TO THE EDITOR: I would like to answ...

TO THE EDITOR: I would like to answer to the article and editorial onward managing labor pain that appeared in the September 15 2003 issue of American Family Physician. The authors of the article (1) appropriately defined maternal satisfaction (which is not necessarily 100 percent pain relief) along with stressing the value of labor support. However, in the editorial, (2) the authors state that "few women are afforded this option (of a doula and continuous labor support)."

in the greatest degree physicians are not familiar enough with the general [i]or[/i] abstract notion of doulas to fully under-stand their part where to find one, or for what cause to recommend them to their patients. The sum of two units largest professional certifying organizations of doulas in North America are Doulas of North America (DONA, http://www.dona.org) and Childbirth and Postpartum Professional Association (CAPPA, http://www.cappa.net). These organizations maintain online directories of certified doulas on geographic area and current evidence-based research of the benefits of having a doula at hand during labor.

Experienced doulas charge between $50 and $900 by means of birth, depending on experience, geographic area, demand, patient's requires traveling time, and sliding scale. Without knowing the "doula climate" in one's area, it is presumptive to insist that patients cannot afford the labor support. A requirement to become certified is three "certification" births. These are done without the expectation of monetary payment. It is beneficial to the physician and the patient to find disclosed through DONA and CAPPA who is pursuing certification in their area for patients who may not be able to afford a doula. There also is a program, Operation Special Delivery (http://www.operationspecialdelivery.com) that supports the United States military by means of providing free doula services during wartime to women who are preparing for and giving birth while their partners are forward military deployment.

Physicians should not dismiss the value of recommending certified doulas to their patients based forward a preconceived difficulty of obtaining single The authors of the article clearly stated: "Continuous labor support provided according to a doula, a lay woman trained in labor support, consistently has decreased the use of obstetric interventions.... Fewer women had unsatisfactory birth experiences." (1)

I also would like to stres the significance of recommending a certified doula or single in kind pursuing certification if you are not familiar with the doula's skills, because anyone can call themselves a doula (friends, sisters, and other relatives). Referring to a doula as a lay woman should not be confused with "lack of credentials." Birth experience, physician regards and formal training are required to become certified as a doula. Continuing education also is required to maintain certification.

DENISE PUNGER MD

Coquelet & Punger Family Medicine, P.A.

4640 s 25th St.

Ft Pierce, FL 34981

REFERENCES

(1) Leeman L Fontaine P King V Klein MC Ratcliffe s The nature and management of labor pain: Part I. Nonpharmacologic pain relief. Am Fam Physician 2003;68:1109-12

(2) Leeman L Fontaine P King V Klein MC Ratcliffe s Management of labor pain: promoting patient choice [Editorial]. Am Fam Physician 2003;68:1023-36

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