Doulas: 17 Science-Backed Benefits

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]

An infographic displaying doula studies and science.

Doula Support: Examining the Evidence

There are a huge 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 round-up of 17 scientific studies highlights some of the most compelling findings.

Doula trains mother in birthing positions.

Taken by Wendy Kenin

1) Leads to better birth outcomes

Many studies have shown that doula-support has a positive impact on birth outcomes. In this study of at-risk moms found, a group of pregnant women facing social disadvantages and the 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 child. (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 are intense, it’s very possible to create a positive, fulfilling experience that women look back on with fondness. Conversely, uninformed personnel and a lack of information and adequacy are factors that can contribute to a negative or traumatic birthing experience – these are factors that doulas can help to abate.

Empirical evidence gleaned from a variety of international studies on the effects of using doulas for pregnancy and birth strongly suggests that women have more positive feelings about their labor and delivery experiences when they use a doula. This may be because doulas can provide physical, emotional and informational support as well as advocacy in a unique way that partners, family members and medical staff can not, which can help to steer the direction of the experience in a way that favors mom’s needs and best 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 may provide. Randomized control trials indicated that not only did moms need less pain relief and have fewer c-sections, labor lengths were also lessened when a doula was used. One reason for this may be breathing and positioning techniques taught by doulas that 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 rate

C-sections are invasive surgeries that most moms hope to avoid. The recovery process takes longer than a vaginal birth because it’s a major operation that cuts into the wall of your abdomen. That’s not a blast to deal with when you’re caring for a newborn, so opportunities to reduce the chances of a cesarean birth are advantageous.

Among their many benefits, doulas offer a reduction in cesarean section rates. In one research study, 100 pregnant women were randomly divided into groups of 50, half of which were offered a birth coach or doula. When compared to the second group of women, those that used doulas had only a 2% rate of c-sections – their counterparts had a cesarean rate of 24%, or nearly 1/4. Additionally, laboring women who were offered a doula had less need for Pitocin or an epidural and experienced shorter labor durations overall. (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

When most of us imagine childbirth, it’s what doctors term a spontaneous vaginal delivery. This means that the baby leaves the birth canal through the force of your uterine muscles and without the need for doctors or nurses to use instruments like forceps or vacuums. Although instrument-free delivery isn’t always possible, proper birth coaching can increase the likelihood of a spontaneous vaginal birth.

One way to minimize the likelihood that instruments will be needed during delivery is through the use of a doula. A clinical neonatal medical trial compared two groups of low-risk pregnant mothers, pairing half with doulas during their labor and delivery. Those who had a doula for their companion not only requested pain medication less often, they 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.

Source: www.nature.com/articles/pr1999215

6) Lessens experience of pain

It’s fair to say that nobody goes into labor thinking it’s going to be breezy and pain-free, but with the right techniques, keeping pain at a manageable level 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 an epidural.

In randomized control trials performed on two groups of pregnant women, results demonstrated that the decrease in laboring women’s pain levels when a doula was used compared to when an epidural was administered was similar. This is especially significant when noting that 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 a lot of moms, a drug-free labor is a goal that’s top of mind. They’d rather not take chances with the effects that epidurals can have on labor and delivery, nor expose themselves or their babies to some pretty serious medication. A doula can help reduce the likelihood that mom will request an epidural.

One trial, which compared labor and delivery outcomes with and without the use of doulas, noted that women who used a doula during birth were less likely to use an epidural. It’s likely that this is because doulas help birthing women to cope with their pain in natural ways like breathing, movement, position changes and meditation. In addition, women using doulas also felt more positively about their birth experience and more confident in both the way they handled their labor and their body’s 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. They sound complex, but they’re an easy way for doctors and nurses to perform a quick check of a newborn baby’s vital signs and quantify 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 – think 7 to 9 – means baby is doing well.

Among the many benefits of using a doula during labor and birth is an improvement in Apgar scores for infants, according to a study of pregnant women at risk for negative birth outcomes. The communication, minimization of stress and pain management techniques doulas offer may be part of the reason for this, as very stressful labors can reduce baby’s Apgar score significantly. (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 when it’s an option, it’s the best one to take. Not only does breast milk have everything your baby needs to be healthy and nourished, it also has antibodies that travel straight from your body to theirs. It can also help your uterus to contract after pregnancy, and may help you take off a few pesky pounds.

