Langer A, Campero L, Garcia C, Reynoso S
The Population Council, Regional Office for Latin America and the Caribbean, Colonia Coyoacán, México DF, Mexico.
Br J Obstet Gynaecol. 1998 Oct;105(10):1056-63. doi: 10.1111/j.1471-0528.1998.tb09936.x.
To evaluate the effects of psychosocial support during labour, delivery and the immediate postpartum period provided by a female companion (doula).
The effects of the intervention were assessed by means of a randomised clinical trial. Social support by a doula was provided to women in the intervention group, while women in the control arm received routine care.
A large social security hospital in Mexico City.
Seven hundred and twenty-four women with a single fetus, no previous vaginal delivery, < 6 cm of cervical dilatation, and no indications for an elective caesarean section were randomly assigned to be accompanied by a doula, or to receive routine care.
Breastfeeding practices, duration of labour, medical interventions, mother's emotional conditions, and newborn's health.
Blinded interviewers obtained data from the clinical records, during encounters with women in the immediate postpartum period, and at their homes 40 days after birth. Relative risks and confidence intervals were estimated for all relevant outcomes.
The frequency of exclusive breastfeeding one month after birth was significantly higher in the intervention group (RR 1.64; I-C: 1.01-2.64), as were the behaviours that promote breastfeeding. However, the programme did not achieve a significant effect on full breastfeeding. More women in the intervention group perceived a high degree of control over the delivery experience, and the duration of labour was shorter than in the control group (4.56 hours vs 5.58 hours; RR 1.07 CI (95%) = 1.52 to -0.51). There were no effects either on medical interventions, mothers' anxiety, self-esteem, perception of pain and satisfaction, or in newborns' conditions.
Psychosocial support by doulas had a positive effect on breastfeeding and duration of labour. It had a more limited impact on medical interventions, perhaps because of the strict routine in hospital procedures, the cultural background of the women, the short duration of the intervention, and the profile of the doulas. It is important to include psychosocial support as a component of breastfeeding promotion strategies.
评估女性陪伴者（导乐）在分娩、生产及产后即刻提供的心理社会支持的效果。
通过随机临床试验评估干预效果。干预组女性接受导乐的社会支持，而对照组女性接受常规护理。
墨西哥城一家大型社会保障医院。
724名单胎妊娠、既往无阴道分娩史、宫颈扩张小于6厘米且无择期剖宫产指征的女性被随机分配，一组由导乐陪伴，另一组接受常规护理。
母乳喂养情况、产程、医疗干预措施、母亲情绪状况及新生儿健康状况。
盲法访谈者从临床记录、产后即刻与女性的面谈以及产后40天她们家中获取数据。对所有相关结果估计相对风险和置信区间。
干预组产后1个月纯母乳喂养的频率显著更高（相对风险1.64；95%置信区间：1.01 - 2.64），促进母乳喂养的行为也是如此。然而，该项目对完全母乳喂养未取得显著效果。干预组中更多女性感觉对分娩体验有高度掌控，且产程短于对照组（4.56小时对5.58小时；相对风险1.07，95%置信区间 = 1.52至 -0.51）。对医疗干预措施、母亲的焦虑、自尊、疼痛感知及满意度，或新生儿状况均无影响。
导乐提供的心理社会支持对母乳喂养和产程有积极影响。对医疗干预措施的影响较为有限，这可能是由于医院程序严格、女性的文化背景、干预持续时间短以及导乐的特征所致。将心理社会支持纳入母乳喂养促进策略的组成部分很重要。
