A birth intervention: the therapeutic effects of Doula support versus Lamaze preparation on first-time mothers' working models of caregiving

Abstract

Context: A working model of caregiving has been defined as an internalized schema of caregiving that guides a mother's behavior with her infant. This schema is strongly influenced by the mother's first attachment relationship with her own mother, which frequently operates outside her conscious awareness.

Objective: To examine doula support at birth as an intervention that might correct distortions of a mother's unconscious schema of caregiving, promoting more secure caregiving following childbirth.

Design: The effects of doula support versus Lamaze birth preparation on the working models of caregiving of 35 first-time pregnant mothers were compared.

Interventions: An interview was used to assess the mothers' working models in the third trimester of pregnancy and again 4 months after the mothers gave birth. Mood state and self-esteem were measured at these times. A post hoc analysis was performed on the mothers' birth experiences, the quality of their postpartum support, and their evaluations of their infants' temperaments.

Results: The prebirth to postbirth rating analysis of the interviews revealed that the mothers in the doula group were significantly less rejecting and helpless in their working models of caregiving than were the mothers in the Lamaze group. The mothers in the doula group also showed greater security than did mothers in the Lamaze group, a difference that approached but did not reach significance. In addition, the women in the doula group were less emotionally distressed and had higher self-esteem than did the women in the Lamaze group, and the women in the doula group rated their infants as significantly less fussy than the mothers in the Lamaze group rated their infants.

Conclusions: When viewed in the context of working models of caregiving, mothers who used a doula were significantly less rejecting and helpless, and approached significantly higher scores on the secure scale, than did mothers who used Lamaze birth preparation. Mothers rated as secure showed significantly less mood disturbance and higher prebirth and postbirth self-esteem than did mothers rated as insecure, providing construct validity for the caregiving interviews.