and thereby improves breastfeeding success. 44 low-income primiparae receiving doula care (DC) were compared with 97 women with standard care (SC). Groups were similar at baseline except that DC women were more likely to be Hispanic and obese and less likely to be in labor when admitted. Adjusting for baseline differences, DC women had greater odds of a short stage II labor (< 1 h: adjusted odds ratio [95% confidence interval], 3.1[1.2-7.9]) and an unassisted vaginal delivery (vs. vacuum or forceps, 4.7[1.1-19.3]). Early feeding practices did not differ between groups, but DC women were more likely to experience onset of lactogenesis (OL) before 72 h (AOR 2.7[1.1-6.8]). In both groups, about half of infants “sucked well” on day 3. Timely OL and “sucked well” were associated with breastfeeding > 6 weeks (AOR 4.9[1.7-13.8] and 3.7[1.4-10.1], respectively). 68% of DC and 54% of SC women breastfed > 6 weeks (AOR 2.6[1.0-7.0]), but in those with a prenatal stressor (e.g. a medical or mental health condition, n=63), the percentages were DC 89% vs. SC 40% (AOR 12.0[2.4-60.5]). We conclude that DC improves childbirth and breastfeeding outcomes. Despite similar feeding practices, DC women were more likely to have timely OL, suggesting a physiological effect of DC on OL via a less stressful childbirth. Delayed OL was a risk factor for weaning. Thus, interventions to minimize childbirth stress, such as doula care, may help extend breastfeeding duration.

Learning Objectives:
1. Learn of how the labor and delivery environment affect early lactation outcomes 2. Learn of how early lactation outcomes affect breastfeeding status at 6 weeks postpartum among low-income primiparae

Keywords: Breastfeeding, Alternative Perinatal Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have no conflicts of interest.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.