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Pile of Books

Evidence in Support of Doulas

Evidence in support of doulas

There is evidence to show that having a doula can mean:

  • Reduced risk of Caesarean birth † *.

  • Reduced risk of instrumental birth † *.

  • Reduced need for painkillers or epidural during birth † *.

  • Reduced rate of induction of labour † *.

  • Shorter labour †.

  • Increased parental satisfaction with the birth experience. †

  • Increased likelihood of initiating breastfeeding *.

  • Increased likelihood of successfully establishing breastfeeding & breastfeeding at 6 weeks *.

  • Lower incidence of depressive symptomatology †.

  • Improve equity and provide culturally responsive care#


* Brigstocke S. MIDIRS Midwifery Digest, vol 24, no 2, 2014, pp 157-160

#Meghan A Bohren and Sarah Chapman Cochrane review

† Hodnett ED, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5 and Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6.


Research shows that no matter where or how a person gives birth, doulas help make that experience a more positive one. A doula provides physical and emotional support during pregnancy, childbirth and the postpartum period. Families can face various challenges during these times.

Research studies have shown that continuous support from doulas during childbirth might be associated with:

  • A decreased use of pain relief medication during labor

  • A decreased incidence of C-sections

  • A decrease in the length of labor

  • A decrease in negative childbirth experiences

Postpartum doulas are trained to understand what new babies – and new parents – truly need. 

Life with a new baby or babies doesn’t have to be overwhelming. Our postpartum doulas help families settle in and feel supported in their parenting choices. Studies show that this kind of support can help in the following ways:

  • Help reduce postpartum mood disorders

  • Improve breastfeeding success

Research Papers

This is a selection of the research papers published on doula support.


Meghan A Bohren, G Justus Hofmeyr, Carol Sakala, Rieko K Fukuzawa, Anna Cuthbert. Continuous support for women during childbirth Cochrane Database of Systematic Reviews 2017. 

Hodnett ED, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth Cochrane Database of Systematic Reviews 2013. 

Hodnett, ED., Gates, S., Hofmeyr, GJ. & Sakala, C. Continuous support for women during childbirth Cochrane Database of Systematic Reviews 2007, Issue 3.

Keenan, P. Benefits of massage therapy and use of a doula during labor and childbirth Alternative Therapies in Health & Medicine Jan 2000, 6(1), pp.66-74.

Rosen, P. Supporting women in labor: analysis of different types of caregivers Journal of Midwifery & Women’s Health Jan-Feb 2004, Vol 49(1), pp.24-31.

Yogev, S. Support in Labour: a literature review MIDIRS Midwifery Digest 2004, 14(4), pp.486-492

Birth & Postnatal related

Brigstocke S. MIDIRS Midwifery Digest, vol 24, no 2, 2014, pp 157-160

Harris SJ1, Janssen PA, Saxell L, Carty EA, MacRae GS, Petersen KL. CMAJ. Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes. 2012 Nov 20;184(17):1885-92. doi: 10.1503/cmaj.111753. Epub 2012 Sep 10. 

Goedkoop V. MIDIRS Midwifery Digest, vol 19, no 2, June 2009, pp 217-218

Birth related

Kozhimannil KB1, Attanasio LB, Jou J, Joarnt LK, Johnson PJ, Gjerdingen DK. Potential benefits of increased access to doula support during childbirth. The American Journal of Managed Care. 2014 Aug 1;20(8):e340-52.

Masoudi Z1, Akbarzadeh M2, Vaziri F1, Zare N3, Ramzi M4. The effects of decreasing maternal anxiety on fetal oxygenation and nucleated red blood cells count in the cord blood. Iranian Journal of Pediatrics. 2014 Jun;24(3):285-92. 

Amram NL, Klein MC, Mok H, Simkin P, Lindstrom K, Grant J. How birth doulas help clients adapt to changes in circumstances, clinical care, and client preferences during labor. The Journal of Perinatal Education . 2014 Spring;23(2):96-103. doi: 10.1891/1058-1243.23.2.96. 

Ballen, LE. & Fulcher, AJ. Nurses and doulas. Complementary roles to provide optimal maternity care Journal of Obstetric, Gynecologic, and Neonatal Nursing 2006, 35, pp.304–311

Berg, M. & Terstad, A. Swedish women’s experiences of doula support during childbirth Midwifery 2006, 22(4), pp.330-338

Campbell, D., Scott, KD., Klaus, MH. & Falk, M. Female Relatives or Friends Trained as Labor Doulas: Outcomes at 6 to 8 Weeks Postpartum. Birth Sept 2007, Vol 34(3), pp.220–227.

