Evidence on Doula’s

Question: What is a doula?

Answer: A birth doula is a companion who provides people with continuous support during labor and birth.

Question: What does doula support look like?

Answer: Physical support from a doula includes the use of massage, pressure, and soothing touch. Doulas create a calm environment, assist with water therapy, and help keep you nourished with ice chips, food, and drinks. Emotional support from doulas helps people feel a sense of pride and empowerment after the birth. Examples of emotional support include encouragement and praise, helping you see your situation more positively, keeping you company, showing that they care for you, and helping you debrief after the birth. Doulas can also support you with information during pregnancy and birth. For example, they can guide you and your partner through labor and suggest techniques like breathing, relaxation, movement, and changing positions. Doulas help you find evidence-based information about your options, and they can help explain medical procedures. As far as advocacy goes, most doulas will not speak on your behalf. However, doulas should support you in your right to make decisions about your body and your baby. They will also use advocacy techniques such as encouraging you to ask questions and speak up for what you want. Doulas can also enhance communication between parents and providers.

Question: What is the evidence on doulas?

Answer: There have been 26 randomized trials that tested the effects of continuous labor support on more than 15,000 people giving birth. Overall, people who receive continuous support are more likely to have a normal vaginal birth and less likely to have pain medication, negative feelings about childbirth, and Cesareans. In addition, their labors are shorter and their babies are less likely to have complications at birth or be admitted to a NICU. In these studies, the best results occurred when the continuous support was provided by a trained doula—someone who was not a staff member at the hospital and not part of the birthing person’s social network.

Question: How can doulas work with partners?

Answer: Ideally, doulas and the birth partner (i.e. spouse, partner, family member) work together to improve the mother’s birth. Studies have shown that the most positive birth experiences for fathers/partners are ones where they have continuous support from a doula or midwife. In one important randomized trial, adding a doula to a supportive partner reduced Cesarean rates from 25% down to 13%. These differences were even more apparent with a labor induction. When labor was induced, the Cesarean rate was 59% with a partner alone, and 13% when partners worked together with doulas.

Question: What’s the bottom line?

Answer: Of all the ways birth outcomes could be improved, continuous labor support seems like one of the most important and basic needs for birthing people. Research has shown that labor support from doulas is both risk-free and highly effective.

For more information visit EvidenceBasedBirth.com/Doulas