title: Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae.
abstract: OBJECTIVE
  To examine associations between doula care, early breastfeeding outcomes, and breastfeeding duration.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Regional hospital in northern California.
  
  
  METHODS
  Low-income, full gestation primiparae receiving doula care (n=44) or standard care (n=97).
  
  
  METHODS
  Birth outcomes and newborn feeding data obtained from the hospital record. Follow-up interviews conducted at day 3 to record the timing of onset of lactogenesis and breastfeeding behavior and at 6 weeks to obtain current breastfeeding status.
  
  
  RESULTS
  Adjusting for baseline differences, women receiving doula care were significantly more likely to have a short stage II labor, a noninstrumental vaginal delivery, and to experience onset of lactogenesis within 72 hours postpartum (timely onset of lactogenesis). Overall, 68% of women receiving doula care and 54% of women receiving standard care were breastfeeding at 6 weeks. In the subset with a prenatal stressor (n=63), the doula care group was more than twice as likely to be breastfeeding at 6 weeks (89% vs. standard care, 40%). Breastfeeding at 6 weeks was also significantly associated with timely onset of lactogenesis and maternal report that the infant "sucked well" at day 3.
  
  
  CONCLUSIONS
  Doula care was associated with improved childbirth outcomes and timely onset of lactogenesis. Both directly and as mediated by timely onset of lactogenesis, doula care was also associated with higher breastfeeding prevalence at 6 weeks.
authors.affiliation: Division of Neonatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH 45229-3039, USA. laurie.nommsen-rivers@cchmc.org
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Nommsen-Rivers
authors.forename: Ann M
authors.initials: AM
authors.lastname: Mastergeorge
authors.forename: Robin L
authors.initials: RL
authors.lastname: Hansen
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Cullum
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey