Evidence shows that the type of support doulas provide can contribute to:
Lowering unnecessary C-sections rates
Delivering healthier newborns
Lowering rates of postpartum depression
Lowering the chances of preterm birth
Increasing breastfeeding rates and duration
Doula support is associated with improved maternal and infant outcomes. A 2017 Cochrane review [i] included 26 studies from 17 countries and involved more than 15,000 women. The review found numerous benefits of continuous labor support including:
Higher likelihood of: spontaneous vaginal birth, shorter labor
Less likelihood of: reporting negative ratings or feelings about their childbirth, experiencing intrapartum analgesia, C-section or assisted birth, having low five‐minute Apgar scores, developing postpartum depression
Click on each article to learn about the study outcomes:
This 2008 study compared birth outcomes of two groups of mothers: one received doula support from a certified doula and the other did not receive doula support. Mothers with doula support had four times less likely chances of having a low birth-weight baby, two times less likely to experience a birth complication, and higher rates of breastfeeding initiation.
This study conducted a secondary analysis of a nationally-representative survey of women who gave birth between 2011 and 2012. Based on their analysis, doula support is associated with lower odds of non-indicated cesareans compared to those that did not have a doula and those who wanted but did not have doula support.
"Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population" [iv]
Healthy Start Brooklyn (HSB)’s By My Side Birth Support Program (BMS) offers free doula services to Black and Latina women. BMS participants from 2010 to 2015 had significantly lower rates of preterm birth and low birthweight. Regardless of their birth experience, more than 95% of the surveyed 244 clients were highly satisfied with the program and would recommend or use it again in a future pregnancy.
Survey responses from the 2018 Listening to Mothers in California survey showed that doula support is associated with high respectful care, particularly for Black and low-income/Medi-Cal populations.
In a national study examining the impact doulas have on reducing cesarean birth rates among Medicaid-funded births, those with doula support had a 22.3% cesarean rate compared to 31.5% among a national sample of Medicaid beneficiaries. The study also revealed that doulas have a positive impact on reducing preterm birth rates: the preterm birth rate among doula-supported births was 6.1% compared to 7.3% among non-doula-supported births. Overall, the odds of cesarean delivery were approximately 40% lower for people who had doula support during labor. This study also highlights the doula care’s potential impact on cost saving efforts in state Medicaid programs by preventing extra costs (NICU care, C-section, etc.).
“The Value of Care Provided by Student Doulas: An Examination of the Perceptions of Women in Their Care” [vii]
A 2013 Australian study found that care provided even by student doulas is positively received. Doulas in training provided support in all four researched domains: physical aspects, emotional aspects, acting as a support person for other family members, and overall usefulness.
“Outcomes of Care for 1,892 Doula-Supported Adolescent Births in the United States: The DONA International Data Project, 2000 to 2013” [viii]
A national sample of 1,892 adolescent births supported by DONA International doulas (including certified, candidates, and non-certified doulas) over a 13 year time period showed that both teen mothers and their newborns had better health outcomes and lower rates of intervention than the national statistics for adolescent births in the U.S.
“Promoting Positive Mother-Infant Relationships: A Randomized Trial of Community Doula Support for Young Mothers”[ix]
In another study, the Chicago Doula Project showed that doulas can positively impact early bonding and parent-baby relationships in the first 4 months. Based on the study’s findings, those who had postpartum doula support showed more positive engagement with their newborns. The mothers were also more likely to respond to infant distress such as crying and fussing at 4 months.
“Doulas in the Operating Room: An Innovative Approach to Supporting Skin‐To‐Skin Care during Cesarean Birth” [x]
A small-scale project trained volunteer doulas from Birth Partners to support initiation of skin-to-skin after cesarean delivery in the operating and recovery rooms. The results of the post-birth client survey indicated that most of the clients felt that their doula was an important part of the birth experience.
Culturally appropriate services increase breastfeeding initiation among low-income women. Kozhimannil et al. compared breastfeeding initiation rates among 1,069 women who received doula care against a general sample of Black people with Medicaid. Those with doula care had an initiation rate of 92.7% compared to 70.3% in the general Black Medicaid population.
“Doula Care, Early Breastfeeding Outcomes, and Breastfeeding Status at 6 Weeks Postpartum among Low-Income Primiparae” [xii]
People who receive doula care are more likely to experience the onset of lactogenesis within 72 hours after birth and keep breastfeeding at 6 weeks postpartum.
Doula support is associated with a higher rate of attempting to breastfeed. In a randomized controlled trial that examined the association between community doula home visitation and breastfeeding rates among young Black mothers, 63.9% of those who received doula support attempted breastfeeding compared to 49.6% of those who did not receive doula support.
