The life-changing, life-giving process of childbirth is a tremendous, singular undertaking.
Science has shown that when a mother is supported by a doula she is significantly more likely to achieve positive birth outcomes.
As non-medical, non-familial birth coaches, doulas provide mothers with focused and grounded support. They attend to women physically and emotionally, as well as offering vital advocacy and information.
Let’s dive in and examine 17 compelling studies that reveal the evidence-based benefits of doula-support.
Doula Science & Evidence [INFOGRAPHIC]
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Doula Support: Examining the Evidence
There are a vast number of scientific studies that examine the efficacy of doula support. Together, their findings confirm that doulas improve antenatal, birth, and post-partum outcomes for mothers and babies.
This roundup of 17 scientific studies highlights some of the most compelling findings.
1) Leads to better birth outcomes
Many studies have shown that doula-support has a positive impact on birth outcomes.
In one study of at-risk moms, a group of pregnant women facing social disadvantages, and at risk of negative birth outcomes, were given the option to use a doula for support during their pregnancy and birth.
Those who opted to receive support from a trained doula were two times less likely to experience complications during birth and four times less likely to have a baby with low birth weight.
Women who utilized a doula were also much more likely to initiate breastfeeding with their children. (Source)
Key study/paper: Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). “Impact of doulas on healthy birth outcomes.” The Journal of Perinatal Education, 22(1): 49–58.
Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727
2) Improves experience of pregnancy and birth
Although pregnancy and birth can be stressful, it’s possible to create a positive, fulfilling experience that women look back on with fondness.
On the other hand, uninformed personnel and/or lack of information and adequacy can contribute to a negative, or even traumatic, birthing experience — factors that doulas can help diminish.
Evidence gleaned from a variety of international studies on the effects of using doulas for pregnancy and births strongly suggests that women have more positive feelings about their labor and delivery experiences when using a doula.
This is because doulas provide physical, emotional, and informational support and assistance in a way that partners, family members, and medical staff cannot.
This means the experience will favor the mother’s needs and greater interests. (Source)
Key study/paper: Steel A. et al. (2015). “Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review”. Health and Social Care in the Community, 23(3):225-241.
Source: onlinelibrary.wiley.com/doi/full/10.1111/hsc.12112
3) Shortens duration of labor
A reduction in labor duration is one of the many benefits that using a doula can provide.
Randomized control trials show that not only did moms require less pain relief and fewer C-sections, but labor lengths were also shortened when a doula was used.
One reason for this is that breathing and positioning techniques taught by doulas allow labor to progress more easily and comfortably for a laboring woman. (Source)
Key study/paper: MH Klaus, JH Kennell. (2008). “The doula: an essential ingredient of childbirth rediscovered”. Acta Paediatrica. 86(10):1034-1036.
Source: onlinelibrary.wiley.com/doi/abs/10.1111/j.1651-2227.1997.tb14800.x
4) Lowers cesarean rates
C-sections are invasive surgeries that most moms hope to avoid. The recovery process takes longer than a vaginal birth as it’s a major operation that cuts into the wall of your abdomen.
This is no fun when you’re caring for a newborn, so opportunities to reduce the chances of a cesarean birth are extremely welcome!
Among numerous other benefits, doulas offer the chances of a reduction in cesarean section rates.
In one research study, 100 pregnant women were randomly divided into two groups of 50, one of which was offered a birth coach, or doula.
Those who used doulas had only a 2% rate of C-sections, while their counterparts on the second group had a Cesarean count of 24%, (or nearly 1/4).
Additionally, laboring women who were offered a doula found less need for Pitocin or an epidural, and also experienced shorter labor durations. (Source)
Key study/paper: Trueba G. et al. (2000). “Alternative strategy to decrease cesarean section: support by doulas during labor.” The Journal of Perinatal Education, 9(2):8–13.
Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC1595013
5) Decreases instrumental deliveries
Most of us imagine childbirth as what doctors describe as a ‘spontaneous vaginal delivery’.
This is when the baby exits the birth canal through the force of your uterine muscles, without the doctor or nurse needing to use instruments like forceps or vacuums.
Although instrument-free delivery isn’t always possible, proper birth coaching can increase the likelihood of spontaneous vaginal birth.
The use of a doula can minimize the need for instruments to be used during delivery.
A clinical neonatal medical trial compared two groups of low-risk pregnant mothers, pairing half with doulas during their labor and delivery.
