Crawford Allison D, Carder Emily C, Lopez Emme, McGlothen-Bell Kelly
School of Nursing, University of Texas Health at San Antonio, San Antonio, Texas.
Texas A&M University, San Antonio, Texas.
J Midwifery Womens Health. 2024 Jan-Feb;69(1):118-126. doi: 10.1111/jmwh.13543. Epub 2023 Jul 24.
The potential benefits of perinatal doula support are many; however, doulas are underutilized, which may heighten pregnancy-related complications. In this scoping review, we assess the influence of perinatal doula support on pregnancy-related complications and death in the United States.
We searched PubMed, CINAHL, Scopus, and Alt HealthWatch for literature on doula support and its influence on pregnancy-related complications (maternal fever or infection, postpartum hemorrhage, amniotic fluid embolism, complications from anesthesia, preeclampsia, eclampsia, cardiomyopathy, pulmonary or thrombotic embolism, and cerebrovascular accident). Peer-reviewed articles written in English and conducted in the United States from 1969 to 2021 were included. Screening at all levels was blinded. We extracted data based on title, author, year, design, population, sample size, methods, limitations, recommendations, and definition of doula support.
Following removal of duplicates, review of 3679 article titles and abstracts yielded 42 articles for full-text review; 3 articles met final inclusion criteria. One included study focused on intrapartum doula support and 2 on doula support that extended throughout the perinatal period. Within the included studies, doula support was associated with decreased rates of intrapartum maternal fever and gestational hypertension; however, it was not associated with decreased rates of gestational diabetes or depression.
The literature has addressed the benefits of perinatal doula support, but studies with validated tools to examine associations between doula support and pregnancy-related complications and death are lacking. The studies that addressed intrapartum and continuous doula care included large generalizable samples, from which future research can draw to improve the practice of caring for patients during the perinatal period. Extensive research shows that unfavorable conditions can influence perinatal outcomes across generations. Implementing doula support may offer a potential approach to reduce and help alleviate resulting disparities in perinatal health.
围产期导乐支持有诸多潜在益处；然而，导乐服务未得到充分利用，这可能会增加与妊娠相关的并发症。在本范围综述中，我们评估围产期导乐支持对美国妊娠相关并发症及死亡的影响。
我们在PubMed、CINAHL、Scopus和Alt HealthWatch中检索有关导乐支持及其对妊娠相关并发症（产妇发热或感染、产后出血、羊水栓塞、麻醉并发症、先兆子痫、子痫、心肌病、肺栓塞或血栓栓塞以及脑血管意外）影响的文献。纳入1969年至2021年在美国进行的、以英文撰写且经过同行评审的文章。所有层面的筛选均采用盲法。我们根据标题、作者、年份、设计、人群、样本量、方法、局限性、建议以及导乐支持的定义提取数据。
在去除重复项后，对3679篇文章标题和摘要进行审查，筛选出42篇文章进行全文审查；3篇文章符合最终纳入标准。其中一项纳入研究聚焦于分娩期导乐支持，另外两项聚焦于贯穿围产期的导乐支持。在纳入的研究中，导乐支持与分娩期产妇发热率和妊娠期高血压发生率降低相关；然而，与妊娠期糖尿病或抑郁症发生率降低无关。
文献已经阐述了围产期导乐支持的益处，但缺乏使用经过验证的工具来检验导乐支持与妊娠相关并发症及死亡之间关联的研究。涉及分娩期和持续导乐护理的研究纳入了具有广泛代表性的大样本，未来研究可从中借鉴经验，以改善围产期患者的护理实践。广泛的研究表明，不利条件会影响几代人的围产期结局。实施导乐支持可能为减少并帮助缓解由此产生的围产期健康差异提供一种潜在方法。
