``ALONE, I WOULDN'T HAVE KNOWN WHAT TO DO'': A QUALITATIVE STUDY ON SOCIAL SUPPORT DURING LABOR AND DELIVERY IN MEXICO LOURDES CAMPERO, 1 * CECILIA GARCõÂA, 1 CARMEN DõÂAZ, 1 OLIVIA ORTIZ, 1 SOFõÂA REYNOSO 2 and ANA LANGER 3 1 Centro de Investigaciones en Salud Poblacional, Instituto Nacional de Salud PuÂblica, Av. Universidad 655, 3er. piso, Col. Sta. MarõÂa AhuacatitlaÂn, C. P. 62508, Cuernavaca, Morelos, MeÂxico, 2 DireccioÂn General de Salud Reproductiva, SecretarõÂa de Salud, Insurgentes sur 1397, Col. Insurgentes Mixcoac, C.P. 03920, MeÂxico D. F. and 3 The Population Council, Regional Oce for Latin American and the Caribbean, Escondida 110, Col. Villa coyoacan, C.P. 04000, MeÂxico D.F. AbstractÐThis article presents some of the most relevant qualitative results of a trial to evaluate the eects of the provision of psychosocial support to ®rst-time mothers during labor, childbirth and in the immediate postpartum period in a social security hospital in Mexico City. The article focuses on the ex- periences of mothers who have received psychosocial support from a doula (the term doula is used to identify a woman who provides continuous support to a woman during labor, delivery and the immedi- ate postpartum period) and compares them with the experiences of those women who gave birth follow- ing normal hospital routine. Sixteen in-depth interviews were held with women in the immediate post partum period (eight of whom had been accompanied by a doula and eight who had not) before they were discharged from hospital, and the results were analyzed using qualitative techniques. The interviews showed that the women accompanied by a doula had a more positive childbirth ex- perience. The dierences between both groups related to their perceptions of the childbirth experience; the treatment they received from hospital sta; the information they were given and how well they understood it; their perception of hospital routines; their feelings about cesarean sections and, spatial and temporal perceptions. The most important dierence between the two groups was the way they expressed their feelings about their own labor, their sense of control and their self-perception. # 1998 Elsevier Science Ltd. All rights reserved Key wordsÐsocial support, doula, labor, childbirth, Mexico INTRODUCTION Providing psychosocial support during labor and childbirth has been gaining interest, particularly because of its impact on the results of obstetric treatment and on the health of the newborn baby. In various clinical trials carried out in Guatemala, the United States and South Africa, positive eects have been demonstrated when psychosocial assist- ance was provided by doulas{ to women giving birth. These studies highlight the relationship between psychosocial support and the reduction of various types of medical interventions such as the use of anesthesia, analgesics, cesarean sections and forceps (Sosa and Kennell, 1980; Klaus and Kennell, 1986, 1992; Keirse and Enkin, 1989; Kennell and Klaus, 1991), and have also found that support during labor accelerates recovery, favors early bonding between mother and child, decreases anxiety and depression during the ®rst six postpar- tum weeks, and reduces the time spent in labor (Klaus and Kennell, 1992; Hofmeyr and Nikodem, 1991). In the most recent study (South Africa) a positive eect of psychosocial support was also found on the initiation and duration of breastfeed- ing (Hofmeyr and Nikodem, 1991). These results led us to conduct a similar interven- tion in Mexico, which consisted of continuous psychological and physical support to the woman during labor, childbirth and immediately following birth, and was provided by a group of women (dou- las) who had been trained as companions for the ®rst-time mothers. In previous studies, the pro®le of the doula has varied. In some cases, doulas had been women of the community while in others the doula was a person who received speci®c training (Sosa and Kennell, 1980). For this study, it was decided that those women considered suitable to take part in the study as doulas would be seven retired nurses. However, four young women who participated in the training course and had shown interest in the intervention but were not nurses, also took part. The theoretical and practical training ses- sions took place in the same hospital during a Soc. Sci. Med. Vol. 47, No. 3, pp. 395±403, 1998 # 1998 Elsevier Science Ltd. All rights reserved Printed in Great Britain 0277-9536/98 $19.00 + 0.00 PII: S0277-9536(98)00077-X *Author for correspondence. {Doula is a Greek word meaning a woman who accompanies another woman. The term is used to identify a woman who provides continuous support to a woman during labor, delivery and the immediate postpartum period (Keirse and Enkin, 1989). 395