Those with a doula for a companion not only used pain medication less often, but also saw a reduction in instrumental and C-section deliveries. (Source)
Key study/paper: Susan McGrath et al. (1999). “Doula Support Vs Epidural Analgesia: Impact on Cesarean Rates”. Pediatric Research, 45:16.
6) Reduces painful experience
It’s fair to say that no mums go into labor thinking it’ll be a breeze and pain-free, but, with the right techniques, keeping pain manageable is possible.
Not all pain reduction during childbirth has to come in the form of epidurals and other drugs — in fact, coaching from a doula has been shown to provide a similar reduction in pain to that of an epidural.
In randomized control trials performed on two groups of pregnant women, results showed that the decrease in laboring women’s pain levels when a doula was used could be compared to that in which an epidural was administered.
This is especially significant when noting that those in the group who received epidurals experienced more complications and required more intervention during delivery, up to and including C-sections. (Source)
Key study/paper: Susan McGrath et al. (1999). “Doula Support Vs Epidural Analgesia: Impact on Cesarean Rates”. Pediatric Research, 45:16.
Source: www.nature.com/articles/pr1999215
7) Reduces epidural use
For most moms, drug-free labor is the most desirable goal.
They’d rather not risk the chances that epidurals can have on labor and delivery, nor expose themselves or their babies to serious medication.
A doula can help reduce the likelihood that mom will request an epidural.
One trial, which compared labor and delivery outcomes both with and without the use of a doula, noted that women who used a doula during birth were less likely to use an epidural.
This could be because doulas help birthing women cope with pain in more natural ways, such as through breathing, movement, positional changes, and meditation.
In addition, women using a doula also felt more positive and confident with their birth experience, and in how they handled their labor and bodily strength. (Source)
Key study/paper: Nancy Gordon et al. (1999). “Effects of providing hospital-based doulas in health maintenance organization hospitals”. Obstetrics & Gynecology, 93(3):422-426.
Source: www.sciencedirect.com/science/article/pii/S002978449800430X
8) Leads to better newborn Apgar scores
Apgar scores are a part of every delivery room.
Though they sound complex, they’re an easy way for doctors and nurses to quickly check a newborn baby’s vital signs to see if they’re in any immediate danger.
The score rates baby’s appearance (A), pulse (P), grimace (G), activity (A), and respiration (R), and a high score — for instance, 7 to 9 — means baby is doing well.
Among the many benefits of using a doula during labor and birth are improved Apgar scores for infants, according to studies of pregnant women at risk of negative birth outcomes.
The communication, minimization of stress, and pain-management techniques doulas offer may be part of the reason for this, as stressful labors can significantly reduce a baby’s Apgar score. (Source)
Key study/paper: Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). “Impact of doulas on healthy birth outcomes.” The Journal of Perinatal Education, 22(1): 49–58.
Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727
9) Boosts early breastfeeding rates
Breastfeeding has innumerable benefits, so, whenever possible, it’s the best option to take.
Not only does breast milk have all that your baby needs for health and nourishment, but it also contains antibodies that travel straight from your body to theirs.
It can also help your uterus to contract after pregnancy and could even help you lose a few pesky pounds!
Breastfeeding can sometimes become a major issue for new moms, mainly due to a lack of understanding and support.
Latching doesn’t always happen as easily as we imagined, and, without someone to turn to for help, exhausted new mothers tend to rely on formula.
Doulas help women understand both the importance and the mechanics of breastfeeding, helping them and their new babies achieve latching and feeding while learning to repeat the process successfully.
One trial demonstrated that at a month after birth, women who used doulas were significantly more likely to be exclusively breastfeeding their babies. (Source)
Key study/paper: Langer A, Campero L, Garcia C, Reynoso S. (1998). “Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers’ wellbeing in a Mexican public hospital: a randomised clinical trial.” British journal of obstetrics and gynaecology. 105(10):1056-63
Source: www.ncbi.nlm.nih.gov/pubmed/9800927
10) Raises mothers’ self-esteem and resilience
Pregnancy hormones are the best. Well — sometimes it’s true, such as when your skin glows radiantly and your hair is extra-long and thick, though most of the time, well…maybe not so much!
It’s easy to feel out of control, cranky, and not so great about yourself when your body is changing so much both physically and chemically.
A good support system can make a huge difference to your mood and self-esteem, and this is where a doula can prove to be an ideal choice.
Women who used doulas, rather than traditional, Lamaze-style birth support, were assessed both during the final trimester of their pregnancy and 16 weeks after they’d given birth.
