title: A hospital-based doula program and childbirth outcomes in an urban, multicultural setting.
abstract: OBJECTIVE
  The objective of this study is to determine whether there are differences in birth and breastfeeding outcomes for women who received labor support through a hospital-based doula program, compared with those who did not receive doula support in labor.
  
  
  METHODS
  We conducted a retrospective program evaluation to compare differences in birth outcomes between births at 37 weeks or greater with doula support and births at 37 weeks or greater without doula support through the first seven years of a hospital-based doula support program. Log-binomial regression models were used to compare differences in cesarean delivery rates, epidural use, operative vaginal delivery, Apgar scores, breastfeeding intent and early breastfeeding initiation after controlling for demographic and medical risk factors. The propensity score was included as an additional covariate in our regression model to minimize issues of selection bias. Analyses were conducted for the whole cohort of 11,471 women and by parity and provider service in subgroup analyses. Cochran-Mantel-Haenszel test was performed to detect differences in effects over time.
  
  
  RESULTS
  For the whole cohort, women with doula support had significantly higher rates of breastfeeding intent and early initiation. Subgroup analysis showed that having doula support was significantly related to: (a) higher rates of breastfeeding intent and early initiation rates for all women regardless of parity or provider with the exception of multiparous women with physician providers; (b) lower rates of cesarean deliveries for primiparous women with midwife providers.
  
  
  CONCLUSIONS
  A hospital-based doula support program is strongly related to improved breastfeeding outcomes in an urban, multicultural setting.
authors.affiliation: Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, 91 East Concord Street, Rm 4113, Boston, MA 02118, USA. Julie.MottlSantiago@bmc.org
authors.forename: Julie
authors.initials: J
authors.lastname: Mottl-Santiago
authors.forename: Catherine
authors.initials: C
authors.lastname: Walker
authors.forename: Jean
authors.initials: J
authors.lastname: Ewan
authors.forename: Olivera
authors.initials: O
authors.lastname: Vragovic
authors.forename: Suzanne
authors.initials: S
authors.lastname: Winder
authors.forename: Phillip
authors.initials: P
authors.lastname: Stubblefield
mesh_terms: D000328:Adult; D001942:Breast Feeding; D002585:Cesarean Section; D018864:Cultural Diversity; D036861:Delivery, Obstetric / Q000193:education*; D005260:Female; D006266:Health Education; D006801:Humans; D007743:Labor, Obstetric; D008404:Massachusetts; D008880:Midwifery; D036801:Parturition; D011247:Pregnancy; D011256:Pregnancy Outcome; D016730:Program Development; D015397:Program Evaluation; D012189:Retrospective Studies; D014505:Urban Population