The American College of Obstetricians and Gynecologists (ACOG) and the Society of Maternal Fetal Medicine (SMFM) released an Obstetric Care Consensus document in 2014 on the Safe Prevention of Primary Cesarean Delivery. In the document, ACOG and SMFM mentioned doula care in the context of effective ways to improve birth experiences and outcomes. They state that continuous labor support by a doula is “one of the most effective tools to improve labor and delivery outcomes.” [xiv]
References:
i. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7(7):CD003766. doi: 10.1002/14651858.CD003766.pub6. PMID: 28681500; PMCID: PMC6483123. https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth
ii. Gruber, Kenneth J., Susan H. Cupito, and Christina F. Dobson. 2013. “Impact of Doulas on Healthy Birth Outcomes.” The Journal of Perinatal Education 22 (1): 49–58. https://doi.org/10.1891/1058-1243.22.1.49.
iii. Kozhimannil, Katy B., Laura B. Attanasio, Judy Jou, Lauren K. Joarnt, Pamela J. Johnson, and Dwenda K. Gjerdingen. 2014. “Potential Benefits of Increased Access to Doula Support during Childbirth.” The American Journal of Managed Care 20 (8): e340–52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538578/.
iv. Thomas, MP., Ammann, G., Brazier, E. et al. Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Matern Child Health J 21 (Suppl 1), 59–64 (2017). https://doi.org/10.1007/s10995-017-2402-0
v. Mallick, Lindsay M., Marie E. Thoma, and Edmond D. Shenassa. 2022. “The Role of Doulas in Respectful Care for Communities of Color and Medicaid Recipients.” Birth, June. https://doi.org/10.1111/birt.12655
vi. Kozhimannil, Katy Backes, Rachel R. Hardeman, Laura B. Attanasio, Cori Blauer-Peterson, and Michelle O’Brien. 2013. “Doula Care, Birth Outcomes, and Costs among Medicaid Beneficiaries.” American Journal of Public Health 103 (4): e113–21. https://doi.org/10.2105/ajph.2012.301201.
vii. Steel, Amie, Helene Diezel, Kate Johnstone, David Sibbritt, Jon Adams, and Renee Adair. 2013. “The Value of Care Provided by Student Doulas: An Examination of the Perceptions of Women in Their Care.” The Journal of Perinatal Education 22 (1): 39–48. https://doi.org/10.1891/1058-1243.22.1.39.
viii. Everson, Courtney L., Melissa Cheyney, and Marit L. Bovbjerg. 2018. “Outcomes of Care for 1,892 Doula-Supported Adolescent Births in the United States: The DONA International Data Project, 2000 to 2013.” The Journal of Perinatal Education 27 (3): 135–47. https://doi.org/10.1891/1058-1243.27.3.135.
ix. Hans, Sydney L., Matthew Thullen, Linda G. Henson, Helen Lee, Renee C. Edwards, and Victor J. Bernstein. 2013. “Promoting Positive Mother-Infant Relationships: A Randomized Trial of Community Doula Support for Young Mothers.” Infant Mental Health Journal 34 (5): 446–57. https://doi.org/10.1002/imhj.21400.
x. Lanning, Rhonda K., Marilyn H. Oermann, Julee Waldrop, Laura G. Brown, and Julie A. Thompson. 2018. “Doulas in the Operating Room: An Innovative Approach to Supporting Skin‐To‐Skin Care during Cesarean Birth.” Journal of Midwifery & Women’s Health, December. https://doi.org/10.1111/jmwh.12930.
xi. Kozhimannil, Katy B., Laura B. Attanasio, Rachel R. Hardeman, and Michelle O’Brien. 2013. “Doula Care Supports Near-Universal Breastfeeding Initiation among Diverse, Low-Income Women.” Journal of Midwifery & Women’s Health 58 (4): 378–82. https://doi.org/10.1111/jmwh.12065.
xii. Nommsen-Rivers, Laurie A., Ann M. Mastergeorge, Robin L. Hansen, Arlene S. Cullum, and Kathryn G. Dewey. 2009. “Doula Care, Early Breastfeeding Outcomes, and Breastfeeding Status at 6 Weeks Postpartum among Low-Income Primiparae.” Journal of Obstetric, Gynecologic & Neonatal Nursing 38 (2): 157–73. https://doi.org/10.1111/j.1552-6909.2009.01005.x.
xiii. Edwards, R. C., M. J. Thullen, J. Korfmacher, J. D. Lantos, L. G. Henson, and S. L. Hans. 2013. “Breastfeeding and Complementary Food: Randomized Trial of Community Doula Home Visiting.” PEDIATRICS 132 (Supplement): S160–66. https://doi.org/10.1542/peds.2013-1021p.
xiv. Lothian JA. Safe Prevention of the Primary Cesarean Delivery: ACOG and SMFM Change the Game. J Perinat Educ. 2014;23(3):115-118. doi:10.1891/1058-1243.23.3.115
The BLACK Doula Network Infrastructure in Fresno is supported by Elevance Health, Blue Meridian Partners, and Kaiser Permanente.