Asked to quantify their mood and self-esteem, women who had used doulas reported feeling more stable, in greater control, and generally better about themselves. (Source)
Key study/paper: Manning-Orenstein G. (1998). “A birth intervention: the therapeutic effects of Doula support versus Lamaze preparation on first-time mothers’ working models of caregiving.” Alternative Therapies in Health and Medicine. 4(4):73-81.
Source: www.ncbi.nlm.nih.gov/pubmed/9656503
11) Improves mother/infant interaction
In the days, weeks, and months after the baby is born, bonding is the parents’ primary goal.
Developing positive interactions with your baby is how they will get to know and recognize you — they’re already starting to establish important baselines about the way human interaction works, and those lessons start with you!
The support that a doula can offer a pregnant woman can extend far beyond labor, even improving the quality of interaction between a mother and child for months after the birth.
Two groups of women were assessed, one being given access to a doula for labor and delivery support. At eight weeks postpartum, all participants were given a (hidden) five-point interaction analysis during a home visit.
Mothers who used doulas were rated as having more positive interactions with their infants than those who hadn’t. (Source)
Key study/paper:Susan H Landry et al. (1998). “The Effect of Doula Support During Labor on Mother-Infant Interaction at 2 Months”. Pediatric Research 43:13.
Source: www.nature.com/articles/pr1998210
12) Helps mother adapt if birth doesn’t go to plan
Having a plan is something that helps many parents approach birth with confidence, but, as we all know, our best-laid plans can change quickly.
Without proper support, this can feel deeply traumatic, especially to laboring women who are already experiencing physical stress and pain.
An ability to adapt to changes, both mentally and emotionally, can improve a birth outcome and also a mom’s perception of her labor and delivery experience; which is where doulas come in.
A doula will provide appropriate advice and emotional support to help women feel reassured on the occasion of unexpected changes to their birth plans.
They will explain what’s going on, as well as any procedures that may be performed.
They can also observe the behavior of doctors and nurses, making sure that all of their actions are being verbally conveyed.
A study on their reactions to changes in their clients’ birth plans revealed that providing non-judgmental advice and support was seen by doulas as essential to their role. (Source)
Key study/paper: Amram N. L. et al. (2014). “How birth doulas help clients adapt to changes in circumstances, clinical care, and client preferences during labor.” The Journal of Perinatal Education, 23(2):96–103.
Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3976643
13) Minimizes mother’s fear and anxiety
Anxiety is natural during childbirth, but keeping it manageable can go a long way to ensuring a positive birth experience.
The presence of a support system is tremendously helpful for keeping anxiety levels low, and an informed birth coach, or doula, can offer moms peace of mind in the form of support and knowledge.
A study of the attitudes of intrapartum nurses toward the use of doulas for support has revealed that both parties feel strongly that working together in order to create happy and positive labor and birth for a laboring woman should be their goal.
While labor and delivery nurses offer critical medical support, doulas offer emotional support that can also have a positive impact on labor. (Source)
14) Provides companionship to those in need
For a variety of valid personal reasons, some moms may find themselves heading into labor and delivery without support.
Relying solely on stressed, overworked hospital staff to meet their physical, emotional, and informational needs can sometimes prove overwhelming to everyone involved.
It’s been proven that the use of a doula can lead to moms having a more positive birth experience.
We also know that going it alone in the delivery room can lead to even more negative feelings about birth, making a doula an ideal solution.
Not only will mom avoid the harrowing experience of laboring solo, but she’ll also reap the countless benefits of doula companionship! (Source)
Key study/paper: Bohren, M. A. et al Berger, B. O., Munthe-Kaas, H., & Tunçalp, Ö. (2019). “Perceptions and experiences of labour companionship: a qualitative evidence synthesis.” The Cochrane Database of Systematic Reviews, 3(3)
Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC6422112/
15) May reduce postpartum depression
Postpartum depression is both serious and extremely common.
One in ten women who’ve given birth will experience this condition, which can make it difficult to bond with or even care for their baby.
Motherhood isn’t the only thing this condition makes challenging — as with ‘regular’ depression, it can lead to deep sadness, loss of appetite, anhedonia, suicidal ideations, feelings of exhaustion, even an increased sense of physical pain.
Postpartum depression is very serious, and it’s essential that moms who are suffering get help as soon as possible.
Two studies suggest that the use of a doula during pregnancy and delivery can reduce the chances of developing postpartum depression.