Campbell, DA., Lake, MF., Falk, M. & Backstrand, JR. A randomized control trial of continuous support in labor by a lay doula Journal of Obstetric, Gynecologic & Neonatal Nursing 2006, 35, pp.456–464.

Khreisheh, R. Support in the first stage of labour from a female relative: the first step in improving the quality of maternity services Midwifery 2009 (Article in Press).

Lundgren, I. Swedish women’s experiences of doula support during childbirth Midwifery April 2010, Vol 26(2), pp.173-180

Martin, T., Stein, JH., Kennell, JH. & Fulcher, A. Benefits of a Doula Present at the Birth of a Child Pediatrics 2004, 114(5), pp.1488-1491.

McGrath, SK. & Kennel, JH. A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates Birth 2008, 35(2), pp.92-97.

Trueba, G., Contreras, C., Velazco, MT., Lara, EG. & Martínez, HB. Alternative Strategy to Decrease Cesarean Section: Support by Doulas During Labor Journal of Perinatal Education Spring 2000, 9(2), pp.8-13.

Postnatal related

Gjerdingen DK1, McGovern P, Pratt R, Johnson L, Crow S. Postpartum doula and peer telephone support for postpartum depression: a pilot randomized controlled trial. J Prim Care Community Health. 2013 Jan;4(1):36-43. doi: 10.1177/2150131912451598. Epub 2012 Jun 20. 

McComish, JF. & Visger, JM. Domains of Postpartum Doula Care and Maternal Responsiveness and Competence Journal of Obstetric, Gynaecologic & Neonatal Nursing Mar/Apr 2009, Vol 38(2), pp.148-156.

Goldbort, J. Postpartum depression: Bridging the gap between medicalized birth and social supportInternational Journal of Childbirth Education December 2002.

Breastfeeding related

Edwards RC1, Thullen MJ, Korfmacher J, Lantos JD, Henson LG, Hans SL. Breastfeeding and complementary food: randomized trial of community doula home visiting. Pediatrics. 2013 Nov;132 Suppl 2:S160-6. doi: 10.1542/peds.2013-1021P. 

Kozhimannil KB1, Attanasio LB, Hardeman RR, O’Brien M. Doula care supports near-universal breastfeeding initiation among diverse, low-income women. J Midwifery Womens Health. 2013 Jul-Aug;58(4):378-82. doi: 10.1111/jmwh.12065. Epub 2013 Jul 9. 

Mottl-Santiago, J., Walker, C., Ewan, J., Vragovic, O., Winder, S. & Stubblefield, P. A hospital-based doula program and childbirth outcomes in an urban, multicultural setting Maternal and Child Health Journal May 2008, Vol 12(3), pp.372-377.

Fathers/partners & family related

Thullen MJ1, McMillin SE, Korfmacher J, Humphries ML, Bellamy J, Henson L, Hans S. Father participation in a community-doula home-visiting intervention with young, african american mothers. Infant Ment Health J. 2014 Sep;35(5):422-34. doi: 10.1002/imhj.21463. Epub 2014 Aug 25. 

Key studies from pre-2000

Hofmeyr, GJ., Nikodem, VC., Wolman, W., Chalmers, BE. & Kramer, T. Companionship to modify the clinical birth environment: Effects on progress and perceptions of labour and breastfeeding British Journal of Obstetrics & Gynaecology Aug 1991, 98, pp.756–764.

Kennell, JH., Klaus, MH., McGrath, S., Robertson, S. & Hinkley, C. Continuous emotional support during labor in a US hospital: A randomized controlled trial. Journal of the American Medical Association May 1991, 265(17), pp.2197-201.

Klaus, MH. & Kennell, JH. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatrica 1997, 86(10), pp.1034–1036.

Klaus MH, Kennell JH, Robertson SS, Sosa R. Effects of social support during parturition on maternal and infant morbidity British Medical Journal 1986; 293:585–587.

Langer, A., Campero, L., Garcia, C. & Reynoso, S. 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 & Gynaecology Oct 1998, 105(10), pp.1056-63.

Madi, BC., Sandall, J., Bennett, R. & MacLeod, C. Effects of female relative support in labour: a randomised controlled trial Birth 1999; 26(1), 4-8.

Scott, KD., Klaus, PH., & Klaus, MH. The obstetrical and postpartum benefits of continuous support during childbirth Journal of Women’s Health Gender Based Medicine Dec 1999, 8(10), pp.1257-64.

Wolman, WL., Chambers, B., Hofmeyr, GJ. & Nikodem, V. Post-partum depression and companionship in the clinical birth environment: A randomized, controlled study American Journal of Obstetrics & Gynaecology 1993, 168, pp.1380–1393.

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