Do you doula? An exclusive interview with Dr. John Kennell

New Life Journal, Dec, 2003 by Emily Ray

Recently, New Life Journal had the opportunity to speak with the renowned Dr. John Kennell, a pioneer in the field of perinatal healthcare. It was Dr. Kennell (along with his colleague Dr. Marshall Klaus) who introduced the United States to the benefits of having a doula (birth attendant) present during a birth. His near 200 publications reflect a prominent career as a pediatrician, scholar, and most importantly, as an advocate for children and their families. As a Founding Member of the Doulas of North America (DONA) and as Ohio Pediatrician of the Year, many credit Dr. Kennell with revolutionizing maternal and newborn care practices.

NLJ: Dr. Kennell, you are an adamant supporter of doulas, and much of your research has focused on the benefits of having a doula present during the birth process. You are often quoted, having stated: "If a doula were a drug, it would be malpractice not to use it." That's a pretty, strong statement.

Dr. Kennell: Yes it is.

NLJ: Why do you feel doulas are so important?

Dr. Kennell: Up until 100 years ago, mothers almost entirely delivered at home. They were usually in a familiar environment, usually with people they knew very well. There was no separation of mother and baby. The baby was delivered, started breastfeeding, and they just stayed together. In the Twentieth Century, there were big changes, motivated to a great extent by the great problems of infections. Fortunately, antibiotics came along and helped to improve that situation. Then, along came "Twilight Sleep" which was originally thought to be so good. Mothers who had the medication were just wild; they didn't know what they were doing. Their families weren't allowed to see them. So that separated the mother from her family, and separated the baby from its mother. A lot of things happened that took the woman supporting the mother out of the picture. In the 1950s and 1960s, there was a big movement to get away from medication and to get back to more natural childbirth. Mothers were awake and conscious, and many were doing it by natural childbirth. The support for the mother, which had been the nurse up until that point, needed to be replaced. The first thought was that the replacement would be the father, but there was initially a struggle to get the fathers admitted into the labor and delivery areas. But in the 1960s and 1970s, we saw a great increase in the amount of father participation.

NLJ: Why do you think that was?

Dr. Kennell: Oh, I think that was due to mother's wanting to have someone with them. Why I feel so strongly about a doula ... I haven't gotten there yet, have I? [Laughter] When providing the mother with a doula, which is really bringing back an old, old practice, we found that it just made a remarkable difference in the obstetric outcomes. So that's one reason. There are strong suggestions that mothers who have a doula feel much better about themselves and how they did during labor. Mothers think they've got a great baby They think they've got a very clever baby. That they have the most beautiful baby. Essentially, there is a greater enthusiasm. Remarkably, the mothers who have a doula think their relationship with their partner after the birth improved. So, something that makes mothers enthusiastic about their baby and about what they did themselves, that's great.

In the late 1960s, [Dr. Klaus and I] did the bonding study. Back at that time, the practice in almost every medical center was that mothers would have medication. Mothers would deliver their baby. The obstetrician might show the baby to the mother. Then the nurse would bring the baby to the mother six, ten, twelve hours later and would show her that the baby had ten fingers and toes. Often, the mother didn't get to hold the baby at that point. Then the baby would come in every four hours for a twenty-minute feeding. This was terrible thing for breastfeeding.

NIJ: Why did that happen?

Dr. Kennell: Some of the early pediatricians did studies on babies that had died, on how much fluid the stomach could hold. [These pediatricians] figured out that if you gave a certain amount every four hours, it would meet the needs of the baby. There was no paying attention to what the baby wanted. The babies would be ready to eat right away, but they wouldn't get to their mother for twelve hours. Then, the poor baby would cry for hours and would fall asleep, exhausted. Then the baby comes in for twenty minutes, and the mother is trying to get the baby up and get the breastfeeding going. So, in our bonding studies, we wanted to get mothers and babies together within the first hour. The babies had early contact an hour or so after birth mother and baby together. When the babies were a month of age, we had them come back. There was a significant difference in the behavior of the mothers who had that early contact.

There were behaviors of the mother, in that study, that are similar to what I'm talking about with the mothers who have doulas. That keeps me wondering if we haven't done away with a lot of the natural, wonderful behaviors mothers have towards their babies. Modern obstetrics is so high pressure, so rush-rush. So many things for a mother to worry, about.