This may be thanks to the emotional support and information that doulas provide, such as helping pregnant women feel better and more confident, preparing them for the inevitability of forthcoming mood changes, and offering ways to improve their overall well-being. (Source)
Key study/paper: Meghan A Bohren et al. (2017). “Continuous support for women during childbirth”. Cochrane Systematic Review – Intervention.
Source: www.nature.com/articles/pr1999215
16) Cuts hospital costs
Having a baby is not exactly cheap — with bills racking up from the moment your doctor says, “Congratulations!”
Hospital costs can be particularly exorbitant. We all know that cup of ice chips didn’t really cost $150, and trying hard not to touch anything in the hospital room is not the most effective cost-saving measure.
What can actually help, though, is the kind of support that minimizes the need for complex procedures.
We’ve already established that a doula can reduce the rate of C-section deliveries, the need for epidurals, and the number of deliveries that use forceps or vacuums.
The unspoken bonus of all these benefits is that they cut hospital bills by an average of $424 per delivery. When it comes to both your labor and your pocketbook, the fewer ‘procedures’, the better. (Source)
Key study/paper: Chapple W. et al. (2013). “An Economic Model of the Benefits of Professional Doula Labor Support in Wisconsin Births” Wisconsin Medical Journal, 112(2):58-64.
Source: www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/112/2/58.pdf
17) Improves outcome equality across socioeconomic divide
When assessing data on pregnancy, labor, and birth around the world, it quickly becomes clear that there are some major discrepancies. There are a lot of factors at play, the most significant being socioeconomics.
Deficits in finances, security, support, and information, can lead to adverse birth outcomes for disadvantaged people, as seen on a small scale in one study of radically diverse pregnant women.
There, it showed that the use of a doula helped to even up the birth outcomes of these women, providing them with crucial physical and emotional support as well as other important information about social services and health care needs. (Source)
Key study/paper: Katy B. Kozhimannil et al. (2016). “Disrupting the Pathways of Social Determinants of Health: Doula Support during Pregnancy and Childbirth”. The Journal of the American Board of Family Medicine, 29(3):308-317.
Source: www.jabfm.org/content/29/3/308.short
FAQs: A micro-guide to doula support
What follows is a carefully crafted, short overview of doulas and the support they provide. It’s by no means a complete guide, so if that’s what you’re after, we’d recommend you start here.
What are doulas and how commonly are they used?
Doulas are people trained to be advocates and companions for women as they journey through their labor and deliver their babies.
They support both birthing women and their partners physically and emotionally, offering the kind of personal, focused attention that doctors and nurses can’t.
As of 2012, approximately 6% of people reported using a doula during their childbirth process.
What’s the purpose of using a doula during labor?
Because doctors and nurses are caring for multiple patients and handling paperwork, medication, and assorted machinery, it’s impossible for them to be fully focused on a birth-giving woman’s personal needs.
A doula becomes an advocate for women and their partners, using a variety of support techniques to facilitate a happy, healthy birth experience for the whole family.
In what specific ways do doulas support pregnant women and their partners?
- Physically; which includes touch therapy, assistance with movement, providing requested items, creating and maintaining the environment to mom’s comfort level, and more
- Emotionally; which includes helping birthgivers and their partners to feel valid in their emotions and experience; listening, reassuring and bolstering confidence
- Educationally; by using their knowledge of pregnancy and birth to guide birthgivers and partners through their experience
- As an advocate; helping pregnant women and partners feel comfortable speaking up and asking questions, stepping in respectfully where necessary
What does research say about using a doula during childbirth?
- Choosing to partner with a doula for labor support has the potential to reduce the likelihood of a C-section by 39%
- Spontaneous vaginal deliveries, which happen on their own without doctors or nurses applying force or using tools to deliver the baby, up to 15% more likely when using a doula
- The kind of continuous support doulas offer has been shown to offer shorter labors, increase the likelihood of good Apgar scores immediately after birth, and decrease the chances of mothers having negative feelings about their labor/delivery experience
Wrapping up
The benefits of continuous support during labor cannot be underestimated, and doulas are an exceptional choice for offering personal companionship that includes physical support, emotional bolstering, and tireless advocacy.
With better pregnancy outcomes, reduced labor costs, and even improved interaction between mothers and infants, it’s easy to see why this ancient role has seen a notable revival in recent years.
[Photo Credits: All photos used which are hosted on Flickr are licensed under the Creative Commons.]
