The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth, 2nd ed., by Marshall H. Klaus, John H. Kennell, and Phyllis H. Klaus, Cambridge, Mass: Perseus Publishing; 2002. 243 pages, paperback, $19.00.

From the well-known experts in the field of maternal-infant bonding comes a new publication on the benefits of having a trained labor companion, a doula, to assist families in having the best possible childbirth experience. Portions of this content were covered in a 1993 publication by the same authors, entitled Mothering the Mother (Addison-Wesley).

This book does an excellent job of defining the term doula, and describing this unique role and how it differs from and complements the role of the partner, the nurse, and the midwife or physician throughout pregnancy, labor and delivery, and the postpartum period. Each role is put in context, emphasizing the difference in the level of support provided by each of the team members. The authors also review extensive research that has repeatedly shown significant differences in outcomes among the women receiving doula support and those who did not. The research cites fewer medical interventions, fewer cross-sections, shortened length of labor, decreased need for analgesia and anesthesia, and better overall perception of the birthing experience by women.

However, as impressive as these outcomes are, the data are presented in a way that is more appropriate for the health care professional to read. The subtitle, in the second person, implies that this book is designed for patient/consumer information. Understanding results of clinical trials and statistical significance levels might be difficult for consumers without some type of research background.

Another negative is that in an attempt to illustrate the need for this type of one to one continuous labor support the authors at times give a not so favorable portrayal of the medical team and the nursing staff. With continuing evidence of the very positive impact of the doula role, every effort should be made to enhance a collaborative approach and incorporate this role as an integral part of the obstetrical team. The chapter describing the Dublin experience does a nice job demonstrating how this model can be put into place in a medical setting. The Dublin data illustrate the exceptional outcomes of a program that incorporates several major elements of labor management, including the component of continuous one to one labor support. This data have been very widely published and use of the "active management of labor" protocol has spread to many areas of Europe and the United States. However, if the program left out the one to one continual support component, there was not the same impact. Programs developed that did not necessarily incorporate other elements of the active management protocols, such as the definition of labor, or the use of oxytocin, but did adhere to the one to one emotional support provided to the laboring woman, demonstrated almost the same results with regard to shortening and easing labor.

The book also discusses the role of the postpartum doula, and the services and support provided at a time often given too little attention. There are still tremendous physical, psychological, and emotional changes taking place and the time and support from an experienced caregiver is no less needed now.

The two accounts of birth with a doula are excellent examples and illustrate the principles discussed up to this point.

The book also includes 4 appendices; I. Training for a doula, II. Relaxation, visualization, and self-hypnosis, III. Randomized clinical trials looking at labor support, IV. Resource List.