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Clifford M. Gevirtz, MD, MPH; Gertie F. Marx, MD
Albert Einstein College of Medicine Bronx, NY

JAMA. 1991;266(11):1509.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—We read with interest the article by Kennell et al¹ concerning the efficacy of emotional support by doulas during labor in reducing both cesarean section rates and the use of epidural analgesia. We are concerned with the statistically significant difference in childbirth education afforded these patients. Was a truly informed consent obtained with full disclosure of the analgesia options available?

While the study demonstrated decreased uses of cesarean sections and epidural analgesia, there is no documentation of patient satisfaction. Our experience has been that women who had "natural childbirth" with the first delivery and epidural analgesia with the second were markedly more satisfied with the latter. A longitudinal study with crossover comparing these methods would provide the answer.

We would also emphasize that pain relief during labor accomplishes more than mere comfort for the parturient. Appropriate pain relief produces physiological and psychological effects that benefit both . . . [Full Text PDF of this Article]

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