Major boundaries some women face with breastfeeding are a lack of understanding and support – latching doesn’t always happen as easily as we imagine, and without someone to turn to for help, exhausted new mothers rely on formula. A doula can help women understand both the importance and the mechanics of breastfeeding, helping her and her new baby to achieve latching and feeding and learn to repeat the process successfully. One trial demonstrated that at a month after birth, women who used doulas were significantly more likely to be breastfeeding their babies exclusively. (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 mother’s self-esteem and resilience

Pregnancy hormones are the best. Well… sometimes it’s true, like when your skin glows radiantly and your hair is extra long and thick, but most of the time… ah, not so much! It’s easy to feel out of control, cranky, and not so great about yourself when your body is changing both physically and chemically. The right support system makes a huge difference in mood and self-esteem, however, and doulas are 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. They were asked to quantify their mood and self esteem, and women who had used doulas reported feeling more stable, in greater control, and 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 baby is born, bonding is parents’ primary goal. Having positive interactions with your baby is how they 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 doulas offer to pregnant women can extend far beyond labor, even improving the quality of interaction between a mother and child months after birth. Two groups of women were assessed, with one group having 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 had not. (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 birth plan is something that helps many parents approach birth with confidence, but as we all know, our best laid plans can change quickly. Without the right support, this can feel deeply traumatic, especially to laboring women who are already experiencing physical stress and pain. Being able to adapt to changes mentally and emotionally may improve both birth outcomes and mom’s perception of her labor and delivery experience, which is where doulas come in.

The right information and emotional support can help women to feel better about unexpected changes in their birth plan, which is exactly what doulas exist to provide. They’re able to 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 doulas’ reactions to changes in their clients’ birth plans revealed that providing non-judgmental advocacy and support were 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 at a manageable level can go a long way toward making sure the birth experience is a positive one. The presence of a support system is tremendously helpful for keeping anxiety levels low, and an informed birth coach like a doula can offer moms peace of mind in the form of informed support and essential knowledge.

A study of the attitudes of intrapartum nurses toward the use of doulas for support revealed that both parties feel strongly that working together in order to create a 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)

Key study/paperPapagni K., Buckner, E. (2006). ”Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient’s Perspective”. The Journal of Perinatal Education, 15(1):11–18.

Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC1595283

14) Provides companionship to those in need

For a variety of totally valid personal reasons, some moms may find themselves heading into labor and delivery without a support system present. This means relying solely on stressed, overworked hospital staff to meet their physical, emotional and informational needs, which is overwhelming to everyone involved.

It’s been proven that the use of a doula means it’s more likely mom will have a positive perception of her birth experience. What we also know is that going it alone in the delivery room tends to lead to more negative feelings about birth, making a doula an awesome solution. Not only will mom swerve on the detriments of laboring solo, she’ll get the many benefits of doula companionship as well. (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 very serious and very common. One in ten women who have given birth will experience this condition, which can make it difficult to bond with or care for their baby. Motherhood isn’t the only thing this condition makes challenging – like “regular” depression, it can lead to deep sadness, a lack of appetite, anhedonia, suicidal ideations, feelings of exhaustion, and 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 have tentatively suggested that the use of a doula during pregnancy and delivery may reduce the likelihood of developing postpartum depression. This may be thanks to the emotional support and information doulas provide, helping pregnant women to feel better and more confident as well as preparing them for the inevitability of forthcoming mood changes and offering suggestions for improving 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

It’s not exactly cheap to have a baby, with bills racking up from the moment your doctor says the word “congratulations”. Hospital costs can be particularly exorbitant. We all know that cup of ice chips didn’t really cost $150, and trying really hard not to touch anything in the hospital room is not an effective cost-saving measure. What can actually help, though, is the kind of support that lessens the need for complex procedures.

We’ve already established that doulas reduce the rate of c-section deliveries, the need for epidurals and the rate of deliveries that uses forceps or vacuums. The unspoken bonus to all of 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, but the most significant is socioeconomics.

Deficits in money, security, support and information, among others, can lead to adverse birth outcomes for disadvantaged people, a result seen on a small scale in one study of radically diverse pregnant women. It was shown that the use of a doula helped to equalize the birth outcomes of these women, providing them with crucial physical and emotional support as well as 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 but short overview of doulas and the support they provide. It’s no means a complete guide to the topic and so if that’s what you’re after, then 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 go through their labor and deliver their baby. They support both birthing women and their partners physically and emotionally, offering personal, focused attention that doctors and nurses can not. As of 2012, approximately 6% of people reported the use of a doula during their childbirth process.

What is the purpose of using a doula during labor?

Because doctors and nurses are caring for multiple patients and handling paperwork, medication and machines, it’s impossible for them to be fully focused on a birthgiving woman’s unique 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 can include touch therapy, assistance with movement, providing requested items, creating and maintaining the environment to mom’s comfort level, and more
  • Emotionally, which can include 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 who helps 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 a baby, maybe 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 that mothers will have negative feelings about their labor and delivery experience

Wrapping up

The benefits of continuous support during labor are concrete, 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 not hard to see why this ancient role has seen a respected reprise in recent years.

[Photo Credits: All photos used which are hosted on Flickr are licensed under the Creative Commons.]

2 Comments

  1. Pingback: | Yoga Janda August 22, 2019
  2. Pingback: To Doula OR Not TO Doula? | Pelvic Resilience September 4, 2019
  3. Jill Miller September 25, 2019
    • Neve Spicer September 26, 2019

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